中国组织工程研究
中國組織工程研究
중국조직공정연구
Journal of Clinical Rehabilitative Tissue Engineering Research
2014年
31期
5004-5010
,共7页
徐峰%王安庆%闵红巍%殷晓峰%刘克敏
徐峰%王安慶%閔紅巍%慇曉峰%劉剋敏
서봉%왕안경%민홍외%은효봉%류극민
植入物%骨植入物%髌骨骨折%骨关节生物力学%动力加压%静力加压%张力带内固定%生物力学%骨内荷载传递%张应力%压应力
植入物%骨植入物%髕骨骨摺%骨關節生物力學%動力加壓%靜力加壓%張力帶內固定%生物力學%骨內荷載傳遞%張應力%壓應力
식입물%골식입물%빈골골절%골관절생물역학%동력가압%정력가압%장력대내고정%생물역학%골내하재전체%장응력%압응력
biomechanics%patel a%fractures,bone%fixed
背景：骨折块间的静力加压作用由内固定本身(如张力带钢丝和螺钉)产生，而动力加压作用在关节屈曲时产生。髌骨横行骨折张力带固定方法的力学强度和稳定性方面优势明显，但尚缺乏对这些内固定方法的静力和动力加压作用的量化对比研究。<br> 目的：观察目前4种髌骨骨折内固定方法的动力和静力加压作用的强度变化及其临床意义。<br> 方法：选择新鲜牛髌骨制作相同横行骨折模型，随机分成4组，钢丝组用改良张力带钢丝固定技术固定，钢缆组用改良张力带钢缆固定技术固定，螺钉组用单纯加压螺钉内固定技术固定，空心螺钉组采用空心螺钉+张力带钢丝联合固定。进行骨折固定前，于骨折块间放置富士压力敏感膜，用以测量内固定后骨折块间的压力，即静力和动力加压强度。每组骨折固定模型再分别进行以下两种力学测试：①固定完成后即拆除内固定，取出压力敏感膜。②完成内固定后，使用材料试验机，对样本进行3点弯曲试验(5000 N载荷)，模拟膝关节弯曲时产生的骨折块间动力加压作用，而后取出压力敏感膜。使用 prescale FPD-8010E 压力分布图系统软件对每个取出的压力敏感膜进行测量，获得骨断端间的平均压力，并进行统计学分析，比较各组骨断端间的静力和动力加压强度。结果与结论：钢丝组骨折块间的平均静力加压强度显著低于钢缆组、螺钉组和空心螺钉组(P<0.05)。5000 N载荷下动力加压后，钢丝组与钢缆组、螺钉组和空心螺钉组相比较具有相似的骨断端间压力强度(P >0.05)。钢丝组的动力加压强度高于其静力加压强度(P<0.05)。结果证实，比起改良张力带钢丝固定技术，使用钢缆或螺钉可以更显著的增加骨断端的静力加压强度，但同时也削弱了骨断端的动力加压作用。
揹景：骨摺塊間的靜力加壓作用由內固定本身(如張力帶鋼絲和螺釘)產生，而動力加壓作用在關節屈麯時產生。髕骨橫行骨摺張力帶固定方法的力學彊度和穩定性方麵優勢明顯，但尚缺乏對這些內固定方法的靜力和動力加壓作用的量化對比研究。<br> 目的：觀察目前4種髕骨骨摺內固定方法的動力和靜力加壓作用的彊度變化及其臨床意義。<br> 方法：選擇新鮮牛髕骨製作相同橫行骨摺模型，隨機分成4組，鋼絲組用改良張力帶鋼絲固定技術固定，鋼纜組用改良張力帶鋼纜固定技術固定，螺釘組用單純加壓螺釘內固定技術固定，空心螺釘組採用空心螺釘+張力帶鋼絲聯閤固定。進行骨摺固定前，于骨摺塊間放置富士壓力敏感膜，用以測量內固定後骨摺塊間的壓力，即靜力和動力加壓彊度。每組骨摺固定模型再分彆進行以下兩種力學測試：①固定完成後即拆除內固定，取齣壓力敏感膜。②完成內固定後，使用材料試驗機，對樣本進行3點彎麯試驗(5000 N載荷)，模擬膝關節彎麯時產生的骨摺塊間動力加壓作用，而後取齣壓力敏感膜。使用 prescale FPD-8010E 壓力分佈圖繫統軟件對每箇取齣的壓力敏感膜進行測量，穫得骨斷耑間的平均壓力，併進行統計學分析，比較各組骨斷耑間的靜力和動力加壓彊度。結果與結論：鋼絲組骨摺塊間的平均靜力加壓彊度顯著低于鋼纜組、螺釘組和空心螺釘組(P<0.05)。5000 N載荷下動力加壓後，鋼絲組與鋼纜組、螺釘組和空心螺釘組相比較具有相似的骨斷耑間壓力彊度(P >0.05)。鋼絲組的動力加壓彊度高于其靜力加壓彊度(P<0.05)。結果證實，比起改良張力帶鋼絲固定技術，使用鋼纜或螺釘可以更顯著的增加骨斷耑的靜力加壓彊度，但同時也削弱瞭骨斷耑的動力加壓作用。
배경：골절괴간적정력가압작용유내고정본신(여장력대강사화라정)산생，이동력가압작용재관절굴곡시산생。빈골횡행골절장력대고정방법적역학강도화은정성방면우세명현，단상결핍대저사내고정방법적정력화동력가압작용적양화대비연구。<br> 목적：관찰목전4충빈골골절내고정방법적동력화정력가압작용적강도변화급기림상의의。<br> 방법：선택신선우빈골제작상동횡행골절모형，수궤분성4조，강사조용개량장력대강사고정기술고정，강람조용개량장력대강람고정기술고정，라정조용단순가압라정내고정기술고정，공심라정조채용공심라정+장력대강사연합고정。진행골절고정전，우골절괴간방치부사압력민감막，용이측량내고정후골절괴간적압력，즉정력화동력가압강도。매조골절고정모형재분별진행이하량충역학측시：①고정완성후즉탁제내고정，취출압력민감막。②완성내고정후，사용재료시험궤，대양본진행3점만곡시험(5000 N재하)，모의슬관절만곡시산생적골절괴간동력가압작용，이후취출압력민감막。사용 prescale FPD-8010E 압력분포도계통연건대매개취출적압력민감막진행측량，획득골단단간적평균압력，병진행통계학분석，비교각조골단단간적정력화동력가압강도。결과여결론：강사조골절괴간적평균정력가압강도현저저우강람조、라정조화공심라정조(P<0.05)。5000 N재하하동력가압후，강사조여강람조、라정조화공심라정조상비교구유상사적골단단간압력강도(P >0.05)。강사조적동력가압강도고우기정력가압강도(P<0.05)。결과증실，비기개량장력대강사고정기술，사용강람혹라정가이경현저적증가골단단적정력가압강도，단동시야삭약료골단단적동력가압작용。
BACKGROUND:Static compressure effect between the fracture fragments was generated by fixation itself (tension band wire and screw), but dynamic compression effects were generated during flexion. Mechanical strength and stability of patel ar fracture fixation have obvious advantages. However, there are lacks of quantitative comparative studies on static and dynamic compression effects of these fixation methods. <br> OBJECTIVE:To observe strength changes and clinical significance of static and dynamic compression using four fixation techniques. <br> METHODS:Standardized transverse patel ar fracture models were created with fresh cow patel as. The patel as were randomly divided into four groups:fixation was accomplished with modified tension band wiring (wire group);modified tension band with braided cable (cable group);interfragmentary screws (screw group);cannulated screw tension band with wire (cannulated screw group). Before fracture fixation, Fuji pressure-sensitive film was laid among fracture fragments to measure the pressure among fracture fragments after fixation, i.e., static and dynamic compression. Model of each group was measured as fol ows:(1) after fixation, the fixation was removed, and the Fuji pressure-sensitive film was taken out;(2) after fixation, material testing machine was used. Samples underwent a three-point bending test with a 5 000 N load, simulating dynamic compression during knee flexion. Subsequently, Fuji pressure-sensitive film was taken out. Each Fuji pressure-sensitive film was tested using prescale FPD-8010E software. Thus, average pressure among broken bone ends was obtained, and statistical analysis was performed. Static and dynamic compression among broken bone ends was compared in each group. <br> RESULTS AND CONCLUSION:Average static compression was significantly lower in the wire group than in the cable group, screw group and cannulated screw group (P<0.05). Under 5 000 N load of dynamic compression, similar compression among broken bone ends was visible among wire group and cable group, screw group and cannulated screw group (P>0.05). Dynamic compression was higher than static compression in the wire group (P<0.05). Results verified that compared with modified tension band wire fixation technique, cable or screw could evidently increase static compression among broken bone ends, but simultaneously weaken dynamic compression among broken bone ends.
