胫骨板式外固定架的生物力学性能研究
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摘要
目的通过生物力学实验比较胫骨板式外固定架与单边式外固定架固定胫骨骨折的力学性能差异,为胫骨板式外固定架用于胫骨骨折的治疗提供理论支持。方法选取新鲜成年牛胫骨15根,根据不同固定方式随机分为板式经典型组、板式延长型组、单边式外固定架组三组,每组5根,均制作成胫骨中段骨折模型,分别用胫骨板式外固定架的2种构型(经典型、延长型)及单边式外固定架固定(均来自上海康定医疗器械有限公司),记录各组在不同载荷下骨折断端的相应位移,并依据载荷及相应的位移计算各组的轴向压缩、四点弯曲及扭转刚度。结果板式经典型组、板式延长型组及单边式外固定架组三组的轴向压缩刚度分别为244.82、166.69、133.63N/mm,四点弯曲刚度分别为9.74、8.53、7.55Nm/deg,扭转刚度分别为1.65、1.08、0.76Nm/deg,差异均有统计学意义(P<0.0001)。结论胫骨板式外固定架的两种构型在轴向压缩、四点弯曲及扭转刚度方面均优于临床常用的单边式外固定架,能够满足胫骨开放性骨折及粉碎性骨折的治疗需要。
Objective To compare the biomechanical properties of the tibia plate type external fixator and unilateral external fixator for the fixation of the tibial fracture by biomechanical test,and to provide a theoretical basis for the therapy of tibial fractures by the tibia plate type external fixator. Methods Fifteen fresh adult bovine tibia were selected and randomly divided into three groups of five specimens in each according to different fixing methods: the classical plate type group,the extended plate type group and the unilateral external fixator group. All of the selected tibias were made into middle tibia fracture models. The specimens were stabilized either with two configurations of tibia plate external fixator(classical type and extended type),or the unilateral external fixator. The constructs were loaded under three conditions(axial compression,four-point bending,as well as torsion). The displacements at the fracture site,corresponding to the different applied loads,were recorded to calculate the stiffness of the tibia fixation configuration in each group. The axial compression stiffness,the four-point bending stiffness and the torsional stiffness were calculated for each specimen. Results The axial compression stiffness was significantly(F(2,12)=90.099,P< 0.0001) different for the classical plate type(244.82 N/mm),the extended plate type(166.69 N/mm),and the unilateral external fixator(133.63 N/mm). The four-point bending stiffness was significantly(F(2,12)=17.873,P<0.0001)different for the classical plate type(9.74 Nm/deg),the extended plate type(8.53 Nm/deg),and the unilateral external fixator(7.55 Nm/deg). The torsion stiffness was also significantly(F(2,12)=50.397,P<0.0001)different for the classical plate type(1.65 Nm/deg),the extended plate type(1.08 Nm/deg),and the unilateral external fixator(0.76 Nm/deg). Conclusion The two configurations of tibia plate type external fixators can provide a promising and satisfactory alternative,since the constructs are superior to the commonly used unilateral external fixators in axial compression,four-point bending,as well as torsion stiffness.
Objective To compare the biomechanical properties of the tibia plate type external fixator and unilateral external fixator for the fixation of the tibial fracture by biomechanical test,and to provide a theoretical basis for the therapy of tibial fractures by the tibia plate type external fixator. Methods Fifteen fresh adult bovine tibia were selected and randomly divided into three groups of five specimens in each according to different fixing methods: the classical plate type group,the extended plate type group and the unilateral external fixator group. All of the selected tibias were made into middle tibia fracture models. The specimens were stabilized either with two configurations of tibia plate external fixator(classical type and extended type),or the unilateral external fixator. The constructs were loaded under three conditions(axial compression,four-point bending,as well as torsion). The displacements at the fracture site,corresponding to the different applied loads,were recorded to calculate the stiffness of the tibia fixation configuration in each group. The axial compression stiffness,the four-point bending stiffness and the torsional stiffness were calculated for each specimen. Results The axial compression stiffness was significantly(F(2,12)=90.099,P< 0.0001) different for the classical plate type(244.82 N/mm),the extended plate type(166.69 N/mm),and the unilateral external fixator(133.63 N/mm). The four-point bending stiffness was significantly(F(2,12)=17.873,P<0.0001)different for the classical plate type(9.74 Nm/deg),the extended plate type(8.53 Nm/deg),and the unilateral external fixator(7.55 Nm/deg). The torsion stiffness was also significantly(F(2,12)=50.397,P<0.0001)different for the classical plate type(1.65 Nm/deg),the extended plate type(1.08 Nm/deg),and the unilateral external fixator(0.76 Nm/deg). Conclusion The two configurations of tibia plate type external fixators can provide a promising and satisfactory alternative,since the constructs are superior to the commonly used unilateral external fixators in axial compression,four-point bending,as well as torsion stiffness.
引文
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[10] Liu W,Yang L,Kong X,et al.Stiffness of the locking compression plate as an external fixator for treating distal tibial fractures:a biomechanics study[J].BMC Musculoskelet Disord,2017,18(1):26.
[11] 杨俊生,夏超,童梁成,等.TW-702F型外固定架3种构型的生物力学研究[J].中国骨与关节损伤杂志,2017,32(5):494-496.
[12] 李达与,樊仕才.锁定钢板外置与外固定架固定胫骨骨折的生物力学比较[J].中国骨与关节损伤杂志,2018,33(8):813-816.
[13] Miller DL,Goswami T.A review of locking compression plate biomechanics and their advantages as internal fixators in fracture healing[J].Clin Biomech(Bristol,Avon),2007,22(10):1049-1062.
[14] Ray JG,Zipursky J,Park AL.Injury-related maternal mortality[J].Am J Obstet Gyneco,2018.219(3):307-308.
[15] Ya Ish FMM,Nanu AM,Cross AT.Can DCP and LCP plates generate more compression?The effect of multiple eccentrically placed screws and their drill positioning guides[J].Injury,2011,42(10):1095-1100.
[16] Bottlang M,Doornink J,Fitzpatrick DC,et al.Far cortical locking can reduce stiffness of locked plating constructs while retaining construct strength[J].J Bone Joint Surg(Am),2009,91(8):1985-1994.
[17] Epari DR,Kassi JP,Schell H,et al.Timely fracture-healing requires optimization of axial fixation stability[J].J Bone Joint Surg(Am),2007,89(7):1575-1585.
[18] Epari DR,Stoffel K,Lorenz KU,et al.Biomechanical considerations in plate osteosynthesis:the effect of plate-to-bone compression with and without angular screw stability[J].J Orthop Trauma,2007,21(6):362-368.
[19] Schmidt U,Penzkofer R,Bachmaier S,et al.Implant material and design alter construct stiffness in distal femur locking plate fxation:a pilot study[J].Clin Orthop Relat Res,2013,471(9):2808-2814.
[20] Stoffel K,Dieter U,Stachowiak G,et al.Biomechanical testing of the LCP-how can stability in locked internal fixators be controlled[J].Injury,2003,34(S2):11-19.
[2] Zelle BA,Bhandari M,Espiritu M,et al.Treatment of distal tibia fractures without articular involvement:a systematic review of 1125 fractures[J].J Orthop Trauma,2006,20(1):76-79.
[3] Hoffmeier KL,Hofmann GO,Mückley T.Choosing a proper working length can improve the lifespan of locked plates[J].Clin Biomech (Bristol,Avon),2011,26(4):405-409.
[4] Ang BFH,Chen JY,Yew AKS,et al.Externalised locking compression plate as an alternative to the unilateral external fixator:a biomechanical comparative study of axial and torsional stiffness[J].Bone Joint Res,2017,6(4):216-223.
[5] Luo P,Xu D,Wu J,et al.Locked plating as an external fixator in treating tibial fractures[J].Medicine,2017,96(49):e9083.
[6] Ma CH,Wu CH,Jiang JR,et al.Metaphyseal locking plate as an external fixator for open tibial fracture:clinical outcomes and biomechanical assessment[J].Injury,2017,48(2):501-505.
[7] Sellei RM,Kobbe P,Dadgar A,et al.External fixation design evolution enhances biomechanical frame performance[J].Injury,2015,46 (S3):S23-26.
[8] Bottlang M,Doornink J,Lujan TJ,et al.Effects of construct stiffness on healing of fractures stabilized with locking plates[J].J Bone Joint Surg(Am),2010,92(S2):12-22.
[9] Oh JK,Sahu D,Ahn YH,et al.Effect of fracture gap on stability of compression plate fixation:a finite element study[J].J Orthop Res,2010,28(4):462-467.
[10] Liu W,Yang L,Kong X,et al.Stiffness of the locking compression plate as an external fixator for treating distal tibial fractures:a biomechanics study[J].BMC Musculoskelet Disord,2017,18(1):26.
[11] 杨俊生,夏超,童梁成,等.TW-702F型外固定架3种构型的生物力学研究[J].中国骨与关节损伤杂志,2017,32(5):494-496.
[12] 李达与,樊仕才.锁定钢板外置与外固定架固定胫骨骨折的生物力学比较[J].中国骨与关节损伤杂志,2018,33(8):813-816.
[13] Miller DL,Goswami T.A review of locking compression plate biomechanics and their advantages as internal fixators in fracture healing[J].Clin Biomech(Bristol,Avon),2007,22(10):1049-1062.
[14] Ray JG,Zipursky J,Park AL.Injury-related maternal mortality[J].Am J Obstet Gyneco,2018.219(3):307-308.
[15] Ya Ish FMM,Nanu AM,Cross AT.Can DCP and LCP plates generate more compression?The effect of multiple eccentrically placed screws and their drill positioning guides[J].Injury,2011,42(10):1095-1100.
[16] Bottlang M,Doornink J,Fitzpatrick DC,et al.Far cortical locking can reduce stiffness of locked plating constructs while retaining construct strength[J].J Bone Joint Surg(Am),2009,91(8):1985-1994.
[17] Epari DR,Kassi JP,Schell H,et al.Timely fracture-healing requires optimization of axial fixation stability[J].J Bone Joint Surg(Am),2007,89(7):1575-1585.
[18] Epari DR,Stoffel K,Lorenz KU,et al.Biomechanical considerations in plate osteosynthesis:the effect of plate-to-bone compression with and without angular screw stability[J].J Orthop Trauma,2007,21(6):362-368.
[19] Schmidt U,Penzkofer R,Bachmaier S,et al.Implant material and design alter construct stiffness in distal femur locking plate fxation:a pilot study[J].Clin Orthop Relat Res,2013,471(9):2808-2814.
[20] Stoffel K,Dieter U,Stachowiak G,et al.Biomechanical testing of the LCP-how can stability in locked internal fixators be controlled[J].Injury,2003,34(S2):11-19.