外侧钢板结合内侧经皮拉力螺钉的生物力学性能及在胫骨远端骨折中的应用

Biomechanical properties of lateral plate combined with medial percutaneous lag screw and its application in the distal tibial fractures

背景:目前临床上对于外侧钢板结合内侧经皮拉力螺钉的生物力学性能研究相对较少,且在胫骨远端骨折患者中的临床应用效果也未见研究。目的:探讨外侧钢板结合内侧经皮拉力螺钉的生物力学性能,并分析其对胫骨远端骨折的修复效果。方法:选取6具成年防腐胫骨标本,采用骨锯做一个长为1 cm的骨缺损,分别采用外侧钢板和外侧钢板组结合内侧经皮拉力螺钉固定,并进行三点弯曲实验、轴向压缩实验以及旋转实验。选取河北医科大学骨科收治的20例胫骨远端骨折患者的临床资料进行分析,随机分为2组,外侧钢板组和外侧钢板组结合内侧经皮拉力螺钉组每组10例,比较2组患者的临床修复效果。结果与结论:1尸体标本生物力学指标:两种固定方法的扭转强度差异无显著性意义(P>0.05);外侧钢板结合内侧经皮拉力螺钉固定的抗弯应力以及轴向位移均显著低于外侧钢板固定(P<0.05);2修复手术相关指标:外侧钢板结合内侧经皮拉力螺钉组手术时间、术中出血量、住院时间以及骨折愈合时间均显著少于外侧钢板组(P<0.05);3修复效果:外侧钢板结合内侧经皮拉力螺钉组治疗后3个月9例骨折愈合,总有效率为90%,显著高于外侧钢板组(总有效率70%)(P<0.05);4结果提示,外侧钢板结合内侧经皮拉力螺钉在抗轴向压缩、扭转以及弯曲等方面具有独特优势,将其应用于胫骨远端骨折中效果理想,能够提高骨折修复效果及稳定性。

BACKGROUND：Current clinical studies seldom concern biomechanical properties of lateral plate combined with medial percutaneous lag screw.Moreover,effects of clinical application to distal tibial fractures are not investigated.OBJECTIVE：To explore biomechanical properties of lateral plate combined with medial percutaneous lag screw,and to analyze the repair effect on distal tibial fractures.METHODS：Six adult antiseptic tibia specimens were studied.Bone saw was used to make a bone defect in 1 cm length,which was fixed with lateral plate and lateral plate combined with medial percutaneous lag screw.Three point bending test,axial compression test and rotation test were performed.Clinical data of twenty cases of distal tibial fracture patients from the Department of Orthopedics of Hebei Medical University were analyzed and randomly divided into lateral plate group and lateral plate combined with medial percutaneous lag screw group（n=10）.Clinical repair effects were compared between the two groups.RESULTS AND CONCLUSION：（1） Biomechanical indexes of cadaver specimens：no significant difference in torsional strength was determined between the two groups（P〈 0.05）.Bending stress and axial displacement were significantly lower in the lateral plate combined with medial percutaneous lag screw group than in the lateral plate group（P〈 0.05）.（2） Repair surgery related indicators：operation time,intraoperative blood loss,length of stay and fracture healing time were significantly less in the lateral plate combined with medial percutaneous lag screw group than in the lateral plate group（P〈 0.05）.（3） Repair effects：There were nine cases of fracture healing in the lateral plate combined with medial percutaneous lag screw group 3 months after treatment.The total effective rate was significantly higher in the lateral plate combined with medial percutaneous lag screw group（90%） than in the lateral plate group（70%）（P〈 0.05）.（4） These findings indicate that lateral plate combined with medial percutaneous lag screw has a unique advantage in resisting axial compression,torsion and bending.Its application to distal tibial fractures obtains ideal effects,can improve the clinical efficacy and stability.