CAJ | 학술논문

目的探讨不同方法固定胫骨不稳定pilon骨折的生物力学性能. 方法用7具新鲜国人踝关节标本制备Ruedi-Allgower Ⅲ型pilon骨折,根据不同固定方法分5组,A组:内侧支撑钢板固定,B组:胫骨远端前外侧解剖型钢板加内侧空心钉固定,C组:外侧外固定支架加内侧空心钉固定,D组:外侧外固定支架加内侧支撑钢板固定,E组:内侧外固定支架加胫骨远端前外侧解剖型钢板固定.比较各组的强度、刚度、失效载荷等生物力学性能. 结果 A、B、C、D、E组胫骨远端的抗压应力值分别为(1.31±0.10)、(1.61±0.14)、(1.17±0.13)、(0.90±0.08)、(0.98±0.08)MPa,轴向刚度分别为(1224.49±115.40)、(1016.95±102.32)、(1395.34±140.12)、(1935.48±180.42)、(1764.71±174.76)N/mm,水平剪切刚度分别为(3076.92±304.20)、(2553.19±250.73)、(3529.41±344.42)、(4800.00±490.61)、(4444.45±451.52)N/mm,失效载荷分别为(2448±208)、(2034±184)、(2791±265)、(3871±382)、(3529±342)N,等效刚度值分别为(703±56)、(583±62)、(805±74)、(1100±108)、(1035±110)N·m/Deg. 结论对于胫骨不稳定性pilon骨折,采用胫骨内侧支撑钢板或胫骨远端前外侧解剖型钢板附加外固定支架固定,不但具有优越的生物力学性能,等效刚度高,而且固定坚强、可靠,操作方便,踝关节稳定性好,为Ruedi-Allgower Ⅲ型pilon骨折切开复位手术固定选择提供了理论参考.
목적 탐토불동방법 고정경골불은정pilon골절적생물역학성능. 방법 용7구신선국인과관절표본제비Ruedi-Allgower Ⅲ형pilon골절,근거불동고정방법 분5조,A조:내측지탱강판고정,B조:경골원단전외측해부형강판가내측공심정고정,C조:외측외고정지가가내측공심정고정,D조:외측외고정지가가내측지탱강판고정,E조:내측외고정지가가경골원단전외측해부형강판고정.비교각조적강도、강도、실효재하등생물역학성능. 결과 A、B、C、D、E조경골원단적항압응력치분별위(1.31±0.10)、(1.61±0.14)、(1.17±0.13)、(0.90±0.08)、(0.98±0.08)MPa,축향강도분별위(1224.49±115.40)、(1016.95±102.32)、(1395.34±140.12)、(1935.48±180.42)、(1764.71±174.76)N/mm,수평전절강도분별위(3076.92±304.20)、(2553.19±250.73)、(3529.41±344.42)、(4800.00±490.61)、(4444.45±451.52)N/mm,실효재하분별위(2448±208)、(2034±184)、(2791±265)、(3871±382)、(3529±342)N,등효강도치분별위(703±56)、(583±62)、(805±74)、(1100±108)、(1035±110)N·m/Deg. 결론 대우경골불은정성pilon골절,채용경골내측지탱강판혹경골원단전외측해부형강판부가외고정지가고정,불단구유우월적생물역학성능,등효강도고,이차고정견강、가고,조작방편,과관절은정성호,위Ruedi-Allgower Ⅲ형pilon골절절개복위수술고정선택제공료이론삼고.
Objective To investigate the biomechanical properties of different fixations in the treatment of unstable pilon fracture of distal tibia. Methods Ruedi-Allgower type Ⅲ unstable pilon fractures were created on 7 fresh cadaveric ankle specimens and then fixed with 5 different methods: medial buttress plate(Group A), distal tibial anatomic plate plus medial cannulated screw (Group B), external fixator plus medial cannulated screw (Group C), external fixator plus medial plate (Group D), external fixator plus distal tibial anatomic plate (Group E) . Biomechanical properties such as strength, stiffness and failure load were tested respectively and comparisons among the different groups were conducted.Results In groups D and E, the compressive strengths (MPa) were 0.90±0.08 and 0.98±0.08, and the stiffnesses (N / mm) were 4800.00±490.61 and 4444.45±451.52, respectively. Fixation of pilon fractures with external fixator plus either medial tibial buttress plate or lateral anatomic plate had best biomechanical properties than the other devices. Conclusion Fixation of unstable distal tibial fracture with extemal fixator plus either medial tibial buttress plate or lateral anatomic plate is an effective option for complex un-stable pilon fracture.