胫骨骨折三种固定器械的生物力学比较和临床研究

Biomechanics and Clinical Study in Different Fixation Instrument of Tibial Fracture

目的 明确不同固定器械在胫骨不同骨折类型固定中的优缺点 ,以指导临床应用。方法 36具胫骨标本制成中段无缺损及有缺损骨折模型 ,行GD型单侧外固定支架、Grosse -kempf钉、TCP三种不同器械固定后 ,进行各项生物力学性能测试 ;选择上述三种器械固定的胫骨中段稳定及不稳定骨折临床病人各 6 0例 ,行临床疗效对比。结果 抗压刚度GK钉最强 ,弯曲刚度TCP最强 ,GD支架此二项刚度差 ,抗扭刚度三者差异不明显。临床GK钉组弃拐行走时间最早 ,但三者骨折愈合时间差异不明显。结论 胫骨骨折髓内固定较其它二种方法更能达到坚强固定且应力遮挡最小 ,髓内固定无论是生物力学还是临床应用均优越 ,髓外固定易产生应力遮挡 ,外固定支架生物力学性能较差 ,需延迟术后下地负重时间。

Objective Toclearthevirtuesanddefectsofdifferenttypesoffixationinstrumentinfractureoftibiaandtodirecttheclinical practice.Methods Thirty -sixtibialspecimensweremadeintomiddlefracturewithdefectiveorindefectivemodels.Eachgrouphad eighteenmodels.Thefracturemodelswerefixeddifferentlybyunilateralmultifunctionexternalfixture,Grosse-KempfnailandTCP . Eachperformanceofbiomechanicswasdone .Choseonehundredandtwentycasesofmiddletibialfracture,whichweredividedintotwo groupsofstableandunstable .Andeachcasewasfixedwithoneoftheinstrumentsabovementioned .Thencontrastthecurativeeffect. Results Thefirmdegreeofanti-compressionshowsthatGrosse -Kempfnailisthestrongest,andanti-bendingpowersGDisthe weakest.Thereisnosignificantdifferenceintorsionalrigiditypowerinthesethreegroups.Inclinic,thegroupofGKnailhastheshort esttimeofdiscardingsticktowalk .Butthereisnoobviousdifferenceinhealingtime .Conclusion Intibialfractureintramedullaryfixa tioncanachievethefirmfixationandstressshelteristheleast.Itissuperiorinbiomechanicsandclinicalapplication .Extramedullaryfix ationcanleadtostresssheltereasily .Thefunctionofbiomechanicsofexternalfixtureisbadanditprolongsthetimeofwalkingafterop eration .