CAJ | 학술논문

目的测量第1跖跗关节骨折脱位后3种内固定对骨面应力传导变化,为选择内固定提供参考.方法取6具新鲜足标本,制成第1跖跗关节骨折脱位模型,依次采用3.5 mm全螺纹皮质骨螺钉、1/4管型钢板及加压骑缝钉固定.经加载600 N后,通过电阻应变片法测量第1跖骨基底及内侧楔骨的应变.另选取健康男性志愿者1名,经有限元建模软件建立第1跖跗关节骨折脱位模型,并依次模拟螺钉、钢板、骑缝钉固定,模拟600 N加载,观察内固定上的应力分布.结果第1跖跗关节骨折脱位分别进行螺钉、钢板及骑缝钉固定后,第1跖骨基底及内侧楔骨的应力都减小;螺钉与钢板固定后的应力较骑缝钉固定后的应力更小,差异有统计学意义(P＜0.05).而有限元分析显示,螺钉固定应力最集中,并在中部表现出较高的应力;而钢板和骑缝钉应力则较为分散,最高应力也较螺钉小.结论第1跖跗关节骨折脱位会引起中前足应力传导障碍.从应力传导角度看,钢板或螺钉固定比骑缝钉更能表现出较明显的应力遮挡效应,有利于骨折脱位的早期愈合,但螺钉由于应力较为集中,负重前要及时去除.
목적 측량제1척부관절골절탈위후3충내고정대골면응력전도변화,위선택내고정제공삼고.방법 취6구신선족표본,제성제1척부관절골절탈위모형,의차채용3.5 mm전라문피질골라정、1/4관형강판급가압기봉정고정.경가재600 N후,통과전조응변편법측량제1척골기저급내측설골적응변.령선취건강남성지원자1명,경유한원건모연건건립제1척부관절골절탈위모형,병의차모의라정、강판、기봉정고정,모의600 N가재,관찰내고정상적응력분포.결과 제1척부관절골절탈위분별진행라정、강판급기봉정고정후,제1척골기저급내측설골적응력도감소;라정여강판고정후적응력교기봉정고정후적응력경소,차이유통계학의의(P＜0.05).이유한원분석현시,라정고정응력최집중,병재중부표현출교고적응력;이강판화기봉정응력칙교위분산,최고응력야교라정소.결론 제1척부관절골절탈위회인기중전족응력전도장애.종응력전도각도간,강판혹라정고정비기봉정경능표현출교명현적응력차당효응,유리우골절탈위적조기유합,단라정유우응력교위집중,부중전요급시거제.
Objective To compare the effects of 3 different internal implants for the first tarsometatarsal joint fracture-dislocation on the bone stress conduction.Methods Six fresh cadaveric specimens of the foot were used to make models of the first tarsometatarsal joint fracture-dislocation which were then fixated with 3.5 mm cortical screws,I/4 tubular plate and compressive staples respectively in turn.After a 600 N loading was applied,the strain was measured by the resistance strain gauge at the base of the first metatarsal and at the medial cuneiform.In addition,one healthy male volunteer was recruited for establishment of a finite element model of the first tarsometatarsal joint fracture-dislocation by the finite element software.The fixations with screws,tubular plate and staples were simulated in the model under a 600 N loading to observe the stress distribution on the implants.Results After fixation of the first tarsometatarsal joint fracture-dislocation with screw,plate and staple respectively,the stress was reduced at the base of the first metatarsal and the medial cuneiform.The stress produced by plate and screw was significantly smaller than by staple (P ＜ 0.05).The finite element analysis demonstrated that the stress produced by screw fixation was the most centralized and mostly at the middle part while the stress produced by plate and staple was decentralized and not as high as by screw fixation.Conclusions The first tarsometatarsal joint fracture-dislocation will cause the disturbed stress conduction in the middle and anterior part of the foot.As far as stress conduetion is concerned,fixation with plate and screw may faeilitate early healing of the injury since it shows more obvious stress shielding effect than fixation with staple.However,since the stress produced by screws is comparatively centralized,the screws should be removed in time before weight-bearing.