水平带状钢板治疗胫骨平台后外侧象限骨折的生物力学研究

Horizontal belt plate fixation for treating the isolated posterolateral tibial plateau fracture:a biomechanical study

目的比较胫骨平台后外侧象限骨折不同内固定方式的力学稳定性效果。方法采用Synbone人工合成胫骨18个,切割构建孤立的胫骨平台后外侧象限骨折模型,随机分为3组,分别采用外侧水平带状钢板固定、外侧低切迹解剖锁定钢板固定、后侧直形重建钢板固定。将固定好的骨折模型置于万能水压材料测试机进行测试,分别进行静态加载、疲劳测试和极限加载,检测骨块的相对空间位移。结果以10 mm/min加载至总载荷1050 N,重复加载10000次后,带状钢板组骨折块的纵向位移（2.77±1.79）mm,外侧锁定钢板组的纵向位移为（2.69±1.14）mm;后方重建钢板组骨折块的纵向位移为（1.62±0.60）mm,组间差异无统计学意义（P〉0.05）。施加载荷到骨或内固定的结构破坏后,带状钢板组的极限支撑力为（2055±263）N,外侧锁定钢板组的为（1968±209）N,后方重建钢板组的极限支撑力为（2272±130）N,组间差异具有显著的统计学意义（P〈0.05）。结论治疗孤立的胫骨平台后外侧象限骨折,侧方带状钢板水平固定能取得满意的效果。

Objective To compare and analyze the biomechanical stability of 3 different fixations for the posterolateral tibial plateau fracture. Methods The posterolateral shearing fracture models were created in 18 synthetic tibia（Synbone） and randomly assigned into 3 groups. The fractures were fixed by horizontal belt plate（Group A）, lateral low-profile anatomical LCP（Group B） and posterior reconstructive plate（Group C）. Vertical displacements of the posterolateral fragments and failure loads were measured under axial loads including static loading test（from 300 N to 1050 N）, fatigue loading test and damage loading teat.Results The vertical displacements in groups A,B,and C were respectively（2.77 ± 1.79）mm,（2.69 ± 1.14）mm, and（1.62 ± 0.60）mm under fatigue loading test, the total load 1050 N with 10 mm/min and repeat load10000 times. There was no significant difference between the groups（P〉0.05）. After the damage loading test, the final force in groups A,B,and C were respectively（2055±263） N,（1968±209） N and（2272±130） N,and there was significant difference among the groups（P〈0.05）. Conclusion Horizontal belt plate fixation for isolated posterolateral tibial plateau fracture can bring sufficient stability for the posterolateral fragment.