手掌骨折内外固定器之刚度比较
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COMPARISON OF FIXATION RIGIDITY IN HAND FRACTURES
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    摘要:

    为了比较微型内固定器和微型外固定器的机械强度,本实验以材质均匀的枫木空管模拟手部小骨,植入(1)Aesculap微型外固定器(2)微型A-O接骨板(3)交叉钢针及(4)自制骨水泥外固定器。并设计(1)横截断面(2)断面留2mm间隙及(3)45°斜切来模拟稳定性骨折、不稳定性骨折及螺旋型骨折。在INSTRON材料试验机分别做张力、扭力及弯曲负荷测试。实验资料经统计之变异数分析(ANOVA)及成对资料分析(Tukeypairwisecomparison),发现在不同的骨折断面中,张力刚度均以微型接骨板最好(P<0.001)。侧弯刚度以置放在背面的微型接骨板最好。在稳定和不稳定骨折时,扭力刚度以Aesculap的微型外固定器最好(P<0.01),但在45°斜切断面时,扭力刚度以微型接骨板最好(P<0.001)。在稳定性骨折时,微型接骨板(背面或侧面)与微型外固定器的前弯刚度较好,但没有明显差异。在不稳定性骨折和45°斜切时,前弯刚度以侧面骨板和微型外固定器较好。除了扭力刚度以外,Aesculap微型外固定器和自制骨水泥外固定器并无明显差异。而如预期的,交叉钢针的机械强度是最弱的(P<0.01...更多)。

    Abstract:

    In order to compare mechanical properties between various types of small bone fixators, hollow maple dowels are uniformly produced to simulate small bones in this study. Furthermore, transverse osteotonmy with 2mm gap, and 45°oblique osteotomies are created to simulate stable, unstable, and spiral fractures. Each fractue pattern is then approximated with four types fo fixators :(1)Aesculap mini extermal fixator,(2)mini A-O plate and screw,(3)cross pin, and(4) self-assembled mini external fixator. Finally,tension,torsion, and bending tests are performed with INSTRON.Dorsal plating has the strongest tensile rigidity and lateral bending rigidity in three different fracture patterns. Aesculap mini external fixator has the strongest torsional rigidity in stable and unstable fractures. Nevertheless, mini A-o plate has the strongest torsional rigidity in 45°oblique fracture. Dorsal plating, lateral plating, and mini external fixator all have good anterior bending rigidity without significant difference in stable fracture. Furthermore, only lateral plating and mini external fixator show good anterior bending rigidity in unstable and 45°oblique fractures. Except in torsional rigidity, Aesculap mini external fixator is not significantly stiffer than the self-assembled external fixator. As expected, cross pin is the weakest fixator.In this study, differences in mechanical stiffness among four types of small bone fixators are provided. Additionally. the indication should be considered when choosing a proper fixator.Complication rate can then be lowered to achieve a successful surgery in treating small bone fractures.

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周伯禧,林高田,林森源,张维军,洪绍鸿.手掌骨折内外固定器之刚度比较[J].医用生物力学,1995,10(3):150-156

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