复杂胫骨平台骨折3种微创内固定的生物力学研究

Three kinds of minimally invasive internal fixations for treatment of complex tibial plateau fractures :a comparative biomechanical study

目的对复杂胫骨平台骨折三种微创内固定方法进行生物力学比较研究。方法采集18具成人防腐尸体胫骨平台标本,制成复杂胫骨平台骨折模型(Schatzker分型Ⅵ型)。分别用外侧LISS锁定钢板+后内侧重建钢板(LISS+RP)、外侧LISS锁定钢板+内侧三枚空心加压螺钉(LISS+CS)、单独外侧锁定钢板(LISS)固定,进行位移、轴向刚度的研究。结果 LISS+RP组和LISS+CS组生物力学稳定性明显优于LISS组(P<0.05),而LISS+RP组和LISS+CS组之间比较,差异无统计学意义(P>0.05)。结论 LISS+RP与LISS+CS是目前治疗复杂胫骨平台骨折较合适的内固定方式。但对于皮肤挫伤、软组织肿胀严重的胫骨平台骨折,LISS+CS注重软组织和血供的保护,更符合生物学固定的要求,是目前最理想的微创内固定方式。

Objective To compare the three kinds of minimally invasive internal fixations for complex tibial plateau fracture using biome-chanics. Methods 18 tibial plateau specimens of adult body were made out to the model of complicate Schatzker VI tibial plateau fractures. Fixa-tion with LISS plate in lateral ＋ reconstruction plate in posteromedial （LISS＋RP）, LISS plate in lateral ＋ three compressed hollow screws in medial （LISS＋CS）, LISS plate in lateral only respectively, test with displacement and axial stiffness. Results The LISS＋RP group and LISS＋CS group were better than the LISS group in stability （P〈0.05）, but there was no statistical significance between the LISS＋RP group and LISS＋CS group （P＆gt;0.05）. Conclusions The LISS＋RP and LISS＋CS are fairly ideal internal fixators for treatment of complex tibial plateau fractures . In the meantime, the LISS＋RP emphasizes conservation of soft tissues and blood supply, can better meet the requirement of the biological fixation of fracture and is the most ideal internal fixator at present.