加压自断螺栓联合双侧锁定加压钢板治疗股骨远端关节内骨折的生物力学分析  

Treatment of intra-articular distal femur fracture by our slot-designed compression bolt combined with bilateral locking compression plates:a biomechanical analysis

作　　者：张浚哲 孟洪宇 李军勇 连晓东[1] 赵阔 朱燕宾 陈伟[1] 张英泽[1] Zhang Junzhe;Meng Hongyu;Li Junyong;Lian Xiaodong;Zhao Kuo;Zhu Yanbin;Chen Wei;Zhang Yingze(Orthopaedic Research Institution of Hebei Province,Key Laboratory of Biomechanics of Hebei Province,Department of Orthopaedic Surgery,The Third Hospital of Hebei Medical University,NHC Key Laboratory of Intelligent Orthopaedic Equipment,Shijiazhuang 050051,China;Department of Orthopaedic,Shijiazhuang People's Hospital,Shijiazhuang 050011,China)

机构地区：[1]河北省骨科研究所,河北省骨科生物力学重点实验室,河北医科大学第三医院创伤急救中心,国家卫生健康委骨科智能器材重点实验室,石家庄050051 [2]石家庄市人民医院骨科,石家庄050011

出　　处：《中华创伤骨科杂志》2022年第5期380-384,共5页Chinese Journal of Orthopaedic Trauma

摘　　要：目的通过人体股骨标本分析加压自断螺栓(SCB)联合双侧锁定加压钢板(LCP)治疗股骨远端关节内骨折的生物力学稳定性。方法选取24例经福尔马林防腐处理的成年男性膝关节标本, 保留股骨骨性部分, 建立标准的股骨远端关节内骨折模型(AO 33-C1型)。根据随机数字表将骨折模型平均分为2组:实验组12例(使用1枚SCB联合10枚锁定螺钉双侧LCP固定), 对照组12例(使用12枚锁定螺钉双侧LCP固定)。每组模型各自完成垂直压载试验(记录系统最大轴向位移)和水平扭转试验(计算系统扭转刚度)。在生物力学机器加载压力负荷为0~1 000 N下, 观察两组模型有无结构异常, 并比较两种内固定模型的系统最大轴向位移和系统扭转刚度。结果在垂直压载压力为400、600、800、1 000 N四种条件下, 实验组的系统最大轴向位移分别为(0.14±0.01)、(0.25±0.01)、(0.41±0.02)、(0.63±0.02)mm, 对照组的系统最大轴向位移分别为(0.15±0.01)、(0.26±0.01)、(0.46±0.03)、(0.67±0.04)mm。与对照组相比, 实验组在600~1 000 N轴向压力下的平均最大轴向位移减小, 两组间差异有统计学意义(P<0.05)。水平扭转至5°时, 实验组和对照组的系统扭转刚度分别是(2.00±0.12)、(2.02±0.07)Nm/°, 两组间差异无统计学意义(P>0.05)。结论相比单纯双侧LCP治疗股骨远端关节内骨折, SCB联合双侧LCP拥有相似的系统扭转稳定性和更好的轴向生物力学稳定性。SCB具有关节内双侧加压和操作微创的优势, 为关节内骨折的复位加压治疗提供了新思路。Objective To evaluate the biomechanical stability of our slot-designed compression bolt(SCB)combined with bilateral locking compression plates(LCPs)in the treatment of intra-articular distal femur fracture.Methods In 24 adult male knee specimens treated with formalin,the femoral bony part was preserved to establish standard models of intra-articular distal femur fracture(AO type 33-C1).According to the random number table,the fracture models were divided into 2 equal groups:an experimental group(n=12)subjected to fixation with one SCB combined with bilateral LCPs with 10 locking screws and a control group(n=12)subjected to fixation with bilateral LCPs with 12 locking screws.In each model,a vertical ballast test was conducted to record the maximum axial displacement of the system and a horizontal torsion test to calculate the torsional stiffness of the system.When the loading pressure was 0-1,000 N in the biomechanical machine,structural abnormalities were observed in the 2 groups of models and the system maximum axial displacement and system torsional stiffness were compared between the 2 groups.Results When the vertical ballast pressure was 400 N,600 N,800 N and 1,000 N,the maximum axial displacement of the system was,respectively,(0.14±0.01)mm,(0.25±0.01)mm,(0.41±0.02)mm and(0.63±0.02)mm in the experimental group,and(0.15±0.01)mm,(0.26±0.01)mm,(0.46±0.03)mm,and(0.67±0.04)mm in the control group.Compared with the control group,the average maximum axial displacement in the experimental group decreased significantly under the axial pressure of 600-1,000 N(P<0.05).When the horizontal torsion reached 5°,the torsional stiffness was,respectively,(2.00±0.12)Nm/°and(2.02±0.07)Nm/°in the experimental group and the control group,showing no significant difference between the 2 groups(P>0.05).Conclusions In the treatment of intra-articular distal femur fracture,compared with simple bilateral LCPs,our SCB combined with bilateral LCPs demonstrate similar torsional stability but better axial biomechanical stabilit

关 键 词：股骨骨折 骨折固定术 内 生物力学 加压自断螺栓 锁定加压钢板 系统刚度 

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