新型微型锁定带钩钢板在固定指骨撕脱性骨折中的应用  

Application of new micro locking hook plate in fixation of phalangeal avulsion fracture

作　　者：尚晓强 段祥林 孙伟 陶圣祥[2] 郑洲[3] Shang Xiaoqiang;Duan Xianglin;Sun Wei;Tao Shengxiang;Zheng Zhou(Department of Orthopedics,Wuhan Red Cross Hospital,Wuhan 430015,China;Department of Trauma and Micro Orthopedics,Zhongnan Hospital of Wuhan University,Wuhan 430071,China;Department of Anatomy,Hubei University of Traditional Chinese Medicine,Wuhan 430070,China)

机构地区：[1]武汉市红十字会医院骨科,430015 [2]武汉大学中南医院创伤与显微骨科,430071 [3]湖北中医药大学解剖教研室,430070

出　　处：《中华实验外科杂志》2022年第5期979-982,共4页Chinese Journal of Experimental Surgery

基　　金：武汉市卫生与计划生育委员会2020年医学科研项目面上项目(WZ20B29)。

摘　　要：目的通过手标本解剖及生物力学实验探讨新型微型锁定带钩钢板在固定指骨撕脱性骨折中的可行性。方法取6对新鲜成人手标本,先测量指甲尖至甲根近端的距离,再用微型骨刀将手指末节制作成伸指肌腱止点撕脱性骨折模型,实验组手标本均采用新型微型锁定带钩钢板固定,对照组拇指行自制单孔带钩钢板,示指行微型螺钉固定,中指行克氏针固定,环指行双孔普通钢板横向固定,小指行钢丝结合克氏针固定。尖刀紧贴钢板远端切开甲根,对伸指肌腱进行加载测试,记录骨折端分离2 mm的最大张力,拆除内固定物后测量并计算钢板压迫甲根长度,组间比较采用独立样本t检验。结果新型微型锁定带钩钢板压迫甲根长度分别为拇指(1.50±0.06)mm,示指(1.90±0.05)mm,中指(1.81±0.03)mm,环指(2.12±0.05)mm,小指(2.24±0.06)mm。自制单孔带钩钢板压迫拇指甲根长度为(3.23±0.12)mm,双孔普通钢板压迫环指甲根长度为(2.14±0.07)mm,实验组在拇指甲根压迫长度上要低于对照组,差异有统计学意义(t=29.835,P<0.05),环指上差异无统计学意义。实验组拇指、示指、中指、环指、小指末节骨折端分离2 mm的最大张力分别为(39.28±1.80)、(28.42±2.44)、(26.60±1.93)、(24.80±3.00)、(21.31±2.96)N;对照组分别为(26.15±3.02)、(10.47±1.12)、(10.73±1.78)、(7.50±1.28)、(14.30±2.15)N。实验组拇指、示指、中指、环指、小指在骨折端分离2mm的最大张力要高于对照组,差异均有统计学意义(t=9.153、16.342、14.831、12.982、4.690,P<0.05)。结论微型钢板固定手指末节撕脱性骨折中均会压迫甲根,但新型微型锁定带钩钢板对甲根损伤更小,对肌腱无明显卡压,生物力学稳定性更好。Objective To explore the feasibility of a new micro locking hook plate in the fixation of phalangeal avulsion fractures through hand anatomy and biomechanical experiments.Methods A total of 6 pairs of fresh adult hand specimens were taken.Firstly,the distance from the nail tip to the proximal end of the nail root was measured,and then the distal segment of the finger was made into a tear fracture model of extensor tendon.The hand specimens in the experimental group were fixed with a new micro locking hook plate.The thumb of the control group was fixed with a self-made single hole hook steel plate,the index finger was fixed with micro screws,the middle finger was fixed with Kirschner wire,the ring finger was fixed with a double hole ordinary steel plate horizontally,and the little finger was fixed with steel wire combined with Kirschner wire.The nail root was cut with a sharp knife close to the distal end of the steel plate.The extensor tendon was loaded and tested,and the maximum tension of 2 mm at the separation of the fracture end was recorded.After the internal fixation was removed,the length of the nail root compressed by the steel plate was measured calculated and analyzed.Independent sample t-test was used for comparison between groups.Results The length of nail root compressed by the new micro locking hook plate was(1.50±0.06)mm for thumb,(1.90±0.05)mm for index finger,(1.81±0.03)mm for middle finger,(2.12±0.05)mm for ring finger and(2.24±0.06)mm for little finger.The length of thumb nail root compressed by self-made single hole hook steel plate was(3.23±0.12)mm,and the length of nail root compressed by double hole ordinary steel plate was(2.14±0.07)mm.The compression length of thumb nail root in the experimental group was shorter than that in the control group.The compression length of thumb nail root in the experimental group was shorter than that in the control group(t=29.835,P<0.05),and there was no significant difference on the ring finger.In the experimental group,the maximum tension of 2 mm s

关 键 词：微型钢板 指骨 撕脱性骨折 

分 类 号：R687.3[医药卫生—骨科学]