不同固定方法治疗胫骨平台外后侧骨折的生物力学分析研究

Biomechanical analysis of different fixation methods for treating posterior tibial plateau fractures

摘要:

目的 通过生物力学分析研究采用掌骨T形钢板和拉力螺钉治疗胫骨平台外后侧骨折的疗效。方法 将20具人工合成的右侧胫骨模形，根据胫骨平台外后侧劈裂塌陷性骨折的形态学特征，建立胫骨平台外后侧劈裂塌陷性骨折模形，随机分为两组（n=10）：A组采用3.5掌骨T形钢板固定；B组采用2枚拉力螺钉固定。测量两组在轴向负荷加载起始为10 N，最大为2 000 N的压力下的垂直位移和最大失效载荷。结果 钢板组和螺钉组在250 N载荷下骨折块的垂直位移分别为（0.21±0.15）mm和（0.35±0.11）mm，在500 N载荷下骨折块的垂直位移分别为（0.32±0.12）mm和（0.91±0.27）mm，在1 000 N载荷下骨折块的垂直位移分别为（0.76±0.16）mm和（1.75±0.21）mm，在1 500 N载荷下骨折块的垂直位移分别为（0.93±0.14）mm和（2.37±0.26）mm，在同一载荷下二者比较差异有统计学意义（P<0.05）。钢板组和螺钉组的最大失效载荷分别为（1 865±183）N和（1 242±146）N，二者最大失效载荷比较差异有统计学意义（P<0.05）。结论 掌骨T形钢板固定胫骨平台外后侧骨折，可以对塌陷的胫骨平台外后侧骨折块起到有效、稳定、坚强的固定，具有较强的稳定性和明显的生物力学优势。

关键词:胫骨平台骨折;胫骨外后侧平台骨折;外后侧骨折;支撑钢板;螺钉

Abstract:

Objective To investigate the therapeutic effect of using metacarpal T-shaped steel plate and tension screw to treat posterior tibial plateau fractures through biomechanical analysis.Methods Twenty artificially synthesized right tibial models were used to establish a tibial plateau lateral split collapse fracture model based on the morphological characteristics of the fracture. The models were randomly divided into two groups (n=10): Group A was fixed with a 3.5 metacarpal T-shaped steel plate; Group B was fixed with 2 tension screws. Measure the vertical displacement and maximum failure load of two groups under axial load starting at 10 N and maximum pressure of 2000 N.Results The vertical displacements of the fracture blocks in the steel plate group and screw group under 250 N load were 0.21±0.15 mm and 0.35±0.11 mm. The vertical displacements of the fracture blocks under 500 N load were 0.32± 0.12 mm and 0.91±0.27 mm. The vertical displacements of the fracture blocks under 1000 N load were 0.76±0.16 mm and 1.75±0.21 mm. The vertical displacements of the fracture blocks under 1500 N load were 0.93±0.14 mm and 2.37±0.26 mm. There was a statistically significant difference between the two under the same load (P<0.05). The maximum failure loads of the steel plate group and screw group were 1865±183 N and 1242±146 N and there was a statistically significant difference in the maximum failure loads between the two groups (P<0.05).Conclusion The use of metacarpal T-shaped steel plate fixation for posterior tibial plateau fractures can effectively, stably, and strongly fix collapsed posterior tibial plateau fractures, demonstrating strong stability and significant biomechanical advantages.

Key words:tibial plateau fracture;fracture of the posterior tibial plateau;external posterior fracture;supporting steel plate;screw