中国组织工程研究
中國組織工程研究
중국조직공정연구
Journal of Clinical Rehabilitative Tissue Engineering Research
2015年
44期
7182-7187
,共6页
王展%张军%张堃%朱养均%王浩%王登峰%邵宇雄
王展%張軍%張堃%硃養均%王浩%王登峰%邵宇雄
왕전%장군%장곤%주양균%왕호%왕등봉%소우웅
骨科植入物%骨植入物%后踝骨折%内固定材料%金属材料%可吸收材料%接骨钢板%螺钉%聚乳酸%聚乙胶酯%生物相容性%生物力学
骨科植入物%骨植入物%後踝骨摺%內固定材料%金屬材料%可吸收材料%接骨鋼闆%螺釘%聚乳痠%聚乙膠酯%生物相容性%生物力學
골과식입물%골식입물%후과골절%내고정재료%금속재료%가흡수재료%접골강판%라정%취유산%취을효지%생물상용성%생물역학
背景：后踝骨折是影响踝部骨折预后的重要因素，后踝骨折常由较高能量损伤导致，采用何种固定物、内固定材料的生物力学，并如何置入成为目前研究的热点。目的：比较不同内固定材料对后踝骨折临床预后的价值，分析不同内固定方式对后踝关节骨折固定的生物力学效果的影响，为临床治疗后踝骨折选择最佳内固定物提供一定的依据及参考。方法：由第一作者通过计算机检索1976到2015年PubMed数据库和中国知网数据库收录的相关的文献。英文检索词为“Ankle fracture；internal fixation；biomechanics；biocompatibility”，中文检索词为“后踝骨折；内固定；生物力学；生物相容性”，总结目前常用的金属内固定材料和可吸收内容材料，临床常用的金属内固定材料包括接骨钢板和螺钉，可吸收内固定材料如降解材料聚乳酸、聚乙胶酯和聚丙胶酯等，分析其生物力学特性。结果与结论：新型锁定螺钉能承受更大的屈曲和剪切力，拉力螺钉具有丝攻作用，攻丝后的螺钉拉力更强，但对于伴有骨质疏松的患者螺钉对骨折块的加压作用有限，强度不够，此时宜选用锁定钢板，锁定钢板稳定性更强，对弯曲应力有较高的对抗性，拔出可能性更低。钢板结合螺钉提供了更好的稳定性。为了避免目前金属材料内固定骨折愈合后存在内固定物二次取出、内固定后应力保护等缺点，由生物降解材料聚乳酸，聚乙胶酯和聚丙胶酯等经高温高压加工而成的可吸收内固定材料强度提高，可吸收内固定材料可克服干扰影像学检查、内置物二次取出等金属内固定物相关的不利影响。说明可吸收螺钉力学特性更接近人体骨骼，无因应力遮档引起的周围骨骼的脆弱，无骨质疏松现象发生，而且可在体内降解，但其固定强度还是不及传统螺钉及接骨钢板，临床上应根据骨折部位受力情况和骨折块的大小选择合适的内固定材料。
揹景：後踝骨摺是影響踝部骨摺預後的重要因素，後踝骨摺常由較高能量損傷導緻，採用何種固定物、內固定材料的生物力學，併如何置入成為目前研究的熱點。目的：比較不同內固定材料對後踝骨摺臨床預後的價值，分析不同內固定方式對後踝關節骨摺固定的生物力學效果的影響，為臨床治療後踝骨摺選擇最佳內固定物提供一定的依據及參攷。方法：由第一作者通過計算機檢索1976到2015年PubMed數據庫和中國知網數據庫收錄的相關的文獻。英文檢索詞為“Ankle fracture；internal fixation；biomechanics；biocompatibility”，中文檢索詞為“後踝骨摺；內固定；生物力學；生物相容性”，總結目前常用的金屬內固定材料和可吸收內容材料，臨床常用的金屬內固定材料包括接骨鋼闆和螺釘，可吸收內固定材料如降解材料聚乳痠、聚乙膠酯和聚丙膠酯等，分析其生物力學特性。結果與結論：新型鎖定螺釘能承受更大的屈麯和剪切力，拉力螺釘具有絲攻作用，攻絲後的螺釘拉力更彊，但對于伴有骨質疏鬆的患者螺釘對骨摺塊的加壓作用有限，彊度不夠，此時宜選用鎖定鋼闆，鎖定鋼闆穩定性更彊，對彎麯應力有較高的對抗性，拔齣可能性更低。鋼闆結閤螺釘提供瞭更好的穩定性。為瞭避免目前金屬材料內固定骨摺愈閤後存在內固定物二次取齣、內固定後應力保護等缺點，由生物降解材料聚乳痠，聚乙膠酯和聚丙膠酯等經高溫高壓加工而成的可吸收內固定材料彊度提高，可吸收內固定材料可剋服榦擾影像學檢查、內置物二次取齣等金屬內固定物相關的不利影響。說明可吸收螺釘力學特性更接近人體骨骼，無因應力遮檔引起的週圍骨骼的脆弱，無骨質疏鬆現象髮生，而且可在體內降解，但其固定彊度還是不及傳統螺釘及接骨鋼闆，臨床上應根據骨摺部位受力情況和骨摺塊的大小選擇閤適的內固定材料。
배경：후과골절시영향과부골절예후적중요인소，후과골절상유교고능량손상도치，채용하충고정물、내고정재료적생물역학，병여하치입성위목전연구적열점。목적：비교불동내고정재료대후과골절림상예후적개치，분석불동내고정방식대후과관절골절고정적생물역학효과적영향，위림상치료후과골절선택최가내고정물제공일정적의거급삼고。방법：유제일작자통과계산궤검색1976도2015년PubMed수거고화중국지망수거고수록적상관적문헌。영문검색사위“Ankle fracture；internal fixation；biomechanics；biocompatibility”，중문검색사위“후과골절；내고정；생물역학；생물상용성”，총결목전상용적금속내고정재료화가흡수내용재료，림상상용적금속내고정재료포괄접골강판화라정，가흡수내고정재료여강해재료취유산、취을효지화취병효지등，분석기생물역학특성。결과여결론：신형쇄정라정능승수경대적굴곡화전절력，랍력라정구유사공작용，공사후적라정랍력경강，단대우반유골질소송적환자라정대골절괴적가압작용유한，강도불구，차시의선용쇄정강판，쇄정강판은정성경강，대만곡응력유교고적대항성，발출가능성경저。강판결합라정제공료경호적은정성。위료피면목전금속재료내고정골절유합후존재내고정물이차취출、내고정후응력보호등결점，유생물강해재료취유산，취을효지화취병효지등경고온고압가공이성적가흡수내고정재료강도제고，가흡수내고정재료가극복간우영상학검사、내치물이차취출등금속내고정물상관적불리영향。설명가흡수라정역학특성경접근인체골격，무인응력차당인기적주위골격적취약，무골질소송현상발생，이차가재체내강해，단기고정강도환시불급전통라정급접골강판，림상상응근거골절부위수력정황화골절괴적대소선택합괄적내고정재료。
BACKGROUND:Posterior maleolar fracture is an important factor affecting the prognosis of ankle fractures. Posterior maleolar fracture often caused by high energy trauma. Using what kind of fixation and fixation materials biomechanics, and how to embed has become a current research hotspot. OBJECTIVE:To compare the clinical outcomes of different fixation materials on posterior maleolar fracture, and analyze the effect of different fixation methods on biomechanical outcome of posterior maleolar fracture fixation, so as to provide a basis and reference of selecting the best fixation for the clinical treatment of ankle fracture. METHODS: The relevant literature included by PubMed database and the China National Knowledge database from the year of 1976 to 2015 were retrieved by the first author through computer. English key words are “Ankle fracture; internal fixation; biomechanics; biocompatibility”, Chinese language search terms are “posterior maleolar fracture; internal fixation; biomechanics; biocompatibility”. Summarize the most commonly used metal fixation materials and absorbable content materials. The clinical commonly used metal fixation materials including bone plate and screws, absorbable fixation materials such as biodegradable material polylactic acid, polyethylene plastic ester, polylactide gum ester, etc. The biomechanical properties were analyzed. RESULTS AND CONCLUSION: The new locking screw can withstand more buckling and shear force. Lag screw has a tapping action, and the puling was stronger after tapping, but for patients with osteoporosis, the pressure effect of screw on fracture fragments was limited, the strength was not enough, at this time, locking plate should be used. Locking plate has a greater stability and higher confrontational feature to bending stress, less likely to pul out. Steel coupling screw provides better stability. To avoid secondary removing of the fixation, stress protection after fixation and other shortcomings after the metal material fixation fracture healing, the strength of the absorbable fixation material made by biodegradable material polylactic acid, polyvinyl acetate glue and polypropylene plastic ester after high temperature and pressure processing was increased. Absorbable fixation material may overcome the adverse effects associated with metal fixation, such as imageological examination, secondary implant removal. These results show that the mechanical properties of the absorbable screws are more closer to human bone, no surrounding bone vulnerability due to stress shields, no osteoporosis occurs, and can degrade in the body, but its fixation strength is stil less than the traditional fixed screw and bone plate. We should choose a suitable fixation material according to the forces of fracture site and the size of the fracture fragments.
