摘要
目的:探讨不同内固定方式对不同后踝关节骨折固定的生物力学效果及临床疗效。方法:生物力学研究:根据后踝关节骨折模型制作后踝骨折标本18对,再根据后踝关节骨折块占胫骨远端关节面1/4、1/3和1/2,分成3大组,每大组6对(12个踝关节),然后随机分为A、B两组,骨折复位后,A组以2枚4.0 mm钢质半螺纹拉力螺钉自后向前固定,B组以"T"型3孔桡骨远端钢板经塑型后以4枚螺钉固定(近端2枚为3.5 mm皮质骨螺钉,远端2枚为3.5 mm松质骨螺钉)。于踝中立位置于生物力学实验机上,做加载实验,记录后踝关节骨折经内固定后发生位移(内固定失效)时加载力的大小,单位以kN表示,收集数据并进行统计学处理。临床应用研究:自2009年1月至2010年12月应用螺钉或钢板螺钉固定三踝骨折中的后踝骨折关节患者31例,均为初次、闭合性、三踝骨折,男16例,女15例;年龄19～65岁,平均55岁;其中对14例后踝关节骨折波及胫骨远端关节面≤25%者行2枚拉力螺钉内固定,对17例后踝关节骨折波及胫骨远端关节面>25%者行钢板螺钉内固定手术治疗,应用Leeds标准进行功能评定。结果:生物力学测试结果显示:应用两枚螺钉由后向前固定1/4、1/3和1/2后踝骨折时,其固定失效的加载强度均显著低于3孔"T"型钢板组,分别为(4.10±0.13)kN vs.(4.60±0.27)kN、(3.20±0.12)kNvs.(4.12±0.14)kN和(1.98±0.18)kN vs.(3.72±0.18)kN,P<0.05。临床应用研究结果:术后随访6～18个月(平均12个月),所有骨折均获得骨性愈合,愈合时间为8～12周(平均10周)。疗效评定:评定为优的28例患者,良的为3例患者,优良率达100%。结论:后踝关节骨折块波及胫骨远端关节面≤25%时拉力螺钉内固定能提供良好的稳定性,>25%时钉板固定是一种有效的固定方法,能提供更为牢固的稳定性,满足早期功能锻炼的需要。
Objective：To study the biomechanical effects and the clinical outcome of different internal fixation methods in treating posterior malleolus fractures.Methods：（1） Biomechaniccal study of 18 pairs of posterior malleolus fracture models was conducted,in which all the cases were divided into 3 groups as Ⅰ,Ⅱ and Ⅲ（n=12）,according to different fracture degrees that included specimens with 1/4,1/3 and 1/2 of articular facets fractured respectively;Each group was further divided into 2 subgroups as group A and group B.Group A was fixed with 2 steel half-thread tensile screws whose diameter was 4.0 mm;and group B was fixed with ＂T-shaped＂ steel distal-radius plates and 4 screws.The uploading experiment was carried out by settling the specimen on an experiment machine at its neutral position,and the data were collected and managed.（2） Clinical Applications： 31 cases with closed trimalleolar fractures were treated from 2009.1-2010.12 in our hospital,in which 14 with posterior malleolus fractures ≤25% of the capital diameter of the tibial plafond were fixed with screws,and 17 with posterior malleolus fractures 25% of the capital diameter of the tibial plafond were fixed with steel plates.Prospective cohort study of these cases were carried out.The outcome was assessed using a Leeds Scoring System.Results： The mechanical fixation strengths of the plates for 1/4,1/3 and 1/2 facets of posterior malleolus fractures were all higher than those of the screw groups[（4.10±0.13）kN vs.（4.60±0.27）kN,（3.20±0.12）kN vs.（4.12±0.14）kN and（1.98±0.18）kN vs.（3.72±0.18）kN,respectively,P0.05].For the clinical study,the mean follow-up period was 12 months（6-18 months）,all the cases acquired bone union,and the mean time for healing was 10 weeks（8-12 weeks）.In the evaluation of therapeutic effects,we found that 28 cases were excellent and 3 good,which was 100% sa-tisfying.Conclusion： If only 1/4 of the posterior articular facet is involved,2 screws are enough to supply the stability;but for the fractures involve more than 1/4 facet,the plate fixation supplies more stable fixation and is superior to simply screws.
出处
《北京大学学报（医学版）》
CAS
CSCD
北大核心
2011年第5期718-723,共6页
Journal of Peking University:Health Sciences
关键词
踝关节
骨折
骨折固定术
内
生物力学
Ankle joint
Fractures
bone
Fracture fixation
internal
Biomechanics
