中华创伤杂志
中華創傷雜誌
중화창상잡지
Chinese Journal of Traumatology
2009年
1期
9-14
,共6页
许硕贵%张春才%吴亚乐%王冠军%张鹏%付青格%王家林%纪方%禹宝庆%张秋林%万岷
許碩貴%張春纔%吳亞樂%王冠軍%張鵬%付青格%王傢林%紀方%禹寶慶%張鞦林%萬岷
허석귀%장춘재%오아악%왕관군%장붕%부청격%왕가림%기방%우보경%장추림%만민
髋臼%骨折固定术%内%生物力学%解剖性重建
髖臼%骨摺固定術%內%生物力學%解剖性重建
관구%골절고정술%내%생물역학%해부성중건
Aeetabulum%Fracture fixation,internal%Biomechanics%Anatomical recon-straction
目的 为严重粉碎性与陈旧性髋臼后壁骨折的重建提供一种新方法.方法 (1)生物力学研究:从稳定性及头臼应力分布两个方面进行研究.6具成人新鲜骨盆股骨标本左右侧两两对应分为实验组与对照组,造成髋臼缺损模型后,实验组用髋臼三维记忆内固定系统(acetabular three dimensional memory fixation system,ATMFS)解剖性重建缺损髋臼;对照组用钢板螺钉系统重新复位固定髋臼骨块.比较两组加载状态下在经度及纬度方向的位移,分析解剖性髋臼后壁重建的稳定性;利用压敏片计算并比较两组头臼对应面积,髋臼前壁、臼顶、后壁的平均压强与最大压强,分析解剖性髋臼后壁重建后的头臼匹配性.(2)临床研究:髋臼后壁解剖性重建:取与髋臼直径相同的髋臼锉,从髂嵴内缘旋锉形成解剖性弧面,髂嵴外缘相当于臼壁唇缘.将凿取的髂骨块用ATMFS三维锁定修复后壁缺损.2000年1月-2002年6月,共用此法治疗10例男性患者,年龄16～50岁,平均36.4岁,其中新鲜髋臼骨折7例,陈旧性髋臼骨折3例.后者从骨折至重建术的时间为58～251 d,平均137.7 d.随访平均5.8年(5.2～7.1年).结果 (1)生物力学研究:实验组与对照组相比,重建后的稳定性与头臼匹配性差异无统计学意义.(2)临床研究:全部患者术后X线片未发现骨折有再移位,下床负重时间为1.6个月(1.2～2.1个月).异位骨化2例,未影响关节功能活动.按照Modified d'Aubigne and Postal临床分级标准,优良率93 %.结论 利用ATMFS进行自体髂骨解剖性髋臼后壁重建具有良好的稳定性及头臼应力分布,临床应用疗效优良,为髋臼后壁严重粉碎与陈旧性骨折的治疗提供了一种新方法.
目的 為嚴重粉碎性與陳舊性髖臼後壁骨摺的重建提供一種新方法.方法 (1)生物力學研究:從穩定性及頭臼應力分佈兩箇方麵進行研究.6具成人新鮮骨盆股骨標本左右側兩兩對應分為實驗組與對照組,造成髖臼缺損模型後,實驗組用髖臼三維記憶內固定繫統(acetabular three dimensional memory fixation system,ATMFS)解剖性重建缺損髖臼;對照組用鋼闆螺釘繫統重新複位固定髖臼骨塊.比較兩組加載狀態下在經度及緯度方嚮的位移,分析解剖性髖臼後壁重建的穩定性;利用壓敏片計算併比較兩組頭臼對應麵積,髖臼前壁、臼頂、後壁的平均壓彊與最大壓彊,分析解剖性髖臼後壁重建後的頭臼匹配性.(2)臨床研究:髖臼後壁解剖性重建:取與髖臼直徑相同的髖臼銼,從髂嵴內緣鏇銼形成解剖性弧麵,髂嵴外緣相噹于臼壁脣緣.將鑿取的髂骨塊用ATMFS三維鎖定脩複後壁缺損.2000年1月-2002年6月,共用此法治療10例男性患者,年齡16～50歲,平均36.4歲,其中新鮮髖臼骨摺7例,陳舊性髖臼骨摺3例.後者從骨摺至重建術的時間為58～251 d,平均137.7 d.隨訪平均5.8年(5.2～7.1年).結果 (1)生物力學研究:實驗組與對照組相比,重建後的穩定性與頭臼匹配性差異無統計學意義.(2)臨床研究:全部患者術後X線片未髮現骨摺有再移位,下床負重時間為1.6箇月(1.2～2.1箇月).異位骨化2例,未影響關節功能活動.按照Modified d'Aubigne and Postal臨床分級標準,優良率93 %.結論 利用ATMFS進行自體髂骨解剖性髖臼後壁重建具有良好的穩定性及頭臼應力分佈,臨床應用療效優良,為髖臼後壁嚴重粉碎與陳舊性骨摺的治療提供瞭一種新方法.
목적 위엄중분쇄성여진구성관구후벽골절적중건제공일충신방법.방법 (1)생물역학연구:종은정성급두구응력분포량개방면진행연구.6구성인신선골분고골표본좌우측량량대응분위실험조여대조조,조성관구결손모형후,실험조용관구삼유기억내고정계통(acetabular three dimensional memory fixation system,ATMFS)해부성중건결손관구;대조조용강판라정계통중신복위고정관구골괴.비교량조가재상태하재경도급위도방향적위이,분석해부성관구후벽중건적은정성;이용압민편계산병비교량조두구대응면적,관구전벽、구정、후벽적평균압강여최대압강,분석해부성관구후벽중건후적두구필배성.(2)림상연구:관구후벽해부성중건:취여관구직경상동적관구촤,종가척내연선촤형성해부성호면,가척외연상당우구벽진연.장착취적가골괴용ATMFS삼유쇄정수복후벽결손.2000년1월-2002년6월,공용차법치료10례남성환자,년령16～50세,평균36.4세,기중신선관구골절7례,진구성관구골절3례.후자종골절지중건술적시간위58～251 d,평균137.7 d.수방평균5.8년(5.2～7.1년).결과 (1)생물역학연구:실험조여대조조상비,중건후적은정성여두구필배성차이무통계학의의.(2)림상연구:전부환자술후X선편미발현골절유재이위,하상부중시간위1.6개월(1.2～2.1개월).이위골화2례,미영향관절공능활동.안조Modified d'Aubigne and Postal림상분급표준,우량솔93 %.결론 이용ATMFS진행자체가골해부성관구후벽중건구유량호적은정성급두구응력분포,림상응용료효우량,위관구후벽엄중분쇄여진구성골절적치료제공료일충신방법.
Objective To design a new method of posterior wall reconstruction for severely corn-minuted and obsolete fracture of the posterior wall of the aeetabulum. Methods (1) Biomechanical study (from two perspectives: the stability and the stress distribution on the femoral head and the acetabu-lure) : six fresh adult' s pelvis and femur specimens were collected and divided into experimental group ( consisted of the left sides) and control group ( consisted of the right sides). After the defects of the pos-terior wall were made, the defects were anatomically reconstructed with the harvested ilium by acetabular tridimentional memory fixation system (ATMFS) in the experimental group, whereas the acetabular frag-ments were repositioned to the defect sites and fixated by the plates and screws in the control group. Lon-gitudinal and latitudinal displacement, stability of the anatomically reconstructed posterior wall of the ace-tabulum, the fitness of femoral head to the acetabulum after anatomical reconstruction and mean and maxi-mum pressure of anterior wall, posterior and cupuh of the acetabuhm were analysed and compared. (2) Cinical study: The posterior wall defect on the harvested ilium piece was repaired with 3-directional loc-king of ATMFS in 10 male patients (at age of 16-50 years, mean 36.4 years) from January 2000 to June 2002. There were seven patients with flesh acetabular fractures and three with old acetabular fractures.The period from fracture to reconstruction for the patients with old fractures was 58-251 days ( 137.7 days an average). The patients were foUowed up for 5.8 years (average 5.2-7.1 years). Results (1) Biomechanical study showed no statistical difference upon stability and fitness of femoral head to acetabu-lum after reconstruction in experimental and control groups. (2) Clinical study: postoperative X-ray film showed no repeated displacement of the fracture and the patients began out-of-bed movement with weight bearing after 1.6 months (1.2-2.1 months). Heterotopic ossification was found in two patients, with no influence on the joint function. According to the elinieal ranking standard of Modified d' Aubigne and Postal, the excellence rate was 93%. Conclusions Anatomical reconstruction of posterior wall of the acetabulum by using serf ilium with ATMS has good stability and stress distribution of the femoral head and the reconstructed acetabulum in clinical application and offers a new method for treatment of severely comminuted and obsolete fracture of posterior wall of acetabulum.
