第二代动力化前路方形区钛板螺钉系统的体外生物力学研究  

In vitro biomechanical analysis of the second-generation dynamic anterior plate-screw system for quadrilateral area

作　　者：吴海洋 蔡贤华 邵启鹏 尚冉冉 宋成璟 刘曦明 汪国栋 李彦锦[5] 丰瑞兵 张红旗[6] Wu Haiyang;Cai Xianhua;Shao Qipeng;Shang Ranran;Song Chengjing;Liu Ximing;Wang Guodong;Li Yanjin;Feng Ruibing;Zhang Hongqi(Department of Orthopaedic Surgery,General Hospital of Central Theater Command,Research Center of Traumatic Orthopaedics in Hubei Province,Wuhan 430070,China;The First Clinical Medical College of Southern Medical University,Guangzhou 510515,China;Department of Orthopaedic Surgery,the First Hospital of Wuhan,Wuhan 430022,China;Department of Orthopaedic Surgery,Huaiyin Hospital of Huaian City,Huaian 223300,China;Hubei University of Chinese Medicine,Wuhan 441300,China;Department of Mechanical Room,Wuhan University of Technology,Wuhan 430070,China)

机构地区：[1]解放军中部战区总医院骨科,湖北省骨创伤救治临床医学研究中心,武汉430070 [2]南方医科大学第一临床医学院,广州510515 [3]武汉市第一医院骨科,430022 [4]淮安市淮阴医院骨科,223300 [5]湖北中医药大学,武汉441300 [6]武汉理工大学力学实验中心,430070

出　　处：《中华骨科杂志》2021年第21期1569-1578,共10页Chinese Journal of Orthopaedics

基　　金：湖北省技术创新专项重大项目(2017ACA099);湖北省卫计委2018年度面上项目(WJ2018H0064)。

摘　　要：目的探讨第二代动力化前路方形区钛板螺钉系统(dynamic anterior plate-screw system for quadrilateral area,DAPSQ)的标准化置钉方法及其稳定性。方法截取6具防腐保湿处理的全骨盆标本,制作左侧髋臼高位双柱骨折模型,随机行第二代DAPSQ或前路重建钛板+1/3管型固定。将标本装载于Zwick Z100电子万能试验机,模拟坐位以200 N、300 N、400 N、500 N、600 N、700 N、800 N垂直载荷加载,分别测试完整骨盆组、DAPSQ固定组和管型固定组轴向压缩位移、髋臼前后柱应变值变化,并计算刚度。结果随垂直载荷从200 N增加至800 N,三组标本轴向压缩位移均呈增加趋势(F=68.581,P<0.001;F=91.795,P<0.001;F=33.819,P=0.002)。管型固定组在各级载荷下轴向压缩位移均大于完整骨盆组和DAPSQ固定组,差异有统计学意义(P<0.05),而完整骨盆组和DAPSQ固定组差异无统计学意义(P>0.05)。600 N垂直载荷下完整骨盆组整体刚度为(220.72±70.33)N/mm、DAPSQ固定组为(185.68±48.49)N/mm、管型固定组为(135.83±60.58)N/mm,管型固定组骨盆整体轴向刚度低于完整骨盆组和DAPSQ固定组,差异有统计学意义(t=5.345,P=0.003;t=6.443,P=0.001),而完整骨盆组和DAPSQ固定组的差异无统计学意义(t=2.138,P=0.086)。在200 N~800 N各级载荷下,三组前柱测量点应变值的组间两两比较差异均无统计学意义(P>0.05)。在500 N~800 N各级载荷下,管型固定组后柱测量点应变值均大于完整骨盆组和DAPSQ固定组(P<0.05),而完整骨盆组和DAPSQ固定组的差异无统计学意义(P>0.05)。结论与传统重建钛板+1/3管型固定相比,第二代DAPSQ固定髋臼双柱骨折模型后骨盆轴向压缩位移更小,轴向刚度更大,髋臼后柱应力的变化更接近完整髋臼应力分布情况,具有更为安全、可靠的生物力学稳定性。Objective To introduce the standard screw implantation methods and to analyze the biomechanical stability of the second-generation dynamic anterior plate-screw system for quadrilateral area(DAPSQ).Methods Six adult formalin-preserved corpses were selected to make a complete pelvic specimen.Further,the left high double-column fracture models were made and randomly fixed with second-generation DAPSQ or anterior reconstruction titanium plate and 1/3 tube buttress-plate(ARTPB).The specimens of intact pelvis(IP)group,DAPSQ group and ARTPB group were fixed on a Zwick Z100 material machine and loaded vertically with 200 N,300 N,400 N,500 N,600 N,700 N,and 800 N in a simulated sitting position,respectively.The axial displacement and strain changes in the anterior and posterior columns were tested in the three groups.The stiffness was calculated accordingly.Results The axial compression displacement in the three groups showed an increase trend as well with the vertical load increased from 200 N to 800 N(F=68.581,P<0.001;F=91.795,P<0.001;F=33.819,P=0.002).The axial displacement in ARTPB group was significantly larger than that in DAPSQ group and IP group(P<0.05),while the difference between DAPSQ and IP groups was not significant(P>0.05).Under the vertical load of 600 N,the pelvic axial stiffness of IP group,DAPSQ group,and ARTPB group were 220.72±70.33 N/mm,185.68±48.49 N/mm and 135.83±60.58 N/mm,respectively.The axial stiffness of ARTPB group was significantly lower than that in DAPSQ group and IP group(t=5.345,P=0.003;t=6.443,P=0.001),while the difference between DAPSQ and IP groups was not significant(t=2.138,P=0.086).There were no significant differences of the strain values in anterior column among the three groups during the load increasing from 200 N to 800 N(P>0.05).With the load increasing from 500 N to 800 N,the strain values of the posterior column in ARTPB group were significantly greater than those of IP and DAPSQ groups(P<0.05).However,the differences between IP and DAPSQ groups were not statistically sig

关 键 词：髋臼 骨折固定术 内 骨螺丝 骨板 力学 

分 类 号：R687.3[医药卫生—骨科学] R318.01[医药卫生—外科学]