外固定架固定Pilon骨折负重稳定性的生物力学研究  

Biomechanical study of load-bearing stability of Pilon fracture fixed with external fixator

作　　者：成永忠[1] 尹晓冬 陈洋 王朝鲁[1] 刘广伟 史长龙[1] 黄晓宇 陈奕历 陈泓颖 汪雄伟 赵继阳 CHENG Yong-zhong;YIN Xiao-dong;CHEN Yang;WANG Chao-lu;LIU Guang-wei;SHI Chang-long;HUANG Xiao-yu;CHEN Yi-li;CHEN Hong-ying;WANG Xiong-wei;ZHAO Ji-yang(The First Department of Trauma,Wangjing Hospital,China Academy of Chinese Medical Sciences,Beijing 100102,China;Beijing Key Laboratory of Bonesetting Technology of Traditional Chinese Medicine,Beijing 100102,China;Clinical Medical College of Beijing University of Chinese Medicine,Beijing 100102,China;Department of Geriatric Fracture,Guangdong Hospital of Traditional Chinese Medicine,Guangzhou 510000,Guangdong,China;Department of Traumatic Joints,The Third Affiliated Hospital of Beijing University of Chinese Medicine,Beijing100102,China)

机构地区：[1]中国中医科学院望京医院创伤一科,北京100102 [2]中医正骨技术北京市重点实验室,北京100102 [3]北京中医药大学临床医学院,北京100102 [4]广东省中医院老年骨折科,广东广州510000 [5]北京中医药大学第三附属医院创伤关节科,北京100102

出　　处：《中国骨伤》2024年第12期1196-1201,共6页China Journal of Orthopaedics and Traumatology

基　　金：国家自然科学基金面上项目(编号:82274561);中国中医科学院望京医院高水平中医医院建设项目中医药临床循证研究专项(编号:WJYY-XZKT-2023-02)。

摘　　要：目的:探讨外固定架固定Pilon骨折后负重稳定性。方法:选取踝关节骨模型(右侧)6个及踝关节尸体标本4对(8只),根据Ruedi-Allgower Pilon骨折分型设计截骨线,采用摆据依据预先设定的截骨线制备Pilon骨折模型;用微创截骨器对尸体标本行骨折造模,制备Pilon骨折尸体模型。使用外固定架固定踝关节骨模型和尸体标本模型后,在力学加载机上进行轴向载荷力学加载。对踝关节骨模型分别施加150、300、450N的轴向载荷,用动态捕捉仪记录腓骨骨折块、胫骨外侧骨折块、胫骨内侧骨折块在三维空间(X、Y、Z轴)上的位移。对外固定架固定后的踝关节尸体标本模型分别施加300、600、900N的轴向载荷,拍摄不同载荷条件下外固定架固定下的Pilon骨折尸体模型X线片,用digimizer软件中测量不同载荷下胫骨前侧角、胫骨踝穴角、距骨移位值、距骨倾斜角度、外踝侧方移位值、内踝侧方移位值、内踝分离移位值、关节面台阶位移值。结果:对外固定架固定的Pilon骨折骨模型分别施加150、300、450N轴向载荷后,未出现外固定架松动、断裂,局部固定骨折端的克氏针也未出现松动、断裂及不可逆的塑性形变。腓骨骨折块在X轴(左右)位移值分别为0.032(-0.022,0.269)、0.061(-0.002,0.427)、0.212(-0.016,1.223) mm,Y轴(上下)位移值分别为0.002(-0.031,0.103)、0.051(-1.133,0.376)、0.128(-1.394,0.516) mm,Z轴(前后)位移值分别为-0.003(-0.130,0.171)、0.137(-0.076,0.433)、0.030(-0.487,0.478) mm;胫骨外侧骨折块在X轴上的位移值分别为0.000(-0.108,0.027)、0.083(-0.364,0.050)、-0.121(-0.289,0.165) mm,Y轴上的位移值分别为-0.009(-0.200,0.025)、-0.179(-0.710,0.084)、-0.257 (-0.799,0.027) mm,Z轴位移值分别为0.112 (-0.024,0.256)、0.157 (-0.068,0.293)、-0.210(-0.035,0.430) mm;胫骨内侧骨折块在X轴上的位移值分别为-0.010(-0.060,0.013)、-0.165(-0.289,0.056)、-0.181(-0.395,0.013) mm,Y轴位移值分别为-0.036Objective To explore weight-bearing stability of Pilon fracture fixed by external fixator.Methods Six ankle bone models(right side)and 4 pairs(8 ankle cadaver specimens)were selected.Pilon fracture model was prepared by using the preset osteotomy line based on Ruedi Allgower Pilon fracture type.Pilon fracture model was built by using a minimally invasive osteotomy.After ankle bone model and cadaver specimen model were fixed with external fixator,axial load was carried out on mechanical loading machine.After ankle bone model and cadaver specimen model were fixed with external fixator,axial load was carried out on mechanical loading machine.Axial loads of 150,300 and 450 N were applied to ankle bone model,and displacements of fibula fracture blocks,lateral tibia fracture blocks and medial tibia fracture blocks in three-dimensional space(X,Y and Z axes)were recorded by dynamic capture instrument.Axial loads of 300,600 and 900 N were applied to ankle cadaver model fixed by external fixator.X-ray films of Pilon fracture cadaver model fixed by external fixator under different loading conditions were taken.The anterior tibial angle,tibial malleolar point angle,talus shift value,talus tilt angle,lateral malleolar shift value,lateral malleolar shift value,medial malleolar separation shift value and articular surface step displacement value were measured under different loads by digimizer software.Results After 150,300 and 450 N axial loads were applied to Pilon fracture models fixed by external fixator,no loosening or fracture of external fixator was observed,and no loosening,fracture or irreversible plastic deformation of Kirschner needle were observed.The displacement values of fibular fracture pieces on X-axis(around)were 0.032(-0.022,0.269),0.061(-0.002,0.427),0.212(-0.016,1.223)mm,and the displacement values on Y-axis(above and below)were 0.002(-0.031,0.103),0.051(-1.133,0.376),0.128(-1.394,0.516)mm,and displacement values on Z-axis(front and rear)were-0.003(-0.130,0.171),0.137(-0.076,0.433),0.030(-0.487,0.478)mm;the

关 键 词：接骨架 PILON骨折 负重稳定性 生物力学 

分 类 号：R274.1[医药卫生—中医骨伤科学]