张力带钢板治疗不稳定骨盆骨折的生物力学性能评价

Biomechanical property of tension band plate in the treatment of unstable pelvic fracture

背景:文献报道,张力带钢板在不稳定骨盆骨折中能取得理想效果,但尚缺乏生物力学方面的证据。目的:观察3种张力带钢板不同固定位置在不稳定骨盆骨折中的治疗效果及生物力学性能情况。方法:取9具成人防腐骨盆标本,完成正常骨盆检测后制作成不稳定骨盆损伤模型,根据张力带钢板不同固定位置不同分为3组:A组钢板固定在双侧髂后上棘水平,钢板两端与耻骨向平行;B组钢板固定在髂后上棘水平,钢板两端指向前方;C组钢板在髂后上棘下方水平,钢板两端指向前上方。比较3组标本固定治疗效果。将骨盆标本放置在生物力学试验机上,完成材料轴向刚度、扭转刚度测定,分析张力带钢板治疗不稳定骨盆骨折的生物力学性能。结果和结论:(1)同一标本测量3次获得的骨盆环轴向刚度差异无显著性意义(P>0.05);骨盆环轴向刚度依次为:A组>C组>B组(均P<0.05);(2)同一标本测量3次获得的扭转刚度水平差异无显著性意义(P>0.05);A组扭转刚度水平显著低于B组与C组(P<0.05);(3)同一标本测量3次获得的垂直方向位移水平差异无显著性意义(P>0.05);垂直方向位移水平依次为:B组>C组>A组(均P<0.05)。(4)结论:采用髂后上棘水平,放置钢板,钢板指向前方的固定方式,生物力学性能更佳,可结合骨盆骨折类型优先考虑。

BACKGROUND： Tension band steel in unstable pelvic fractures can achieve the desired effect, but has not yet been confirmed by biomechanics.OBJECTIVE： To observe treatment effect and biomechanical property of the three kinds of tension band steel in different fixed positions of unstable pelvic fracture.METHODS： Nine adult antiseptic specimen pelvises were made into unstable pelvic injury models after completing normal pelvis detection. Depending on the position of the tension band fixation plate, these models were divided into group A, group B and group C. Group A： Plate fixation in bilateral posterior superior iliac spine, parallel to the plate ends with the pubis; group B： fixation on posterior superior iliac spine, both ends of the plate pointing forward; group C： plate below the posterior superior iliac spine, front top at both ends of the plate. Efficacy was compared among the three groups. The pelvic specimen was placed on the biomechanical testing machine. Axial stiffness and torsional stiffness were measured. Biomechanical properties of tension band plate in the treatment of unstable pelvic fracture were analyzed.RESULTS AND CONCLUSION： （1） The axial stiffness of the pelvic ring of the same specimens measuring three times was not significantly different （P 〉 0.05）. The pelvic ring axial stiffness in order： group A 〉 group C 〉 group B （P 〈 0.05）.（2） Torsional stiffness of the same specimens measuring three times was not significantly different （P 〉 0.05）. Torsional stiffness was significantly lower in group A than in groups B and C （P 〈 0.05）. （3） Vertical displacement of the same specimens measuring three times was not significantly different （P 〉 0.05）. Vertical displacement in order： group B 〉group C 〉 group A （P 〈 0.05）. （4） The fixation on posterior superior iliac spine with both ends of the plate pointing forward obtained better biomechanical properties, and could be given priority by combining with pelvic fracture type.