前路钛板加方形区螺钉治疗髋臼双柱骨折的坐位生物力学分析

摘要

目的 探讨前路钛板加方形区螺钉治疗髋臼双柱骨折早期取坐位的可能性.方法 取成年防腐保湿处理的全骨盆标本6具,保留韧带及髋关节囊,制作单侧髋臼高位双柱骨折模型,随机先后采用前路钛板加方形区螺钉(B组)或常规钛板加1/3管型钛板(C组)内固定,固定标本于ZWICKZ100电子万能材料试验机上,模拟坐立位以400~700N加载,采用循环多次测量的方法,每组含标本6具,先后测定完整骨盆(A组)、B组及C组后柱内壁横向位移、骨盆轴向位移,计算骨盆轴向刚度.结果 随着载荷增加,位移:A组0.05),骨盆轴向位移及刚度有统计学差异(P<0.01).结论 前路钛板加方形区螺钉(B组)与常规钛板加1/3管型钛板(C组)固定髋臼双柱骨折术后均可取坐位,但前路钛板加方形区螺钉固定后骨盆髋关节稳定性更强,与完整骨盆接近,早期取坐位是更安全和可靠的.%Objective To explore the sitting possibility of both-column acetabular fractures fixed by anteri — or titanium plate-screws in quadrilateral area in the early stage.Methods Six adult pelvic specimens which were wetly preserved with antiseptic treatment were selected.Their ligament and joint capsule of hip joint were reserved.The pelvis was made into highly both -column acetabular fractures laterally.After that,the fractures were fixed by anterior titanium plate — screws in quadrilateral area ( group B) or the conventional 1/3 tube type titanium plate ( group C ) on random.The specimen was fixed to simulate the static sitting position on ZWICK -Z100 electronic u— niversal material testing machine ,and was given the vertical loading from 400N to 700N.At the same time,the lateral displacement of posterior column wall and the axial displacement of pelvis were measured in the whole pelvis ( group A) ,group B and group C ,respectively.The axial stiffness of pelvis was calculated.Results As the step load adding ,the displacements were A < B < C,increasing in line.The statistical difference of the lateral displace — ment in posterior column wall was not significant (P >0.05) ,while the difference of the axial displacement and the stiffness in pelvis were markedly significant (P <0.01).Conclusion The both-eolumn acetabular fractures fixed by anterior titanium plate-screws in quadrilateral area or the conventional 1/3 tube type titanium plate has the ideal internal result which allows patients to take the seat early ,but "anterior titanium plate-screws in quadrilateral area" is better than the conventional 1/3 tube type titanium plate on the stability of the hip joint ,which is close to the stability of normal pelvis.Sitting early is more secure and reliable in anterior titanium plate -screws in quadrilateral area.