北京生物医学工程

指骨骨折侧方置板的力学稳定性研究

Mechanical stability of the bone plate placed on the lateral side of the phalangeal fracture

作者：习洪波陈奕文王勤业叶华鑫罗亚平范志娣危涛华子恺

单位：上海市嘉定区南翔医院骨科（上海 201802）; 上海大学机电工程及自动化学院（上海200444）

关键词：指骨骨折；内固定；接骨板；生物力学；稳定性

分类号：R318.04

出版年·卷·期（页码）：2020·39·5（477-483）

摘要：

目的指骨骨折手术中接骨板的置板部位对于指功能康复具有重要影响，背侧置板虽然能为骨折区域提供良好力学稳定性，但容易造成术后软组粘连，不利于手指功能恢复。作为一个新的指骨内固定手术方式，侧方置板能够有效避免软组织粘连的发生，提供更有利的指功能康复条件。目前，侧方固定的力学稳定性尚未得到系统性研究与证实。本文拟通过对背侧置板与侧方置板在抗扭转性能的比对试验，对侧方置板的力学稳定性进行评估。方法采用Synbone 3D打印人工指骨，共4种型号，每种型号2例样品预置骨折。8例指骨骨折模型分为背侧置板组与侧方置板组两组予以内固定。以抗扭性能为主要评价指标，将指骨板样品加载扭转，得到扭转力矩和断裂扭转角，对比两者植入后的力学差异。结果实验中样品失效形式有所不同，指骨骨折侧方置板样品的平均断裂扭矩为（0.96±0.08）N·m，平均断裂扭转角为（115.1±120.0）°，背侧置板样品的平均断裂扭矩为（1.40±0.35）N·m，平均断裂扭转角为126.5°±83.1°，两者的断裂扭矩与断裂角在统计学上均没有显著性差异（P＞0.05）。结论采用指接骨板背侧置板和侧方置板的指骨骨折内固定的扭转性能在统计学上没有显著性差异，侧方置板能够保证指骨骨折重建后的初期稳定性。

Objective The placement of the plate has an important impact on the rehabilitation of finger function in phalangeal fracture surgery. Although the bone plate placed on the dorsal side can provide good mechanical stability for the fracture area, it is easy to cause postoperative soft tissue adhesion and is not conducive to the restoration of finger function. As a new surgical method for internal fixation of phalangeal fractures, the bone plate placed on the dorsal lateral side can effectively avoid the occurrence of soft tissue adhesion and provide more favorable conditions for finger function rehabilitation. At present, the mechanical stability of lateral fixation has not been systematically studied and confirmed. The purpose of this study is to evaluate the mechanical stability of the bone plate on the lateral side of the phalangeal fracture by comparing the torsional performance of bone plate placed on the dorsal side and lateral side. Methods Synbone artificial phalanx of three dimensional printing was used.There was four groups of different artificial phalange and two samples of each model. Eight phalangeal fracture models were divided into two groups: the dorsal side and the lateral side. they were loaded with torsion to obtain data of torsion moment and fracture angle, and took the anti-torsion performance as the main evaluation index to compare two ways in the mechanical differences. Results Specimens presented different failure modes in the test. The average breaking torque of the bone plate placed on the lateral side was (0.96±0.08) N·m, and the average fracture angle was (115.1±120.0) °, while those of the bone plate placed on the dorsal side were (1.40±0.35) N·m and (126.5±83.1) °.Statistically, there was no significant difference in the torsional properties between these two fixation methods (P＞0.05). Conclusions There is no significant difference in the torsion performance of the plate fixation placed on the dorsal side and lateral side of the phalangeal fracture. Bone plate on the dorsal lateral side can ensure the initial stability of the phalangeal fracture after reconstruction.

参考文献：

[1] Nunley JA, Kloen P. Biomechanical and functional testing of plate fixation devices for proximal phalangeal fractures[J]. Journal of Hand Surgery, 1991, 16(6):991-8.

[2] 黄俊伍,罗轶. 指骨背侧与侧方放置微型钢板治疗近节指骨骨折的临床对比研究[J]. 中华手外科杂志, 2012, 28(3):157-159.

Huang JW, Luo Y. Comparative study of clinical results of proximal phalangeal fractures fixed by dorsal mini titanium plate or lateral mini titanium plate[J]. Chinese Journal of Hand Surgery, 2012, 28(3):157-159.

[3] 石海林,罗轶. 微型钢板内固定掌指骨骨折的生物力学评价[J]. 中国组织工程研究, 2013, 17(17):3200-3207.

Shi HL, Luo Y. Mini-plate internal fixation for the treatment of metacarpal and phalangeal fractures: Biomechanical evaluation[J]. Chinese Journal of Tissue Engineering Research, 2013, 17(17):3200-3207.

[4] 马洪顺,王首夫,伊维田. 手指骨扭转弯曲实验研究[J]. 北京生物医学工程, 1992(1):46-47.

[5] 徐润冰,何双华,胡新宇,等. 微型锁定钛板背侧与侧方放置在近节指骨骨折中的临床疗效比较[J]. 中华手外科杂志, 2018,34(1):63-64.

Xu RB, He SH, Hu XY, et al. Comparative study of clinical results of proximal phalangeal fractures fixed by dorsal mini locking titanium plate or lateral mini locking titanium plate[J]. Chinese Journal of Hand Surgery, 2018,34(1):63-64.

[6] Silva MJ, Brodt MD, Boyer MI, et a1. Effects of increased in vivo excursion on digital range of motion and tendon strength following flexor tendon repair[J]. Journal of Orthopaedic Research, 1999, 17(5): 777-783.

[7] 于志军,纪柳,李庆泰,等. 微型钢板放置指骨背侧与侧方在治疗近节指骨骨折的临床对比[J].实用手外科杂志,2013，27(1):21-23.

Yu ZJ, Ji L, Li QT, et al. Comparative study of fixation of proximal phalangeal fractures using mini titanium plates by dorsal and lateral approach[J]. Journal of Practical Hand Surgery,2013，27(1):21-23.

[8] 常小波. 桡骨头骨折两种内固定方式的生物力学研究[J]. 中国矫形外科杂志, 2018, 26(14): 1324-1327.

Chang XB. A biomechanical study on two types of internal fixation for radial head fracture[J]. Orthopedic Journal of China,2018, 26(14): 1324-1327.

[9] Zhao C, Amadio PC, Momose T, et al. Effect of synergistic wrist motion on adhesion formation after repair of partial flexor digitorum profundus tendon lacerations in a canine model in vivo[J]. Journal of Bone & Joint Surgery-american Volume, 2002, 84-A(1):78-84.

[10] Silva MJ, Brodt MD, Boyer M I, et al. Effects of increased in vivo excursion on digital range of motion and tendon strength following flexor tendon repair[J]. Journal of Orthopaedic Research, 2010, 17(5):777-783.

[11] Kodama N, Takemura Y, Ueba H, et al. Operative treatment of metacarpal and phalangeal fractures in athletes: early return to play[J]. Journal of Orthopaedic ence, 2014, 19(5):729-736.

[12] 张长清,田光磊,胡琪,等. AO微型螺钉内固定术在手部骨折治疗中的应用[J]．中华骨科杂志，2007，27(11)：828-831．

Zhang CQ, Tian GL, Hu Q, et a1. Internal fixation with AO mini-screw for the treatment of hand fractures[J]. Chinese Journal of Orthopaedics, 2007, 27(11):828-831.

[13] Ouellette EA, Freeland AE. Use of the minicondylar plate in metacarpal and phalangeal fractures[J]. Clinical Orthopaedics and Related Research, 1996, (327):38-46.

[14] Bfichler U, Fischer T. Use of a minicondylar plate for metacarpal and phalangeal periarticular injuries[J]. Clinical Orthopaedics and Related Research, 1987, (214): 53-58.

[15] 杨勇,李忠哲,刘坤等. 中节、近节指骨骨折微型钛板侧方固定的疗效分析[J].中华手外科杂志, 2016,30(20):1294-1301.

Yang Y, Li ZZ, Liu K, et a1. Treatment of the middle and proximal phalangeal fractures with lateral fixation of mini-titanium plate[J]. Chinese Journal of Hand Surgery, 2016,30(20):1294-1301.

[16] Lu WW, Furumachi K, Ip WY, et al. Fixation for comminuted phalangeal fractures[J]. Journal of Hand Surgery British & European Volume, 1997, 21(6):765-767.

服务与反馈：

【文章下载】【加入收藏】

提示：您还未登录，请登录！点此登录