轴向载荷力学测试在胫腓骨骨折术后外固定器拆除中的临床应用
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摘要
目的探讨外固定器轴向载荷力学测试用于指导临床骨折术后拆除外固定器时间判断的安全性及有效性。方法 2014年1月-2015年8月,收治27例因外伤致胫、腓骨骨折患者。男21例,女6例;年龄19~63岁,平均45岁。闭合骨折7例,开放骨折20例。X线片复查示:螺旋型不稳定骨折4例,粉碎型不稳定骨折23例。一期行外固定器固定。其中3例外固定术后出现感染致骨不连,1例发生骨折不愈合伴骨缺损;行二期胫骨截骨延长术。外固定后待正侧位X线片复查明确骨折处均有连续性高密度骨痂形成后,行外固定器轴向载荷力学测试。当外固定器轴向载荷分担比<10%时,拆除外固定器。结果经外固定治疗21~85周(平均44周)后,行外固定器轴向载荷力学测试。测试结果显示,26例外固定器轴向载荷分担比<10%,拆除外固定器;拆除外固定器后随访6周,患者下肢完全负重,恢复正常生活,无再骨折发生。1例术后85周外固定器轴向载荷分担比为14%,X线片检查显示骨折成角畸形未完全愈合,拆除外固定器后发生再骨折,改行髓内固定术。结论外固定器轴向载荷力学测试可以客观反映并定量评价骨折愈合情况,可用于指导外固定器拆除时间的确定。
Objective To explore the efficacy and safety of the axial load mechanical testing for removing external fixator. Methods Between January 2014 and August 2015, 27 patients with tibia and fibula fractures caused by trauma underwent an external fixation. Of 27 patients, 21 were male and 6 were female with the average age of 45 years(range, 19-63 years), including 7 cases of closed fracture and 20 cases of open fracture. X-ray film results showed spiral unstable fracture in 4 cases and comminuted unstable fracture in 23 cases. All patients underwent an external fixation. Bone nonunion occurred in 3 cases because of infection, and bone nonunion combined with bone defect occurred in 1 case, who received tibial osteotomy lengthening surgery. When X-ray film showed continuity high density callus formation at fracture site, axial load mechanical test was performed. If the axial load ratio of external fixator was less than 10%, the external fixator was removed. Results At 21-85 weeks after external fixation(mean, 44 weeks), axial load mechanical test was performed. The results showed that the axial load ratio of external fixation was less than 10% in 26 cases, and the external fixator was removed; at 6 weeks after removal of external fixator, the patients could endure full load and return to work, without re-fracture. The axial load ratio was 14% in 1 case at 85 weeks, and the X-ray film result showed that fracture did not completely heal with angular deformity; re-fracture occurred after removing external fixator, and intramedullary fixation was used. Conclusion External fixator axial load mechanical testing may objectively reveal and quantitatively evaluate fracture healing, so it is safe and reliable to use for guiding the external fixator removal.
Objective To explore the efficacy and safety of the axial load mechanical testing for removing external fixator. Methods Between January 2014 and August 2015, 27 patients with tibia and fibula fractures caused by trauma underwent an external fixation. Of 27 patients, 21 were male and 6 were female with the average age of 45 years(range, 19-63 years), including 7 cases of closed fracture and 20 cases of open fracture. X-ray film results showed spiral unstable fracture in 4 cases and comminuted unstable fracture in 23 cases. All patients underwent an external fixation. Bone nonunion occurred in 3 cases because of infection, and bone nonunion combined with bone defect occurred in 1 case, who received tibial osteotomy lengthening surgery. When X-ray film showed continuity high density callus formation at fracture site, axial load mechanical test was performed. If the axial load ratio of external fixator was less than 10%, the external fixator was removed. Results At 21-85 weeks after external fixation(mean, 44 weeks), axial load mechanical test was performed. The results showed that the axial load ratio of external fixation was less than 10% in 26 cases, and the external fixator was removed; at 6 weeks after removal of external fixator, the patients could endure full load and return to work, without re-fracture. The axial load ratio was 14% in 1 case at 85 weeks, and the X-ray film result showed that fracture did not completely heal with angular deformity; re-fracture occurred after removing external fixator, and intramedullary fixation was used. Conclusion External fixator axial load mechanical testing may objectively reveal and quantitatively evaluate fracture healing, so it is safe and reliable to use for guiding the external fixator removal.
引文
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9 郭占社,房远勇,梁向党,等.骨科生物力学参数测试理论及方法研究进展.中国医疗器械杂志,2010,34(5):350-354.
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12 马信龙,马剑雄,徐卫国,等.骨科生物力学研究的测量方法学专家共识.中国骨质疏松杂志,2014,20(9):1039-1054.
13 郑诚功.骨科生物力学的进展.中华创伤骨科杂志,2005,7(10):901-902.
14 李跃飞,田贺,张文泰.中西医结合治疗四肢骨折.长春中医药大学学报,2015,31(2):316-317.
15 许志宇,孟和.由“动静结合、筋骨并重”谈孟氏学术理念.西部中医药,2016,29(1):58-60.
16 夏和桃.外固定器刚度对骨折愈合的影响.中华创伤骨科杂志,2007,9(12):1170-1172.
17 秦泗河.骨外固定技术的发展与创新.中医正骨,2012,24(9):643-647.
18 Arora J,Malik AC.External fixation in comminuted,displaced intra-articular fractures of the distal radius:is it sufficient?Arch Orthop Trauma Surg,2005,125(8):536-540.
2 Kocaoglu M,Eralp L,Kilicoglu O,et al.Complications encountered during lengthening over an intramedullary nail.J Bone Joint Surg(Am),2004,86-A(11):2406-2411.
3 Simpson AH,Kenwright J.Fracture at er distraction osteogenesis.J Bone Joint Surg(Br),2000,82(5):659-665.
4 Saran N,Hamdy RC.DEXA as a predictor of fixator removal in distraction osteogenesis.Clin Orthop Relat Res,2008,466(12):2955-2961.
5 Chachan S,Tudu B,Sahu B.Ultrasound monitoring of fracture healing:is this the end of radiography in fracture follow-ups?J Orthop Trauma,2015,29(3):e133-138.
6 Lowet G,Van der Perre G.Ultrasound velocity measurement in long bones:measurement method and simulation of ultrasound wave propagation.J Biomech,1996,29(10):1255-1262.
7 De Backer AI,MorteléKJ,De Keulenaer BL.Picture archiving and communication system—Part one:i lmless radiology and distance radiology.JBR-BTR,2004,87(5):234-241.
8 Aarnes GT,Steen H,Ludvigsen P,et al.In vivo assessment of regenerate axial stif ness in distraction osteogenesis.J Orthop Res,2005,23(2):494-498.
9 郭占社,房远勇,梁向党,等.骨科生物力学参数测试理论及方法研究进展.中国医疗器械杂志,2010,34(5):350-354.
10 Donnan LT,Saleh M,Rigby AS,et al.Radiographic assessment of bone formation in tibia during distraction osteogenesis.J Pediatr Orthop,2002,22(5):645-651.
11 Zhao L,Fan Q,Venkatesh KP,et al.Objective guidelines for removing an external fixator after tibial lengthening using pixel value ratio:a pilot study.Clin Orthop Relat Res,2009,467(12):3321-3326.
12 马信龙,马剑雄,徐卫国,等.骨科生物力学研究的测量方法学专家共识.中国骨质疏松杂志,2014,20(9):1039-1054.
13 郑诚功.骨科生物力学的进展.中华创伤骨科杂志,2005,7(10):901-902.
14 李跃飞,田贺,张文泰.中西医结合治疗四肢骨折.长春中医药大学学报,2015,31(2):316-317.
15 许志宇,孟和.由“动静结合、筋骨并重”谈孟氏学术理念.西部中医药,2016,29(1):58-60.
16 夏和桃.外固定器刚度对骨折愈合的影响.中华创伤骨科杂志,2007,9(12):1170-1172.
17 秦泗河.骨外固定技术的发展与创新.中医正骨,2012,24(9):643-647.
18 Arora J,Malik AC.External fixation in comminuted,displaced intra-articular fractures of the distal radius:is it sufficient?Arch Orthop Trauma Surg,2005,125(8):536-540.