發(fā)布時間：2018-10-07 18:56

【摘要】：目的初步探討單鋼板和不同組合的雙鋼板治療干骺端粉碎股骨遠端骨折的療效,為大樣本量實驗提供研究方向,為臨床治療提供指導。方法健康實驗豬(巴馬小型豬)5頭,建立雙側股骨遠端粉碎性骨折模型[國際內固定研究學會(AO/ASIF)分型為33-C2.3型]。分為5組,對照組1頭雙側后肢予單純外側解剖鎖定鋼板固定;鎖定重建鋼板組和普通重建鋼板組共2頭,每頭豬一側后肢予外側解剖鎖定鋼板+內側鎖定重建鋼板固定,對側后肢予外側解剖鎖定鋼板+內側普通重建鋼板固定,左右側隨機;鎖定加壓鋼板組和普通加壓組共2頭,每頭豬一側后肢予外側解剖鎖定鋼板+內側鎖定加壓鋼板固定,對側后肢予外側解剖鎖定鋼板+內側普通加壓鋼板固定,左右側隨機。術后4、8、12周分別行X線攝片觀察骨折愈合和內固定松動情況。術后12周處死實驗豬,在股骨遠端側位X線片上測量骨痂最大前后徑。所有股骨標本去除內固定后行垂直壓縮實驗,記錄最大軸向壓縮位移,計算平均軸向剛度。結果術后5頭豬均存活,骨折均愈合,未出現(xiàn)感染、內固定失效。在大體標本中,各雙鋼板組實驗豬雙側后肢的骨痂最大前后徑的均值均大于單鋼板組,且鎖定重建鋼板組最大(5.02cm),鎖定加壓鋼板組最小(4.16cm)。在垂直壓縮實驗中,各雙鋼板組實驗豬雙側后肢的最大軸向壓縮位移的均值均小于單鋼板組,平均軸向剛度的均值均大于單鋼板組。在雙鋼板組中,鎖定重建鋼板組實驗豬雙側后肢的最大軸向壓縮位移的均值最小(2.50mm),平均軸向剛度的均值最大(1 200.71N/mm);普通加壓鋼板組實驗豬雙側后肢的最大軸向壓縮位移最大(2.91 mm),平均軸向剛度的均值最小(1 032.76N/mm)。結論雙鋼板固定是治療干骺端粉碎股骨遠端骨折較理想的方法之一,外側使用解剖鎖定鋼板、內側使用鎖定重建鋼板可能最有利于骨折的愈合。
[Abstract]:Objective to explore the curative effect of single plate and different combination of double plate in the treatment of metaphyseal comminuted distal femur fracture, to provide research direction for large sample size experiment and to provide guidance for clinical treatment. Methods A model of bilateral distal femoral comminuted fracture was established in 5 healthy pigs (Bama miniature pig) [International Institute of Internal Fixation (AO/ASIF) classified as 33-C2.3 type]. The control group was divided into five groups: the control group (n = 1) was fixed with a single lateral anatomic locking plate, the control group (n = 2) with a locked reconstruction plate and a control group (n = 2), each pig side of the hind limb was fixed with a lateral anatomic locking plate (LLP). The contralateral hindlimb was fixed with lateral anatomical locking plate, medial reconstruction plate, left and right side randomly, two of them were in locking compression plate group and common compression group, and each pig was fixed with lateral anatomical locking plate on the medial side of the posterior limb. The contralateral hindlimb was fixed with lateral anatomic locking plate medial compression plate. The fracture healing and internal fixation loosening were observed by X-ray radiography at 4 ~ 8 ~ 12 weeks postoperatively. Experimental pigs were killed 12 weeks after operation and the maximum anteroposterior diameter of callus was measured on lateral X-ray films of distal femur. All femur specimens were subjected to vertical compression experiment after removal of internal fixation. The maximum axial compression displacement was recorded and the average axial stiffness was calculated. Results all 5 pigs survived, fracture healed, no infection occurred and internal fixation failed. In the gross specimens, the mean value of the maximum anteroposterior diameter of callus in each double plate group was higher than that in the single plate group, and the largest (5.02cm) in the locked reconstruction plate group and the smallest (4.16cm) in the locking compression plate group. In the vertical compression experiment, the mean value of maximum axial compression displacement of both hind limbs of pigs in each double plate group was lower than that of single plate group, and the mean axial stiffness of each double plate group was higher than that of single plate group. In the double plate group, The maximum axial compression displacement (2.50mm) and average axial stiffness (1 200.71N/mm) of both hind limbs were the smallest (2.50mm) and the maximum axial compression displacement (2. 91 mm), level) of both hind limbs in the LRP group and the normal compression plate group respectively. The mean value of mean axial stiffness is minimum (1 032.76N/mm). Conclusion double plate fixation is an ideal method for the treatment of metaphyseal comminuted distal femur fracture. The lateral anatomic locking plate and the medial locking reconstruction plate may be the most beneficial to the healing of the fracture.
【作者單位】： 上海交通大學醫(yī)學院附屬新華醫(yī)院骨科;
【分類號】：R687.3

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