CAJ | 학술논문

目的探讨耻骨支骨折进行微创钢板固定的力学稳定性和临床疗效. 方法通过有限元分析,比较微创骨折钢板固定技术与传统钢板固定技术对耻骨支骨折钢板固定后稳定性的影响;并对2005-2012年101例126侧使用微创技术进行耻骨支骨折固定的患者进行回顾性分析,评估耻骨支骨折手术固定所需时间、术中出血情况及术后随访耻骨支骨折愈合情况. 结果有限元分析结果显示,使用传统和微创两种技术进行耻骨支骨折钢板固定,盆骨上最大应力分别为7.35 MPa和5.59 MPa,最大位移分别为4.31 mm和4.38 mm,骨折断端间相对位移分别为0.029 mm和0.012 mm;与未固定时比较,骨折端面位移分别减小26％和59％.临床结果显示,耻骨支骨折手术所需平均时间及平均出血量分别为65 min及94 ml.所有患者术后均获5～50个月(平均24.3个月)随访.根据Matta复位标准评估术后骨折复位质量:优118侧(93.7％),良8侧(6.3％).117侧骨折于术后12周内获愈合,另9侧骨折于术后6个月获愈合.本组无医源性神经和血管损伤发生. 结论使用钢板对耻骨支骨折进行微创固定是一项安全、有效的固定技术;其疗效满意,创伤小且更为美观.
목적 탐토치골지골절진행미창강판고정적역학은정성화림상료효. 방법 통과유한원분석,비교미창골절강판고정기술여전통강판고정기술대치골지골절강판고정후은정성적영향;병대2005-2012년101례126측사용미창기술진행치골지골절고정적환자진행회고성분석,평고치골지골절수술고정소수시간、술중출혈정황급술후수방치골지골절유합정황. 결과 유한원분석결과현시,사용전통화미창량충기술진행치골지골절강판고정,분골상최대응력분별위7.35 MPa화5.59 MPa,최대위이분별위4.31 mm화4.38 mm,골절단단간상대위이분별위0.029 mm화0.012 mm;여미고정시비교,골절단면위이분별감소26％화59％.림상결과현시,치골지골절수술소수평균시간급평균출혈량분별위65 min급94 ml.소유환자술후균획5～50개월(평균24.3개월)수방.근거Matta복위표준평고술후골절복위질량:우118측(93.7％),량8측(6.3％).117측골절우술후12주내획유합,령9측골절우술후6개월획유합.본조무의원성신경화혈관손상발생. 결론 사용강판대치골지골절진행미창고정시일항안전、유효적고정기술;기료효만의,창상소차경위미관.
Objective To investigate the mechanical stability and clinical outcome of minimally invasive plate osteosynthesis of pubic ramus fractures.Methods Stability of minimally invasive plate osteosynthesis and traditional open fixation of pubic ramus fractures was compared in finite element analysis.A retrospective analysis was performed on fractures of pubic rami (126 sides) in 101 consecutive patients treated with minimally invasive plate osteosynthesis from 2005 to 2012.Operation time,intraoperative blood loss and follow-up of fracture healing were evaluated.Results In finite element analysis,traditional open fixation and minimally invasive plate osteosynthesis resulted in the maximum pelvic force of 7.35 MPa and 5.59 MPa,maximum fracture displacement of 4.31 mm and 4.38 mm and relative fracture gap displacement of 0.029 mm and 0.012 mm.Displacement of fracture gap after minimally invasive plate osteosynthesis and traditional open fixation was reduced 26％ and 59％ respectively.In the clinical study,the surgery acquired for pubic ramus fractures averaged 65 minutes with mean blood loss of 94 ml.Follow-up duration was 5-50 months (mean,24.3 months).Reduction of the fracture as assessed using Matta' s criteria was excellent in 118 sides (93.7％),good in eight sides (6.3％).Totally,the fracture was healed within postoperative 12 weeks in 117 sides and within postoperative 6 months in 9 sides.No iatrogenic nerve or vascular injury occurred.Conclusions Minimally invasive plate osteosynthesis is a safe and effective technique for fixation of pubic ramus fractures.Moreover,satisfactory results can be achieved together with less trauma and better cosmetic effect.