钢板螺钉内固定技术应用于四肢长管骨创伤骨折的效果及生物力学分析

Effect and biomechanical analysis of steel plate implantation for traumatic fracture of long bone

背景:医用金属材料的研制与发展应从现存的问题出发,采用新技术和新工艺,改善生物金属材料的性能,以适应骨生理条件的需要。目的:以金属钢板螺钉内固定生物力学特征为视角,探讨其对创伤骨折临床疗效方面的影响。方法:应用计算机检索PubMed、维普和万方数据库中2001-01/2012-01关于骨损伤治疗及其金属材料内固定方面的文章,在标题和摘要中以"骨折;钢板;螺钉;内固定;力学"或"Bone;Medical;Metal;Materials"为检索词进行检索。最终选择24篇文章进行综述。结果与结论:随着原材料工业的进步和骨科内固定器械的发展更新,目前绝大多数医疗机构应用的骨科内固定钢板螺钉的生物相容性和刚度都相当好。部分国产钢板的螺钉尾部和螺钉杆连接处有应力薄弱点,有时会出现螺钉松动、螺钉尾部和螺杆连接处发生断裂、螺钉尾部滑丝、打滑等。说明置入钢板的质量、螺钉的数量、锻造工艺以及临床置入方式等因素均对内固定系统生物力学存在影响。

BACKGROUND： The research and development of the medical metal materials should be started from the existing problems, using the new technologies and new processes to improve the performance of bio-metallic materials, in order to meet the bone physiological conditions. OBJECTIVE： To investigate the clinical effect of metal plate implantation for the treatment of traumatic fracture with emphasis on the biomechanical characteristics of bone metal plate. METHODS： A computer-based retrieval of PubMed database, VIP database and Wanfang database from January 2001 to January 2012 was performed for papers regarding the treatment of bone injury and metal materials fixation with the key words of ＂bone, medical, metal, materials＂ in English and ＂fracture, screw, fixation, mechanics＂ in Chinese in the titles and abstracts. Finally, 24 articles were involved in the final analysis according to the inclusion criteria. RESULTS AND CONCLUSION： With the development of the raw material industry progress and the renewal of orthopedic fixation devices, the orthopedic internal fixation plate and screws applied by vast majority of medical institutions have a good biocompatibility and stiffness. The domestic metal plate has the weak stress point at the junction of screw tail and screw rod, which may lead to the screw loosing, fracture at the junction of screw tail and screw rod, sliding-filament of the crew tail and slipping. It indicates that the plate quality, number of screws, forging process and clinical placement method may influence the biomechanics of internal fixation system.