| 外固定架固定Pilon骨折负重稳定性的生物力学研究 |
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摘要点击次数: 86
全文下载次数: 11
投稿时间：2024-10-21
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| 作者 | Author | 单位 | Address | E-Mail |
| 成永忠 |
CHENG Yong-zhong |
中国中医科学院望京医院创伤一科, 北京 100102 |
The First Department of Trauma, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, China |
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| 尹晓冬 |
YIN Xiao-dong |
中国中医科学院望京医院创伤一科, 北京 100102 |
The First Department of Trauma, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, China |
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| 陈洋 |
CHEN Yang |
中国中医科学院望京医院创伤一科, 北京 100102 |
The First Department of Trauma, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, China |
932900418@qq.com |
| 王朝鲁 |
WANG Chao-lu |
中国中医科学院望京医院创伤一科, 北京 100102 |
The First Department of Trauma, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, China |
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| 刘广伟 |
LIU Guang-wei |
中医正骨技术北京市重点实验室, 北京 100102 |
Beijing Key Laboratory of Bonesetting Technology of Traditional Chinese Medicine, Beijing 100102, China |
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| 史长龙 |
SHI Chang-long |
中国中医科学院望京医院创伤一科, 北京 100102 |
The First Department of Trauma, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, China |
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| 黄晓宇 |
HUANG Xiao-yu |
北京中医药大学临床医学院, 北京 100102 |
Clinical Medical College of Beijing University of Chinese Medicine, Beijing 100102, China |
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| 陈奕历 |
CHEN Yi-li |
广东省中医院老年骨折科, 广东 广州 510000 |
Department of Geriatric Fracture, Guangdong Hospital of Traditional Chinese Medicine, Guangzhou 510000, Guangdong, China |
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| 陈泓颖 |
CHEN Hong-ying |
北京中医药大学临床医学院, 北京 100102 |
Clinical Medical College of Beijing University of Chinese Medicine, Beijing 100102, China |
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| 汪雄伟 |
WANG Xiong-wei |
北京中医药大学临床医学院, 北京 100102 |
Clinical Medical College of Beijing University of Chinese Medicine, Beijing 100102, China |
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| 赵继阳 |
ZHAO Ji-yang |
北京中医药大学第三附属医院创伤关节科, 北京 100102 |
Department of Traumatic Joints, The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing 100102, China |
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| 期刊信息：《中国骨伤》2024年，第37卷，第12期，第1196-1201页 |
| DOI：10.12200/j.issn.1003-0034.20230702 |
| 基金项目:国家自然科学基金面上项目(编号:82274561);中国中医科学院望京医院高水平中医医院建设项目中医药临床循证研究专项(编号:WJYY-XZKT-2023-02) |
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中文摘要:
目的: 探讨外固定架固定Pilon骨折后负重稳定性。
方法: 选取踝关节骨模型(右侧)6个及踝关节尸体标本4对(8只),根据Ruedi-Allgower Pilon骨折分型设计截骨线,采用摆据依据预先设定的截骨线制备Pilon骨折模型;用微创截骨器对尸体标本行骨折造模,制备Pilon骨折尸体模型。使用外固定架固定踝关节骨模型和尸体标本模型后,在力学加载机上进行轴向载荷力学加载。对踝关节骨模型分别施加150、300、450 N的轴向载荷,用动态捕捉仪记录腓骨骨折块、胫骨外侧骨折块、胫骨内侧骨折块在三维空间(X、Y、Z轴)上的位移。对外固定架固定后的踝关节尸体标本模型分别施加300、600、900 N的轴向载荷,拍摄不同载荷条件下外固定架固定下的Pilon骨折尸体模型X线片,用digimizer软件中测量不同载荷下胫骨前侧角、胫骨踝穴角、距骨移位值、距骨倾斜角度、外踝侧方移位值、内踝侧方移位值、内踝分离移位值、关节面台阶位移值。
结果: 对外固定架固定的Pilon骨折骨模型分别施加150、300、450 N轴向载荷后,未出现外固定架松动、断裂,局部固定骨折端的克氏针也未出现松动、断裂及不可逆的塑性形变。腓骨骨折块在X轴(左右)位移值分别为0.032(-0.022,0.269)、0.061(-0.002,0.427)、0.212(-0.016,1.223) mm,Y轴(上下)位移值分别为0.002(-0.031,0.103)、0.051(-1.133,0.376)、0.128(-1.394,0.516) mm,Z轴(前后)位移值分别为-0.003(-0.130,0.171)、0.137(-0.076,0.433)、0.030(-0.487,0.478) mm;胫骨外侧骨折块在X轴上的位移值分别为0.000(-0.108,0.027)、0.083(-0.364,0.050)、-0.121(-0.289,0.165) mm,Y轴上的位移值分别为-0.009(-0.200,0.025)、-0.179(-0.710,0.084)、-0.257(-0.799,0.027) mm,Z轴位移值分别为0.112(-0.024,0.256)、0.157(-0.068,0.293)、-0.210(-0.035,0.430) mm;胫骨内侧骨折块在X轴上的位移值分别为-0.010(-0.060,0.013)、-0.165(-0.289,0.056)、-0.181(-0.395,0.013) mm,Y轴位移值分别为-0.036(-0.156,0.007)、-0.104(-0.269,0.178)、-0.245(-0.380,-0.011) mm,Z轴位移值分别为-0.005(-0.372,0.189)、-0.012(-1.774,0.380)、0.200(-1.963,-0.540) mm。对外固定架固定的Pilon骨折尸体模型分别施加300、600、900 N轴向载荷后,胫骨前侧角、胫骨踝穴角、距骨倾斜角、关节面骨折台阶、距骨移位、外踝侧方移位、内踝侧方移位、内踝分离移位在不同加载条件下的数值与未加载比较,差异均无统计学意义(P>0.05)。
结论: 早期负重外固定架能维持骨折端及踝关节稳定,负重量最大不超过300 N,临床实际应用中还需结合植入物的材料特性和骨折类型进行选择。 |
| 【关键词】接骨架 Pilon骨折 负重稳定性 生物力学 |
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| Biomechanical study of load-bearing stability of Pilon fracture fixed with external fixator |
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ABSTRACT
Objective To explore weight-bearing stability of Pilon fracture fixed by external fixator.
Methods Six ankle bone models (right side) and 4 pairs (8 ankle cadaver specimens) were selected. Pilon fracture model was prepared by using the preset osteotomy line based on Ruedi Allgower Pilon fracture type. Pilon fracture model was built by using a minimally invasive osteotomy. After ankle bone model and cadaver specimen model were fixed with external fixator,axial load was carried out on mechanical loading machine. After ankle bone model and cadaver specimen model were fixed with external fixator,axial load was carried out on mechanical loading machine. Axial loads of 150,300 and 450 N were applied to ankle bone model,and displacements of fibula fracture blocks,lateral tibia fracture blocks and medial tibia fracture blocks in three-dimensional space (X,Y and Z axes) were recorded by dynamic capture instrument. Axial loads of 300,600 and 900 N were applied to ankle cadaver model fixed by external fixator. X-ray films of Pilon fracture cadaver model fixed by external fixator under different loading conditions were taken. The anterior tibial angle,tibial malleolar point angle,talus shift value,talus tilt angle,lateral malleolar shift value,lateral malleolar shift value,medial malleolar separation shift value and articular surface step displacement value were measured under different loads by digimizer software.
Results After 150,300 and 450 N axial loads were applied to Pilon fracture models fixed by external fixator,no loosening or fracture of external fixator was observed,and no loosening,fracture or irreversible plastic deformation of Kirschner needle were observed. The displacement values of fibular fracture pieces on X-axis(around) were 0.032 (-0.022,0.269),0.061 (-0.002,0.427),0.212(-0.016,1.223) mm,and the displacement values on Y-axis(above and below) were 0.002(-0.031,0.103),0.051(-1.133, 0.376),0.128 (-1.394,0.516) mm,and displacement values on Z-axis (front and rear) were -0.003 (-0.130,0.171),0.137 (-0.076,0.433),0.030(-0.487,0.478) mm;the displacement values of lateral tibial fractures on X-axis were 0.000(-0.108, 0.027),0.083(-0.364,0.050),-0.121(-0.289,0.165) mm,and displacement values on Y-axis were -0.009(-0.200, 0.025),-0.179(-0.710,0.084),-0.257(-0.799,0.027) mm,and displacement values on Z-axis were 0.112(-0.024, 0.256),0.157(-0.068,0.293),-0.210(-0.035,0.430) mm;the displacement values of medial tibial fracture block on X-axis were -0.010(-0.060,0.013),-0.165(-0.289,0.056),-0.181(-0.395,0.013) mm,and the displacement values on Y-axis were -0.036(-0.156,0.007),-0.104(-0.269,0.178),-0.245(-0.380,-0.011) mm,and displacement values on Z-axis were -0.005(-0.372,0.189),-0.012 (-1.774,0.380),0.200 (-1.963,-0.540) mm. After 300,600 and 900 N axial loads were applied to Pilon fracture cadaverous models fixed with external fixators,there were no significant difference in anterior tibial angles,angles of malleolar points of tibia,oblique angles of talus,fracture steps,shift values of talus,lateral shift values of lateral malleolus,lateral shift values of medial malleolus,lateral shift values of medial malleolus between under different loading conditions and those without loading (P>0.05). No loosening or fracture of external fixator as a whole,loosening,fracture or irreversible deformation of Kirschner needle at the local fixed fracture end occurred.
Conclusion The early weight-bearing external fixator could maintain stability of fracture end and ankle joint,and the maximum weight is not more than 300 N. In clinical practical application,material characteristics of the implant and type of fracture should be selected. |
| KEY WORDS External fixator Pilon fracture Load-bearing stability Biomechanics |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 成永忠,尹晓冬,陈洋,王朝鲁,刘广伟,史长龙,黄晓宇,陈奕历,陈泓颖,汪雄伟,赵继阳.外固定架固定Pilon骨折负重稳定性的生物力学研究[J].中国骨伤,2024,37(12):1196~1201 |
| 英文格式: | CHENG Yong-zhong,YIN Xiao-dong,CHEN Yang,WANG Chao-lu,LIU Guang-wei,SHI Chang-long,HUANG Xiao-yu,CHEN Yi-li,CHEN Hong-ying,WANG Xiong-wei,ZHAO Ji-yang.Biomechanical study of load-bearing stability of Pilon fracture fixed with external fixator[J].zhongguo gu shang / China J Orthop Trauma ,2024,37(12):1196~1201 |
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