髋臼四边体骨折3种内固定方式的生物力学评价

doi:10.13418/j.issn.1001-165x.2015.06.016

中国临床解剖学杂志 ›› 2015, Vol. 33 ›› Issue (6): 690-695.doi: 10.13418/j.issn.1001-165x.2015.06.016

髋臼四边体骨折3种内固定方式的生物力学评价

王雷¹，　吴啸波²，　王永斌³，　齐巍²

1. 华北理工大学研究生学院，河北唐山 063009； 2.唐山市第二医院（华北理工大学附属骨科医院）
创伤骨科, 河北唐山 063000； 3.华北理工大学公共卫生学院，河北唐山 063000

收稿日期:2015-07-26 出版日期:2015-11-25 发布日期:2015-12-18
通讯作者: 吴啸波，教授，硕士生导师，E-mail：drwuxiaobo@ foxmail.com
作者简介:王雷（1989-），男，安徽安庆人，在读硕士，研究方向：骨盆与髋臼骨折的治疗，Tel：15715510488， E-mail:waglei1989@163.com
基金资助:
河北省卫生厅医学科学研究重点课题计划(20130665)

Biomechanical evaluation of three kinds of internal fixation methods for acetabular quadrilateral area fracture

WANG Lei¹,WU Xiao-bo²,WANG Yong-bin³, QI Wei²

1. School of Graduate, North China University of Science and Technology, Tangshan, Hebei 063009, China; 2. Department of Orthopaedics and Traumatology, the 2nd Hospital of Tangshan (North China University of Science and Technology Affiliated Orthopedic Hospital), Tangshan, Hebei 063000； 3. School of Public Health, North China University of Science and Technology，Tangshan, Hebei 063000,China

Received:2015-07-26 Online:2015-11-25 Published:2015-12-18

摘要/Abstract

摘要：

目的　探究髋臼四边体骨折的最优内固定方式。方法　采用半骨盆标本制作髋臼四边体骨折模型12具，按内固定方式随机分成3组，A组：骨盆缘下重建接骨板，B组：骨盆缘下锁定重建接骨板，C组：前柱重建接骨板结合方形区螺钉。将柳叶状压敏片贴于股骨头上，通过垂直加载依次测量生理体重600 N下完整髋臼I组（未制作骨折线）和A、B、C 3组的臼顶接触特性，及连续分级负载下A、B、C 3组的水平位移和纵向位移。结果生理体重600 N下3组内固定的髋臼负重区接触特性未能恢复至正常，负重面积、平均应力、峰值应力及分级载荷下水平位移和纵向位移均存在统计学差异（P<0.05，200 N除外），且水平位移和纵向位移都随载荷的增加而增大，而在1800 N时A组纵向位移达到失效标准。结论对髋臼四边体骨折予以3种不同内固定，前柱重建接骨板结合方形区螺钉内固定的稳定性及接触特性均优于骨盆缘下接骨板内固定，可以减少创伤性关节炎的发生率。

关键词: , 髋臼, 骨折, 生物力学

Abstract:

Objective　The purpose of this study was to evaluate the best internal fixation methods of acetabular quadrilateral area fracture. Methods The quadrilateral area fracture models were created by 12 males hemipelves specimens, divided into three groups randomly. The fractures were treated respectively with the following internal fixaction methods, infrapectineal buttress reconstruction plate (group A), infrapectineal buttress locking compression plate (group B), reconstruction plate combined with trans-plate quadrilateral screws(group C). Then the willow leaf films were stuck on the femoral head and vertical compressing loading was continued via the fracture models, followed by measurement of physiological weight 600 N on intact acetabulum in group I(No fracture line was made) and internal fixation of acetabular dome contact characteristics and horizontal and vertical displacements in A, B, C groups. Results Under physiological weight of 600 N, acetabular dome contact characteristics in three groups failed to return to normal, There was a significant difference on the loading area, the mean pressure, the peak pressure, horizontal displacements and longitudinal displacements among groups (P<0.05，besides 200 N). With loads increasing, horizontal displacements and longitudinal displacements were larger，and under 1800 N the longitudinal displacements of group A reached failure criteria.　Conclusions　For the acetabular quadrilateral area fracture, the internal fixation stability and contact characteristic of reconstruction plate combined with trans-plate quadrilateral screw metho is w better than infrapectineal buttress plate, and it can reduce incidence rate of traumatic arthritis.

Key words: Acetabular, Fracture, Biomechanical

王雷,吴啸波,王永斌,齐巍. 髋臼四边体骨折3种内固定方式的生物力学评价[J]. 中国临床解剖学杂志, 2015, 33(6): 690-695.

参考文献

[1] Qureshi AA, Archdeacon MT, Jenkins MA, et a1.Infrapectineal plating for acetabular fractures: a technical adjunct to internal fixation[J].J Orthop Trauma.2004,18(3):175-178.
[2] El-khadraweT. A, Hammad A.S, Hassaan A.E. Indicators of outcome after internal fixation of complex acetabular fractures[J].Alexandria Journal of Medicine,2012,2(48):99-107.
[3] Sen R K, Tripathy S K, Aggarwal S, et al. Comminuted quadrilateral plate fracture fixation through the iliofemoral approach[J].Injury,2013,44(2):266-273.
[4] 蔡贤华,刘曦明,汪国栋,等.前路钛板结合方形区螺钉内固定治疗涉及方形区的髋臼骨折[J].中华创伤骨科杂志,2013,15(2):102-106.
[5] Malkani AL1, Voor MJ, et al. Increased Peak Contact Stress after Incongruent Reductionof Transverse Acetabular Fractures: A Cadaveric Model s[J]. J Trauma. 2001,51(4):704-9.
[6] 吴啸波,张奇,郭明珂,等. 髋臼后柱骨折不同方式钢板内固定的稳定性研究[J]. 第三军医大学学报,2010,07:665-668.
[7] Bray TJ, Esser M, Fulkerson L. Osteotomy of the trochanterin open reduction and internal fixation of acetabular fractures[J].J Bone Joint Surg Am,1987,69(5):711-717.
[8] Kistler BJ, Smithson IR, Cooper SA, et al. Are quadrilateral surface buttress plates comparable to traditional forms of transverse acetabular fracture fixation [J]. Clin Orthop Relat Res, 2014, 472(11): 3353-3361.
[9] Yildirim AO, Alemdaroglu KB, Yuksel HY, et al. Finite element analysis of the stability of transverse acetabular fractures in standing and sitting positions by different fixation options[J]. Injury, 2015, 46 Suppl 2: S29-35.
[10]Kaku N, Tsumura H, Taira H, et al. Biomechanical study of load transfer of the pubic ramus due to pelvic inclination after hip joint surgery using a three-dimensional finite element model[J]. J Orthop Sci,2004,9(3):264-269.
[11]Cole J D, Bolhofner B R. Acetabular fracture fixation via a modified Stoppa limited intrapelvic approach. Description of operative technique and preliminary treatment results[J].Clin Orthop Relat Res, 1994,305: 112-123.
[12]Archdeacon M T, Kazemi N, Guy P, et al.The modified Stoppa approach for acetabular fracture[J]. J Am Acad Orthop Surg, 2011,19(3):170-175.
[13]Bible J E, Choxi A A, Kadakia R J, et al. Quantification of bony pelvic exposure through the modified Stoppa approach[J]. J Orthop Trauma,2014,28(6):320-323.
[14]Qureshi AA，Archdeacon MT，Jenkins MA，et a1.Infrapectineal plating for acetabular fractures：a technical adjunct to internal fixation[J].J Orthop Trauma, 2004,18(3):175-178.
[15]Sen R K, Tripathy S K, Aggarwal S, et al. Comminuted quadrilateral plate fracture fixation through the iliofemoral approach[J]. Injury, 2013,44(2):266-273.
[16]Kummer B. The clinical relevance of Biomechanical analysis of the hip area[J]. Zorthop Ihre Grenzgeb,1991,129(4):285-294.
[17]Hak DJ, Hamel AJ,Bay BK,et a.Consequences of transverse acetabular fracture malreduction on load transmission across the hip joint[J].J Orthop Trauma.1998,12 (2):90-100.
[18]王庆贤,张英泽,潘进社,李亚洲,薛静,刘向东,宋朝晖. 髋臼横断骨折不同内固定方法臼顶负重区的应力分布[J].中华创伤杂志,2004,12:43-46.
[19]Vailas JC, Hurwitz S, Wiesel SW. Posterior acetabular fracture dislocations: fragment size， joint capsule and stability[J]. J Trauma,1989,29(11):1494-1496．

髋臼四边体骨折3种内固定方式的生物力学评价

Biomechanical evaluation of three kinds of internal fixation methods for acetabular quadrilateral area fracture

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