髌骨下极骨折不同修复方法的生物力学对比  

Biomechanical Comparison of Different Repair Methods for Inferior Pole Fracture of the Patella

作　　者：许玉林 唐元贵 崔永康 刘豫川 王涛 漆万银 刘晋珲 梁成 XU Yulin;TANG Yuangui;CUI Yongkang;LIU Yuchuan;WANG Tao;QI Wanyin;LIU Jinhui;LIANG Cheng(Department of Orthopedics,the Affiliated Hospital of Southwest Medical University,Luzhou 646000,Sichuan,China;Sichuan Provincial Laboratory of Orthopaedic Engineering,Luzhou 646000,Sichuan,China;School of Clinical Medcine,Southwest Medical University,Luzhou 646000,Sichuan,China;Department of Radiology,the Affiliated Hospital of Southwest Medical University,Luzhou 646000,Sichuan,China)

机构地区：[1]西南医科大学附属医院骨科,四川泸州646000 [2]四川省骨科置入器械研发及应用技术工程实验室,四川泸州646000 [3]西南医科大学临床医学院,四川泸州646000 [4]西南医科大学附属医院放射科,四川泸州646000

出　　处：《医用生物力学》2025年第1期100-105,共6页Journal of Medical Biomechanics

基　　金：2023年大学生创新项目(S202310632329);西南医科大学校级课题(2023ZD015);西南医科大学产学研项目(2022CXY03)。

摘　　要：目的 对采用不同缝线缝合方法修复髌骨下极骨折的生物力学性能进行对比研究。方法 以正常髌骨(A组)结构对比,采用Krackow缝合法固定(B组)、Kessler缝合法固定(C组)、“8字”网兜法(D组)、改良缝线桥(E组)4种修复方式。测量髌骨下极骨折各种修复方式下屈膝30°、60°和90°时静态刚度和动态稳定性。结果 E组在各屈膝角度的刚度相比其他修复组更接近正常组,其次为B组,然后为D组,最后为C组。第1个循环周期后,屈膝30°时,C组位移最大,B、E组位移略大于A组,D组位移小于A组。屈膝60°、90°时,各修复组位移均小于正常组。后3个循环周期,200周期以后,各修复组位移变化均小于A组。结论 各种修复均为有效修复。从生物力学固定效果而言,固定效果改良缝线桥组优于Krackow缝合法固定和“8字”网兜法,Kessler缝合法固定相对最差。但实际的临床使用需要考虑损伤程度、切口位置、手术操作时间等因素综合选取修复方案,推荐按E、B、D、C的顺序依次选取。Objective To conduct a comparative study on the biomechanical performance of using sutures for repairing inferior pole patellar fractures.Methods Compared to the normal patellar structure(Group A),four repair methods,namely,‘Krackow’suture(Group B),“Kessler”fixation(Group C),‘8-figure’mesh method(Group D),and modified suture bridge(Group E)were adopted.The static stiffness and dynamic stability of inferior pole patellar fractures fixed by each repair method were measured at 30°,60°,and 90°knee flexion.Results The stiffness at all flexion angles in Group E was closer to that in Group A,compared to other repair groups,followed by Group B,then Group D,and finally Group C.After the first cycle,at 30°knee flexion,Group C showed the greatest displacement,while Groups B and E had slightly larger displacements than the Group A,and the displacement of Group D was smaller than that of Group A.At 60°and 90°knee flexion,the displacement in all repair groups was smaller than that of Group A.After 200 cycles in the subsequent three cycles,displacement changes in all repair groups were smaller than those in Group A.Conclusions All repair methods were effective.In terms of biomechanical fixation performance,the modified suture bridge was superior to the‘Krackow’suture and‘8-figure’mesh,with Kessler fixation being the least effective.However,factors such as the injury severity,incision location,and surgical time should be comprehensively considered in actual clinical use,and it is recommended that the repair method should be selected in the following order:E,B,D,and C.

关 键 词：髌骨下极骨折 骨折修复 生物力学 

分 类 号：R318.01[医药卫生—生物医学工程]