髋臼后壁骨折内固定稳定性的生物力学研究
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Biomechanical Evaluation on the Fixations of the Simulated Fractures on the Posterior Wall of Acetabulum
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    摘要:

    目的 研究髋臼后壁骨折后不同内固定方法的固定强度 ,以确定最理想的内固定方法。方法 左右配对的18具髋关节标本随机分成三组 ,在髋臼后外缘与坐骨大切迹间的中点截骨 ,建立髋臼后壁大块骨折模型。用临床常用的两枚皮质骨螺钉 (CS)、髋臼重建钢板 (RP)以及重建钢板 +两枚皮质骨螺钉 (RP +CS)三种内固定方法分别固定每一组骨折 ,然后屈髋 90°对模型分别进行生物力学测试 ,测量各组骨折块的分离位移以及分离 3mm时的载荷 ,以比较每一种内固定方法的固定强度。结果 载荷下 ,髋臼骨折块的分离位移随载荷的增加而增大 ,统计显示CS组与RP、RP +CS组间差别具有显著意义 (P <0 .0 1) ,而RP组与CS +RP组之间差别无意义 (P >0 .0 5 )。结论 髋臼后壁骨折内固定以RP较为理想 ,单纯CS力量不足以维持骨折块的稳定 ,而在RP之外再加两枚CS并不能增加内固定强度 ,反而增加了手术创伤及难度

    Abstract:

    Objective To define the optimal internal fixation method by means of studying the strength of various internal fixations of simulated fractures on posterior acetabular wall. Methods Eighteen preserved cadaveric hip joints were divided into three groups randomly. The simulated big isolated posterior wall fracture models were created by osteotomy in the middle of the outer rim of posterior acetabulum and the greater sciatic notch. The models were fixed with one of the three different methods: two cortical screws (CS), reconstruction plate (RP) and reconstruction plate plus two cortical screws (CS+RP). Then tests were performed on each model with 90°flexion of the hip. Measure the displacements of the fragments and the loadings when the displacements were 3mm. Results The displacements of fragments increased as the loading increased. There have high significant difference between the CS and RP or RP+CS (P<0.01), but no significance between the RP and CS+RP (P>0.05). Conclusion The ideal method of internal fixation of posterior acetabular wall fracture is RP. The strength of CS cannot maintain the stability of the fragment while RP+CS is not stronger than RP only and it may add more operative trauma and difficulty to operation.

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倪善军,孙俊英,王以进.髋臼后壁骨折内固定稳定性的生物力学研究[J].医用生物力学,2004,19(1):31-34

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