下胫腓联合损伤重建术中螺钉植入角度的生物力学研究  

Biomechanical study of screw implant angle in reconstruction of tibiofibular syndesmosis injury

作　　者：张磊 李明慧 张梦瑶 熊吉祥 王俊秋 周鑫 石厚银 汪国友 ZHANG Lei;LI Minghui;ZHANG Mengyao;XIONG Jixiang;WANG Junqiu;ZHOU Xin;SHI Houyin;WANG Guoyou(Department of Orthopedics,the Affiliated Traditional Chinese Medicine Hospital,Southwest Medical University,Luzhou Sichuan,646000,P.R.China;Center for Orthopedic Diseases Research,the Affiliated Traditional Chinese Medicine Hospital,Southwest Medical University,Luzhou Sichuan,646000,P.R.China;Luzhou Key Laboratory of Orthopedic Disorders of Luzhou,Luzhou Sichuan,646000,P.R.China;School of Physical Education,Southwest Medical University,Luzhou Sichuan,646000,P.R.China;School of Clinical Medicine,Southwest Medical University,Luzhou Sichuan,646000,P.R.China)

机构地区：[1]西南医科大学附属中医医院骨伤科,四川泸州646000 [2]西南医科大学附属中医医院骨伤疾病研究中心,四川泸州646000 [3]骨伤疾病泸州市重点实验室,四川泸州646000 [4]西南医科大学体育学院,四川泸州646000 [5]西南医科大学临床医学院,四川泸州646000

出　　处：《中国修复重建外科杂志》2024年第12期1480-1485,共6页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：2022年西南医科大学附属中医医院科研团队培育项目(2022-CXTD-08);2023年度四川省中医药管理局中医药科研专项课题面上项目(中医药基础)(2023MS248);2023年度泸州市科技计划项目(科技创新领军人才)(2023RCX172)。

摘　　要：目的通过生物力学试验探讨下胫腓联合损伤重建术中螺钉理想植入角度。方法选取24个成年尸体踝关节标本制备下胫腓联合损伤模型后,根据螺钉植入角度随机分为A(0°)、B(10°~15°)、C(20°~25°)、D(30°~35°)组,分别在离踝关节近端2 cm水平处植入螺钉。采用生物力学试验机,在中立、背伸(10°)、跖屈(15°)、内翻(10°)和外翻(15°)位,施加0~700 N轴向载荷,测量腓骨位移(压力分离试验);在中立位以内旋和外旋施加0~5 N·m扭矩载荷,测量腓骨位移(扭矩分离试验)。结果压力分离试验中,不同体位及载荷条件下,C组位移均最小。中立位时,A组300~700 N载荷条件下、B组各载荷条件下位移与C组比较,差异有统计学意义(P<0.05);背伸位时,A组500~700 N载荷下、B组及D组各载荷条件下位移与C组比较,差异有统计学意义(P<0.05),而A组各载荷条件下位移均小于B组(P<0.05);跖屈位时,D组各载荷条件下位移与C组比较,差异有统计学意义(P<0.05);外翻位时,A组400~700 N载荷条件下、B组及D组各载荷条件下位移与C组比较,差异有统计学意义(P<0.05)。扭矩分离试验中,不同载荷条件下C组位移最小、B组最大。内旋时,B组各载荷条件下、D组3~5 N·m载荷条件下位移与C组比较,差异有统计学意义(P<0.05);外旋时,B组和D组各载荷条件下位移与C组比较,差异有统计学意义(P<0.05)。其余条件下各组间差异均无统计学意义(P>0.05)。结论下胫腓联合损伤重建术中螺钉植入理想角度为20°~25°,以该角度植入螺钉固定后腓骨位移更小。Objective To investigate ideal screw implant angle in reconstruction of tibiofibular syndesmosis injury by using a biomechanical test.Methods A total of 24 ankle specimens from adult cadavers were used as the tibiofibular syndesmosis injury model.According to the angle of screw placement,the tibiofibular syndesmosis injury models were randomly divided into groups A(0°),B(10°-15°),C(20°-25°),and D(30°-35°),and the screws were placed at a level 2 cm proximal to the ankle joint.The displacement of fibula was measured by biomechanical testing machine at neutral,dorsiflexion(10°),plantar flexion(15°),varus(10°),and valgus(15°)positions,with axial load of 0-700 N(pressure separation test).The displacement of fibula was also measured at neutral position by applying 0-5 N·m torque load during internal and external rotation(torsional separation test).Results In the pressure separation test,group C exhibited the smallest displacement under different positions and load conditions.At neutral position,significant differences were observed(P<0.05)between group A and group C under load of 300-700 N,as well as between group B and group C under all load conditions.At dorsiflexion position,significant differences were observed(P<0.05)between group A and group C under load of 500-700 N,as well as between groups B,D and group C under all load conditions,and the displacements under all load conditions were significantly smaller in group A than in group B(P<0.05).At plantar flexion position,significant differences were observed(P<0.05)between group D and group C under all load conditions.At valgus position,significant differences were observed(P<0.05)between group A and group C under load of 400-700 N,as well as between groups B,D and group C under all load conditions.In the torsional separation test,group C exhibited the smallest displacement and group B had the largest displacement under different load conditions.During internal rotation,significant differences were observed(P<0.05)between group B and group C under all l

关 键 词：下胫腓联合损伤 螺钉固定 植入角度 生物力学 

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