内侧支撑螺钉在锁定钢板治疗肱骨近端骨折中的生物力学优势
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上海市自然科学基金项目(12ZR1422300)


Biomechanical advantages of medial support screws in locking plate for treating proximal humerus fractures
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    摘要:

    目的 探讨内侧支撑螺钉在肱骨近端锁定钢板固定肱骨近端骨折中的生物力学性能。 方法 将30个人工合成左侧肱骨随机分成3组,建立外科颈骨折模型,采用肱骨近端锁定钢板固定:A组,近端内侧骨皮质支撑,无内侧支撑螺钉;B组,3枚内侧支撑螺钉支撑,无内侧骨皮质支撑;C组,无内侧骨皮质和内侧支撑螺钉支撑。分别对3组标本进行轴向压缩、抗扭、剪切力压缩、模型失效测试。结果A、B、C 3组轴向压缩最大载荷为A组((240.88±19.13) N)>B组((169.04±19.26)N)> C组((128.58±17.53) N),P<0.05);抗压刚度为A组((424.4±101.2) N/mm)>B组((230.7±40.54) N/mm)> C组((147.0±29.2) N/mm,P<0.05);抗扭测试最大扭矩A组((8.92±0.25) N?m)、B组((9.09±0.31) N?m)>C组((7.57±0.53) N?m,P<0.05),抗扭刚度A组((1.80±0.07) N?m/(°))、B组((1.86±0.07) N?m/(°))>C组((1.53±0.10) N?m/(°),P<0.05);剪切力压缩测试最大载荷为A组((444.71±20.87) N)>B组((228.79±28.95) N)> C组((188.73±26.15) N,P<0.05),抗压刚度为A组((470.0± 54.4) N/mm)>B组((183.89±29.64) N/mm)> C组((140.2±32.1) N/mm,P<0.05);模型失效载荷A组((2 949.76±355.08) N)>B组((2 448.13±402.39) N)、C组((2 222.55±336.41) N,P<0.05)。结论 肱骨近端内侧骨皮质支撑具有最佳的生物力学性能,采用3枚内侧支撑螺钉重建肱骨近端内侧柱支撑的生物力学性能较无内侧柱支撑时明显增强。通过内侧骨皮质支撑或内侧支撑螺钉重建肱骨近端内侧柱支撑值得临床运用,以预防术后内固定失败。

    Abstract:

    Objective To evaluate the biomechanical advantages of medial support screws (MSSs) in locking proximal humeral plate for treating proximal humerus fractures. Methods Thirty synthetic left humeri were randomly divided into 3 groups to establish the fracture models. Group A was fixed with a locking proximal humerus plate with medial cortical support, but without MSSs; group B was fixed with 3 MSSs, but without medial cortical support; group C was fixed with neither medial cortical support nor MSSs. Axial compression, torsion, shear stiffness and failure tests were applied on the specimens of the three groups. Results For axial compression tests, the maximum load of group A, B, C was (240.88±19.13), (169.04±19.26), (128.58±17.53) N, respectively; the axial stiffness of group A, B, C was (424.4±101.2), (230.7±40.54), (147.0±29.2) N/mm, respectively, showing significant differences (P<0.05). For torsion tests, the maximum torque of group C was (7.57±0.53) N?m, which was statistically different from both group A((8.92±0.25) N?m) and group B((9.09±0.31) N?m, P<0.05), and the torsional stiffness of group C((1.53±0.10) N?m/(°)) was statistically different from both group A((1.80±0.07) N?m/(°)) and group B((1.86±0.07) N?m/(°), P<0.05), but no significant differences were found between groups A and groups B in the maximum torque and torsional stiffness(P>0.05). For shear stiffness tests, the maximum load of group A, B, C was (444.71±20.87), (228.79±28.95), (188.73±26.15) N, respectively; the shear stiffness of group A, B, C was (70.0± 54.4), (183.89±29.64), (140.2±32.1) N/mm, respectively, showing significant differences (P<0.05). For failure tests, the failure load of group A ((2 949.76±355.08) N) was statistically different from both group B ((2 448.13±402.39)N) and group C ((2 222.55±336.41) N) (P<0.05), but no statistical differences were found between group B and group C (P>0.05). Conclusions Using three MSSs in locking plate for proximal humerus fractures shows optimal biomechanical properties, as compared to the situation without restoration of the medial column support. The reconstruction of the medial cortical support or MSSs for proximal humerus fractures helps to enhance the mechanical stability of the humeral head and prevent failure after internal fixation.

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曾浪清,陈云丰,李元超,王 磊,宋文奇,刘燕洁,章伟,张长青,曾炳芳.内侧支撑螺钉在锁定钢板治疗肱骨近端骨折中的生物力学优势[J].医用生物力学,2013,28(3):338-343

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  • 收稿日期:2012-05-21
  • 最后修改日期:2012-08-01
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