本文選題：下脛腓彈性鉤鋼板 + 損傷�。� 參考：《南昌大學(xué)》2014年碩士論文

【摘要】：目的：本實(shí)驗(yàn)對(duì)一種新型下脛腓彈性鉤鋼板進(jìn)行生物力學(xué)分析，應(yīng)用生物力學(xué)試驗(yàn)方法比較運(yùn)用不同內(nèi)固定方式固定下脛腓分離模型對(duì)下脛腓關(guān)節(jié)微動(dòng)特性的影響，為下脛腓彈性鉤鋼板的臨床推廣提供理論依據(jù)。 方法：取8具下脛腓聯(lián)合完整的新鮮冰凍尸體小腿標(biāo)本，在各小腿標(biāo)本的內(nèi)踝和外踝最高點(diǎn)分別安裝兩個(gè)激光掃描儀探測(cè)端子，將各小腿標(biāo)本分為四種狀態(tài)在BOSE材料試驗(yàn)機(jī)上進(jìn)行測(cè)試，四種狀態(tài)分別為下脛腓聯(lián)合完整（對(duì)照組）及破壞下脛腓聯(lián)合后，，依次使用下脛腓彈性鉤鋼板（組）、脛腓鉤（組）、AO螺釘（組）固定下脛腓聯(lián)合，各狀態(tài)下使用BOSE材料試驗(yàn)機(jī)在小腿近端加載類似于生理負(fù)荷的軸向負(fù)載，逐級(jí)加載至500N，實(shí)驗(yàn)過(guò)程保持標(biāo)本的新鮮濕潤(rùn)，正式實(shí)驗(yàn)前進(jìn)行小量程負(fù)載預(yù)加載，以利于減小骨的松弛及蠕變時(shí)間效應(yīng)影響。通過(guò)3D激光掃描儀測(cè)量以上各狀態(tài)下踝關(guān)節(jié)在中立位、背伸45°、跖屈20°、內(nèi)翻30°及外翻30°等不同位置下腓骨遠(yuǎn)端相對(duì)于脛骨遠(yuǎn)端的探測(cè)端子相對(duì)位置變化，通過(guò)三維笛卡兒坐標(biāo)系描述，原點(diǎn)位于踝關(guān)節(jié)處于中立位時(shí)的中心位置。Z軸沿著脛骨長(zhǎng)軸通過(guò)內(nèi)外踝之間的中點(diǎn)，X軸為冠狀面與Z軸垂直，Y軸為矢狀面與Z軸垂直，遵守右手法則。3D激光掃描儀自動(dòng)捕捉內(nèi)外踝處的探測(cè)端子的位置變化并記錄，探測(cè)端子運(yùn)動(dòng)點(diǎn)云圖通過(guò)geomagic studio5.0軟件計(jì)算并轉(zhuǎn)換成腓骨遠(yuǎn)端相對(duì)于脛骨遠(yuǎn)端在X、Y、Z軸上的相對(duì)位移（單位：mm）及Z軸上的相對(duì)旋轉(zhuǎn)角度（單位：°）。 結(jié)果：①踝關(guān)節(jié)各體位下腓骨遠(yuǎn)端與脛骨遠(yuǎn)端X、Y軸相對(duì)位移比較：對(duì)照組與彈性鉤鋼板組比較P0.05，無(wú)顯著性統(tǒng)計(jì)學(xué)差異；對(duì)照組與脛腓鉤組、對(duì)照組與AO螺釘組，組間兩兩對(duì)比P0.05，存在顯著性統(tǒng)計(jì)學(xué)差異。②踝關(guān)節(jié)各體位下腓骨遠(yuǎn)端與脛骨遠(yuǎn)端Z軸相對(duì)位移及旋轉(zhuǎn)角度比較：對(duì)照組、彈性鉤鋼板組、脛腓鉤組，組間兩兩比較P0.05無(wú)顯著性統(tǒng)計(jì)學(xué)差異，對(duì)照組與AO螺釘組對(duì)比P0.05，存在顯著性統(tǒng)計(jì)學(xué)差異。 結(jié)論：生物力學(xué)測(cè)試結(jié)果表明下脛腓彈性鉤鋼板是一種動(dòng)態(tài)的內(nèi)固定器械符合正常下脛腓關(guān)節(jié)的生物力學(xué)特點(diǎn)，既可使踝穴得到可靠的固定又可最大限度的保留了下脛腓關(guān)節(jié)的微動(dòng)，有利于早期功能鍛煉、促進(jìn)下脛腓韌帶及軟組織的修復(fù)。因此下脛腓彈性鉤鋼板生物力學(xué)性能優(yōu)于其他內(nèi)固定方式，是一種治療下脛腓聯(lián)合分離的理想內(nèi)固定器械。
[Abstract]:Objective: to analyze the biomechanics of a new type of tibiofibular hook plate and to compare the effects of different internal fixation methods on the fretting characteristics of the tibiofibular joint.To provide the theoretical basis for the clinical popularization of the elastic hook plate of the lower tibiofibular.Methods: eight fresh frozen calf specimens of the tibiofibular syndesmosis were collected and two laser scanners were installed on the medial malleolus and lateral malleolus at the highest point of each leg specimen respectively.Each leg specimen was divided into four states, which were tested on BOSE material testing machine. The four states were the integrity of the tibiofibular syndesmosis (control group) and the destruction of the tibiofibular syndesmosis.The tibiofibular elastic hook plate (group B), tibiofibular hook (group B), AO screw (group B) were used to fix the tibiofibular joint in turn. The axial load similar to physiological load was loaded at the proximal end of the leg by using BOSE material testing machine in each state.After loading to 500N step by step, the fresh specimen was wetted and preloaded with small range load before the formal experiment, so as to reduce the effect of relaxation and creep time of bone.The relative position of distal fibula to distal tibia was measured by 3D laser scanner in neutral position, 45 擄extension, 20 擄plantar flexion, 30 擄varus and 30 擄valgus.According to the three dimensional Cartesian coordinate system, the center position of origin in the neutral position of ankle joint. Z axis is vertical to Z axis and coronal plane to Z axis along the midpoint of tibial axis passing through the medial and lateral malleolus, and the X axis is coronal plane and Z axis vertical and Y axis is sagittal plane and Z axis is perpendicular to Z axis.Follow the right-hand rule. 3D laser scanner automatically captures the position of the probe terminal at the inner and lateral malleolus and records,The moving-point cloud map of the probe terminal was calculated by geomagic studio5.0 software and converted into the relative displacement of distal fibula to the distal tibia (unit: mm) and the relative rotation angle on Z axis (unit: 擄).Results the relative displacement of the distal fibula and the distal tibia of the distal fibula and the distal tibia under different positions of the ankle joint were compared: there was no significant difference between the control group and the elastic hook plate group (P 0.05), the control group with the tibiofibular hook group, the control group with AO screw group, the control group and the AO screw group.There was significant statistical difference between the two groups (P0.05). 2 the relative displacement and rotation angle of Z axis of distal fibula and distal tibia under all positions of ankle joint were compared: control group, elastic hook plate group, tibiofibular hook group, and tibiofibular hook group.There was no significant statistical difference between the two groups (P0.05), but there was significant statistical difference between the control group and AO screw group (P0.05).Conclusion: the results of biomechanical test indicate that the elastic hook plate of tibiofibular joint is a kind of dynamic internal fixation instrument which accords with the biomechanical characteristics of the normal tibiofibular joint.It can not only make the ankle point fixed reliably, but also retain the fretting of the lower tibiofibular joint to the maximum extent, which is beneficial to the early functional exercise and promote the repair of the lower tibiofibular ligament and soft tissue.Therefore, the biomechanical properties of the elastic hook plate are superior to those of other internal fixation methods, and it is an ideal internal fixation instrument for the treatment of the separation of the tibiofibular syndesmosis.
【學(xué)位授予單位】：南昌大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R318.01

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