水平带状钢板治疗胫骨平台后外侧象限骨折的生物力学研究
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摘要
目的比较胫骨平台后外侧象限骨折不同内固定方式的力学稳定性效果。方法采用Synbone人工合成胫骨18个,切割构建孤立的胫骨平台后外侧象限骨折模型,随机分为3组,分别采用外侧水平带状钢板固定、外侧低切迹解剖锁定钢板固定、后侧直形重建钢板固定。将固定好的骨折模型置于万能水压材料测试机进行测试,分别进行静态加载、疲劳测试和极限加载,检测骨块的相对空间位移。结果以10 mm/min加载至总载荷1050 N,重复加载10000次后,带状钢板组骨折块的纵向位移(2.77±1.79)mm,外侧锁定钢板组的纵向位移为(2.69±1.14)mm;后方重建钢板组骨折块的纵向位移为(1.62±0.60)mm,组间差异无统计学意义(P>0.05)。施加载荷到骨或内固定的结构破坏后,带状钢板组的极限支撑力为(2055±263)N,外侧锁定钢板组的为(1968±209)N,后方重建钢板组的极限支撑力为(2272±130)N,组间差异具有显著的统计学意义(P<0.05)。结论治疗孤立的胫骨平台后外侧象限骨折,侧方带状钢板水平固定能取得满意的效果。
Objective To compare and analyze the biomechanical stability of 3 different fixations for the posterolateral tibial plateau fracture. Methods The posterolateral shearing fracture models were created in 18 synthetic tibia(Synbone) and randomly assigned into 3 groups. The fractures were fixed by horizontal belt plate(Group A), lateral low-profile anatomical LCP(Group B) and posterior reconstructive plate(Group C). Vertical displacements of the posterolateral fragments and failure loads were measured under axial loads including static loading test(from 300 N to 1050 N), fatigue loading test and damage loading teat.Results The vertical displacements in groups A,B,and C were respectively(2.77 ± 1.79)mm,(2.69 ± 1.14)mm, and(1.62 ± 0.60)mm under fatigue loading test, the total load 1050 N with 10 mm/min and repeat load10000 times. There was no significant difference between the groups(P>0.05). After the damage loading test, the final force in groups A,B,and C were respectively(2055±263) N,(1968±209) N and(2272±130) N,and there was significant difference among the groups(P<0.05). Conclusion Horizontal belt plate fixation for isolated posterolateral tibial plateau fracture can bring sufficient stability for the posterolateral fragment.
Objective To compare and analyze the biomechanical stability of 3 different fixations for the posterolateral tibial plateau fracture. Methods The posterolateral shearing fracture models were created in 18 synthetic tibia(Synbone) and randomly assigned into 3 groups. The fractures were fixed by horizontal belt plate(Group A), lateral low-profile anatomical LCP(Group B) and posterior reconstructive plate(Group C). Vertical displacements of the posterolateral fragments and failure loads were measured under axial loads including static loading test(from 300 N to 1050 N), fatigue loading test and damage loading teat.Results The vertical displacements in groups A,B,and C were respectively(2.77 ± 1.79)mm,(2.69 ± 1.14)mm, and(1.62 ± 0.60)mm under fatigue loading test, the total load 1050 N with 10 mm/min and repeat load10000 times. There was no significant difference between the groups(P>0.05). After the damage loading test, the final force in groups A,B,and C were respectively(2055±263) N,(1968±209) N and(2272±130) N,and there was significant difference among the groups(P<0.05). Conclusion Horizontal belt plate fixation for isolated posterolateral tibial plateau fracture can bring sufficient stability for the posterolateral fragment.
引文
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[9]Garner MR,Warner SJ,Lorich DG.Surgical Approaches to Posterolateral Tibial Plateau Fractures[J].J Knee Surg,2016,29(1):12-20.
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[11]Chang SM.Selection of surgical approaches to the posterolateral tibial plateau fracture by its combination patterns[J].J Orthop Trauma,2011,25(3):e32-e33.
[12]胡孙君,张世民,张英琪,等.胫骨平台后外侧象限骨折手术入路的深层解剖:后外侧与后内侧对比[J].中国临床解剖学杂志,2015,33(5):497-501.
[13]Chen WT,Zhang YQ,Chang SM.Posterolateral approach for plating of tibial plateau fractures and the risk of injury to the anterior tibial vessels[J].J Orthop Trauma,2013,27(9):e228-229.
[14]Huang YG,Chang SM.The posterolateral approach for plating tibial plateau fractures:problems in secondary hardware removal[J].Arch Orthop Trauma Surg,2012,132(5):733-734.
[15]Chen HW,Zhou SH,Liu GD,et al.An extended anterolateral approach for posterolateral tibial plateau fractures[J].Knee Surg Sports Traumatol Arthrosc,2015,23(12):3750-3755.
[16]Yu B,Han K,Zhan C,et al.Fibular head osteotomy:a new approach for the treatment of lateral or posterolateral tibial plateau fractures[J].Knee,2010,17(5):313-318.
[17]储旭东,朱建平,蔡福金,等.胫骨平台后外侧髁骨折腓骨小头上入路设计及临床应用[J].中华骨科杂志,2012,32(12):1145-1150.
[18]Giordano V,Schatzker J,Kfuri M.The"Hoop"Plate for Posterior Bicondylar Shear Tibial Plateau Fractures:Description of a New Surgical Technique[J].J Knee Surg,2017,30(6):509-513.
[19]Cho JW,Samal P,Jeon YS,et al.Rim plating of posterolateral fragment(PLF)through modified anterolateral approach in tibial plateau fractures[J].J Orthop Trauma,2016,30(11):e362-e368.
[20]Cho JW,Kim J,Cho WT,et al.Approaches and fixation of the posterolateral fracture fragment in tibial plateau fractures:a review with an emphasis on rim plating via modified anterolateral approach[J].Int Orthop,2017,41:1887-1897.
[21]Zhang W,Luo CF,Putnis S,et al.Biomechanical analysis of four different fixations for the posterolateral shearing tibial plateau fracture[J].Knee,2012,19(2):94-98.
[2]胡孙君,张英琪,张世民.胫骨平台后外侧骨折的治疗进展[J].中华创伤骨科杂志,2014,16(10):898-901.
[3]毛玉江,张伯松,公茂琪,等.后内和后外侧入路治疗胫骨平台后髁骨折的疗效分析[J].中华创伤骨科杂志,2014,16(7):625-628.
[4]He X,Ye P,Hu Y,et al.A posterior inverted L-shaped approach for the treatment of posterior bicondylar tibial plateau fractures[J].Arch Orthop Trauma Surg,2013,133(1):23-28.
[5]Hu SJ,Chang SM,Zhang YQ,et al.The anterolateral supra-fibularhead approach for plating posterolateral tibial plateau fractures:A novel surgical technique[J].Injury,2016,47(2):502-507.
[6]Chang SM,Zheng HP,Li HF,et al.Treatment of isolated posterior coronal fracture of the lateral tibial plateau through posterolateral approach for direct exposure and buttress plate fixation[J].Arch Orthop Trauma Surg,2009,129(7):955-962.
[7]Xiang G,Zhi-Jun P,Qiang Z,et al.Morphological characteristics of posterolateral articular fragments in tibial plateau fractures[J].Orthopedics,2013,36(10):e1256-e1261.
[8]Li Q,Zhang YQ,Chang SM.Posterolateral fragment characteristics in tibial plateau fractures[J].Int Orthop,2014,38(3):681-682.
[9]Garner MR,Warner SJ,Lorich DG.Surgical Approaches to Posterolateral Tibial Plateau Fractures[J].J Knee Surg,2016,29(1):12-20.
[10]Chen H,Wu L.Surgical options for posterior tibial plateau fracture[J].Int J Clin Exp Med,2015,8(11):21421-21427.
[11]Chang SM.Selection of surgical approaches to the posterolateral tibial plateau fracture by its combination patterns[J].J Orthop Trauma,2011,25(3):e32-e33.
[12]胡孙君,张世民,张英琪,等.胫骨平台后外侧象限骨折手术入路的深层解剖:后外侧与后内侧对比[J].中国临床解剖学杂志,2015,33(5):497-501.
[13]Chen WT,Zhang YQ,Chang SM.Posterolateral approach for plating of tibial plateau fractures and the risk of injury to the anterior tibial vessels[J].J Orthop Trauma,2013,27(9):e228-229.
[14]Huang YG,Chang SM.The posterolateral approach for plating tibial plateau fractures:problems in secondary hardware removal[J].Arch Orthop Trauma Surg,2012,132(5):733-734.
[15]Chen HW,Zhou SH,Liu GD,et al.An extended anterolateral approach for posterolateral tibial plateau fractures[J].Knee Surg Sports Traumatol Arthrosc,2015,23(12):3750-3755.
[16]Yu B,Han K,Zhan C,et al.Fibular head osteotomy:a new approach for the treatment of lateral or posterolateral tibial plateau fractures[J].Knee,2010,17(5):313-318.
[17]储旭东,朱建平,蔡福金,等.胫骨平台后外侧髁骨折腓骨小头上入路设计及临床应用[J].中华骨科杂志,2012,32(12):1145-1150.
[18]Giordano V,Schatzker J,Kfuri M.The"Hoop"Plate for Posterior Bicondylar Shear Tibial Plateau Fractures:Description of a New Surgical Technique[J].J Knee Surg,2017,30(6):509-513.
[19]Cho JW,Samal P,Jeon YS,et al.Rim plating of posterolateral fragment(PLF)through modified anterolateral approach in tibial plateau fractures[J].J Orthop Trauma,2016,30(11):e362-e368.
[20]Cho JW,Kim J,Cho WT,et al.Approaches and fixation of the posterolateral fracture fragment in tibial plateau fractures:a review with an emphasis on rim plating via modified anterolateral approach[J].Int Orthop,2017,41:1887-1897.
[21]Zhang W,Luo CF,Putnis S,et al.Biomechanical analysis of four different fixations for the posterolateral shearing tibial plateau fracture[J].Knee,2012,19(2):94-98.