肌肉活动方式对骨痂骨密度及X线片灰度值的影响

The effects of muscular movement on bone density in the callus and X-ray ash ratio

目的 探讨有利于骨折愈合的肌肉活动方式。方法 应用兔实验性骨折复位固定器对18只兔一侧小腿胫腓骨中段骨折进行复位固定 ,以不同强度的电信号 ,刺激坐骨神经获得不同肌力的肌肉收缩活动。主要影响因素为应力方式 ,初始加载时间 ,日活动量 ,加载持续时间 ,做四因素三水平L9(43 )正交试验设计 ,骨折后 2、4、6周时取材进行骨痂骨密度和X 线片灰度值测定。结果 18例动物L9(43 )正交试验设计 (K =2 )及方差分析结果表明 :骨折复位固定后肌肉活动的最佳组合方式为骨折复位固定 5天后开始给予被动肌肉活动 ,日活动量为 1天 1次或 1天 2次为佳 ,肌力为 1/ 2最大非负重状态下肌力或逐渐加大肌力方式 ,加载持续时间为 6周或 4周。结论 提示骨折复位固定后实施肌肉活动的初始时间不宜过早 ,应在肢体局部充血肿胀消退以后 ,且活动量不宜过大。

Objective [HT5”SS]To investigate the effects of muscular movement suitable for fracture healing.[HT5”H]Methods [HT5”SS]Tibial and fibular fracture models were produced in 18 rabbits.By stimulating the sciatic nerve with different electric parameters,the relationship between the intensity of the elctric stimulation and the muscular force of the individual muscles were recorded in the animals with the fracture fixed with external fixators.The principal affecting factors were the force form,the commencement of the experimental movement,the daily amounts and the period of the movement as well as the continuation period of the added loading.Each factor was divided into three levels and the orthogonal experimental design L 9(4 3)was set up.The tests were carried out in the models at 2,4,6 weeks after fracture.[HT5”H]Results [HT5”SS]The L 9(4 3) orthogonal experiment design and analysis of the variance showed that there was significant difference in the callus bone density in the models subjected to different movement forms ( P <0 05).The best form of muscular movement was found to be as follows:the commencement of the movement at the fifth day after fracture;the amount of the movement being once or twice daily;the period of experimental movement being 4 or 6 weeks;the muscular force being half of the maximum in loading free condition or the force being increased as fracture healing in progress.[HT5”SS][HT5”H]Conclusion[HT5”SS] During the early stage of fracture,the muscular movement should be carried out after the subsidence of the local swelling.The commencement of muscular movement should not be too early and be carried out in a gradually increasing pattern in harmony with the progress of fracture healing. [WT5”HZ]