| 费骏,赖震,吴新红,王以进,魏威.下胫腓联合损伤螺钉固定或加1/3管型钢板固定稳定性重建的生物力学评价[J].浙江中西医结合杂志,2015,25(9): |
| 下胫腓联合损伤螺钉固定或加1/3管型钢板固定稳定性重建的生物力学评价 |
| Biomechanical Study of the stability reconstruction by screws or plus 1/3 tube type plate fixation of Distal tibiofibular syndesmosis injury |
| 投稿时间：2015-02-25 修订日期：2015-04-22 |
| DOI： |
| 中文关键词: 下胫腓联合损伤 内固定 生物力学 |
| 英文关键词:Distal tibiofibular syndesmosis injury Internal fixation Biomechanics |
| 基金项目:浙江省医药卫生科技计划项目2013KYA163资助 |
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| 中文摘要: |
| [摘要]：目的 评价下胫腓联合损伤采用一枚螺钉、两枚螺钉或加1/3管型钢板固定稳定性重建的生物力学性能优劣，为临床选择有效内固定提供理论依据。方法 采集6具新鲜成人下肢尸体标本，制成正常组、损伤组、下胫腓联合损伤复位后分别用1枚螺钉固定（A1）、2枚螺钉固定(B1)、2枚螺钉加1/3管型钢板固定（C1）等三种固定方式，行生物力学实验应力分析，模拟足运动中立位，跖屈位(30°)、背屈位(20°)、旋后外旋位等4种运动工况，测量踝关节的强度、刚度和稳定性。结果 ①下胫腓联合损伤后，在4种运动工况下，踝关节的强度、刚度发生异常变化，内外踝应力强度分别下降21%，39%，前后踝穴处，应力强度分别下降29%和35%；EF，GF分别减小27%，28%，与正常标本相比呈显著性差异（P<0.05）；②下胫腓联合复位后，三种内固定方法均能够使踝关节恢复到正常稳定状态，踝关节的应力强度均超过正常组，其中A1组与正常组无显著性差异（A1/N，t=1.615，P >0.05），而B1与C1组与正常组存在显著性差异（B1/N，C1/N，P<0.05），但两组间无明显差异；踝关节的轴向刚度、踝关节水平剪切刚度三组均超过正常组并存在显著性差异（A1/N，B1/N，C1/N，P<0.05），B1与A1相比，EF，GF平均增加14%和15%，B1与C1相比，两组无显著性差异（t=1.794，P>0.05）。结论 一枚螺钉三皮质固定（A1组）的力学性能更接近正常组，而后两种固定则更为坚强。但坚强的固定会使踝关节对关节活动的顺应性下降，而使螺钉所受的应力增加，易产生螺钉的松动或疲劳断裂。 |
| 英文摘要: |
| Abstract: Objective Biomechanical study of distal tibiofibular syndesmosis injury reconstruction by screws, two screws or plus 1/3 tube type plate fixation stability reconstruction, for clinical selection of effective internal fixation and provide a theoretical basis. Methods Acquisition of 6 fresh adult cadaver specimens made of lower limb, the normal group, injury group, distal tibiofibular syndesmosis injury fracture were fixed with 1 screws (A1), 2 screws, 2 screws (B1) plus 1/3 tube type and plate fixation (C1) three kinds of fixed mode, the analysis of stress for biomechanics the experimental simulation of movement of the foot, neutral position, plantar flexion (30 degrees), dorsal flexion (20 degrees), supination external rotation and other 4 kinds of motion conditions, measurement of ankle joint strength, stiffness and stability. Results The distal tibiofibular syndesmosis injury, in the 4 movement condition, the ankle joint strength, stiffness changes, compared with normal specimens showed significant difference (P<0.05). The ankle strength of internal and external malleolus drops by 21% and 39%, the ankle strength of front and lateral malleolus drops by 29% and 35%; The stiffness changes of EF and GF drops by 27% and 28%. Syndesmotic reduction after the next, three kinds of internal fixation methods can make the ankle joint recovered to the normal steady state, ankle joint stress intensity were higher than the normal group, the A1 group and the normal group had no significant difference (A1/N, t=1.615,P >0.05), and there was a significant difference between the B1 and the C1 group and the normal group (B1/N, C1/N, P<0.05), but no significant difference between the two groups; ankle stiffness, axial ankle closed sections of horizontal shear stiffness in three groups were higher than the normal group and there was significant difference (A1/N, B1/N, C1/N, P<0.05); The stiffness changes of EF and GF increases 14% and 15% between B1 group and A1 group; There was no significant difference between B1 group and C1 group(t=1.794，P>0.05) . Conclusion A screw three cortical fixation (group A1) mechanical properties close to the normal group, and two fixed is more strong. But strong fixed will make the ankle joint to joint activities decreased compliance, and make the screw stress increase, easy to produce fatigue fracture screw loosening or. |
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