基于成人掌骨形态学数据设计的掌骨弹性髓内针治疗掌骨骨折的生物力学研究  

Biomechanical study of metacarpal elastic intramedullary needle based on adult metacarpal morphological data for the treatment of metacarpal fractures

作　　者：邓玖征[1] 袁野[1] 朱剑津[1] 何大炜[1] 赵喆[1] 赵锋 孔德敬 潘勇卫[1] Deng Jiuzheng;Yuan Ye;Zhu Jianjin;He Dawei;Zhao Zhe;Zhao Feng;Kong Dejing;Pan Yongwei(Department of Orthopaedics,Beijing Tsinghua Changgung Hospital,School of Clinical Medicine,Tsinghua University,Beijing 102218,China;Beijing Weigao Yahua Artificial Joint Development Co.,Ltd.,Beijing 101300,China;Shandong Weigao Orthopaedic Device CO.,Ltd.,Weihai 264203,China)

机构地区：[1]清华大学附属北京清华长庚医院骨科,清华大学临床医学院,102218 [2]北京威高亚华人工关节开发有限公司,101300 [3]山东威高骨科材料股份有限公司,威海264203

出　　处：《中华损伤与修复杂志（电子版）》2022年第4期330-335,共6页Chinese Journal of Injury Repair and Wound Healing(Electronic Edition)

基　　金：北京市科学技术委员会医药协同科技创新研究(科研)(Z181100001918030)。

摘　　要：目的探讨基于成人掌骨形态学数据设计的掌骨弹性髓内针的生物力学性能,为临床应用提供基础。方法选用成人新鲜冰冻手掌标本12例,取第2~5掌骨共计48根,按照随机数字表法将切取的掌骨分为3组,钢板螺丝钉内固定组、交叉克氏针内固定组和弹性髓内针内固定组,每组包含第2~5掌骨各4根,共16根掌骨;其中8根用于悬臂折弯测试,8根用于扭转测试。用骨刀距掌骨远端20 mm处横行截骨,制作简单横行骨折模型。钢板螺丝钉内固定组以直列4孔掌骨锁定接骨板,以骨折线为中心,在骨折线远端、近端各采用2枚2.0 mm双皮质锁定螺钉固定;交叉克氏针内固定组采用1.0 mm不锈钢克氏针以骨折线为中心交叉固定;弹性髓内针内固定组使用笔者团队设计的直径2.0 mm的掌骨弹性髓内针,配合把持器和开髓器,自掌骨基底部顺行穿入髓腔,经骨折线到达掌骨头关节面下固定。使用生物力学测试机对3组进行悬臂折弯和扭转测试,计算3组的最大折弯力、折弯刚度和最大扭矩、扭转刚度。数据比较采用单因素方差分析、SNK法。结果(1)在悬臂折弯测试中,钢板螺丝钉内固定组、交叉克氏针内固定组和弹性髓内针内固定组的最大折弯力分别为(126.3±53.9)、(48.7±18.2)、(88.4±13.9)N,3组比较差异有统计学意义(F=10.530,P=0.001);组间两两比较差异均有统计学意义(P<0.05)。钢板螺丝钉内固定组、交叉克氏针内固定组和弹性髓内针内固定组的折弯刚度分别为(12.33±4.90)、(5.86±5.02)、(10.49±2.05)N/mm,3组比较差异有统计学意义(F=4.988,P=0.017);交叉克氏针内固定组分别与另2组比较,差异均有统计学意义(P<0.05),钢板螺丝钉内固定组和弹性髓内针内固定组比较差异无统计学意义(P>0.05)。(2)扭转测试中,钢板螺丝钉内固定组、交叉克氏针内固定组和弹性髓内针内固定组的最大扭矩分别为(1.98±0.42)、(0.61±0.39)、(0.50±0.34)N�Objective To explore the biomechanical properties of metacarpal elastic intramedullary needle designed based on adult metacarpal morphological data,and provide the basis for clinical application.Methods The 2nd to 5th metacarpal bones were selected from 12 fresh frozen palm specimens of adults and the forty-eight metacarpal bones were divided into 3 groups:the plate fixation group,the K-wire fixation group,and the elastic intramedullary needle fixation group according to the random number table method.Each group contained 16 metacarpal bones from the 2nd to 5th metacarpals,8 of them were used for cantilever banding tests and 8 of them were used for torque tests.A simple transverse fracture model was made by making a transverse osteotomy with an osteotome at a distance of 20 mm from the distal end of the metacarpal bone.In the plate fixation group,the fracture was fixed with a four-holes locking plate,the fracture line as the center,and four 2.0 mm bicortical locking screws were used at the distal and proximal ends of the fracture line;in the K-wire fixation group,the fracture was fixed with 1.0 mm stainless steel Kirschner wire with the fracture line as the center for cross fixation;in the elastic intramedullary needle fixation group,the fracture was fixed with antegrade 2.0 mm metacarpal elastic intramedullary needle which was designed by author’s team,cooperated with the handle and pulp opener,and penetrated the medullary cavity antegradely from the base of the metacarpal bone,and then reached the subarticular surface of the metacarpal head through the fracture line for fixation.The biomechanical testing machine was used to test the cantilever bending and torsion of the three groups,and the maximum bending force,bending stiffness,maximum torque and torsion stiffness of the three groups were calculated.Data were compared with one-way ANOVA and SNK method.Results(1)In the cantilever bending test,the maximum bending loads of the plate fixation group,the K-wire fixation group,and the elastic intramedullary needle

关 键 词：掌骨 骨折固定术 内 生物力学 髓内针 

分 类 号：R687.3[医药卫生—骨科学]