北京生物醫(yī)學(xué)工程

指骨骨折側(cè)方置板的力學(xué)穩(wěn)定性研究

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

作者：習(xí)洪波陳奕文王勤業(yè) 葉華鑫羅亞平范志娣危濤華子愷

單位：上海市嘉定區(qū)南翔醫(yī)院骨科（上海 201802）; 上海大學(xué)機(jī)電工程及自動化學(xué)院（上海200444）

關(guān)鍵詞：指骨骨折；內(nèi)固定；接骨板；生物力學(xué)；穩(wěn)定性

分類號：R318.04

出版年·卷·期（頁碼）：2020·39·5（477-483）

摘要：

目的指骨骨折手術(shù)中接骨板的置板部位對于指功能康復(fù)具有重要影響，背側(cè)置板雖然能為骨折區(qū)域提供良好力學(xué)穩(wěn)定性，但容易造成術(shù)后軟組粘連，不利于手指功能恢復(fù)。作為一個新的指骨內(nèi)固定手術(shù)方式，側(cè)方置板能夠有效避免軟組織粘連的發(fā)生，提供更有利的指功能康復(fù)條件。目前，側(cè)方固定的力學(xué)穩(wěn)定性尚未得到系統(tǒng)性研究與證實。本文擬通過對背側(cè)置板與側(cè)方置板在抗扭轉(zhuǎn)性能的比對試驗，對側(cè)方置板的力學(xué)穩(wěn)定性進(jìn)行評估。方法采用Synbone 3D打印人工指骨，共4種型號，每種型號2例樣品預(yù)置骨折。8例指骨骨折模型分為背側(cè)置板組與側(cè)方置板組兩組予以內(nèi)固定。以抗扭性能為主要評價指標(biāo)，將指骨板樣品加載扭轉(zhuǎn)，得到扭轉(zhuǎn)力矩和斷裂扭轉(zhuǎn)角，對比兩者植入后的力學(xué)差異。結(jié)果實驗中樣品失效形式有所不同，指骨骨折側(cè)方置板樣品的平均斷裂扭矩為（0.96±0.08）N·m，平均斷裂扭轉(zhuǎn)角為（115.1±120.0）°，背側(cè)置板樣品的平均斷裂扭矩為（1.40±0.35）N·m，平均斷裂扭轉(zhuǎn)角為126.5°±83.1°，兩者的斷裂扭矩與斷裂角在統(tǒng)計學(xué)上均沒有顯著性差異（P＞0.05）。結(jié)論采用指接骨板背側(cè)置板和側(cè)方置板的指骨骨折內(nèi)固定的扭轉(zhuǎn)性能在統(tǒng)計學(xué)上沒有顯著性差異，側(cè)方置板能夠保證指骨骨折重建后的初期穩(wěn)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.

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