股骨髁骨折植入物内固定后的生物力学变化

摘要

BACKGROUND:Clinical treatment of epicondyle fractures and intercondylar comminuted fractures is quite tricky due to instability and spread to the articular surface. Common complications contained bone delayed union, nonunion, broken nails and broken boards. Internal fixation for fractures is various, but reasonable choice for clinical fixation plays a decisive role for repair of fractures. OBJECTIVE:To explore the repair effects of various fixation methods on femoral condyle fracture from different aspects such as fracture type, bone healing, functional recovery and biomechanics. METHODS:First author searched PubMed database and China National Knowledge Infrastructure for articles about various fixation methods in repair of femoral condyle fracture published from January 2000 to April 2014. Key words were“femoral condyle fracture, internal fixation, biomechanics, load-displacement, axial stiffness, horizontal shear stiffness”. Total y 142 articles were retrieved, but 39 articles met the inclusion criteria. RESULTS AND CONCLUSION:Femoral condyle fracture caused the damage to normal anatomic structure of knee join, changed normal anatomical axis and the mechanical axis of knee joint. Therefore, anatomic reduction and rigid internal fixation are necessary. During treatment, the advantages and disadvantages of various fixation methods should be known. It is necessary to ful y evaluate the type of intercondylar fractures of the femoral condyle and soft tissue injury. According to biological characteristics of the human body and mechanical property, internal fixation device should be reasonably used. Individual treatment programs should be provided. Thus, the occurrence of postoperative complications should be reduced utmostly, resulting in a satisfactory repair outcome.%背景：髁上骨折、髁间骨折常因粉碎不稳定和波及关节面，临床处理相当棘手，常见的并发症有骨延迟愈合、骨不连、断钉及断板等，骨折内固定方法繁多，但合理选择内固定方式对骨折修复起着决定性的作用。　　目的：着重从骨折分型、骨愈合、功能恢复及生物力学等方面探讨不同内固定方法对于股骨髁骨折的修复效果。　　方法：第一作者应用计算机检索2000年1月至2014年4月PubMed数据库、中国期刊全文数据库有关不同内固定方法修复股骨髁骨折的文章，英文检索词“emoral condyle fracture，internal fixation，biomechanics， load-displacement，axial stiffness，horizontal shear stiffness”；中文检索词“股骨髁骨折，内固定器械，生物力学，载荷-位移，轴向刚度，水平剪切刚度”。共检索到142篇相关文献，39篇文献符合纳入标准。　　结果与结论：股骨髁部骨折可以造成膝关节正常解剖关系的破坏，改变膝关节正常的解剖轴和机械轴，所以必须解剖复位和坚强内固定。治疗过程中应掌握各种内固定方法的利弊，全面评估股骨髁及髁间骨折的类型和软组织损伤程度，根据人体的生物特点、力学性能合理使用内固定器械，提供个体化治疗方案，从而最大程度减少术后并发症的出现，达到满意的内固定修复效果。