本文選題：生物力學(xué) + 骶髂關(guān)節(jié)骨折脫位�。� 參考：《蘇州大學(xué)》2015年碩士論文

【摘要】：目的:通過生物力學(xué)研究比較單側(cè)骶髂螺釘、后路“門”形張力帶接骨板、前路接骨板及“π”棒固定治療單側(cè)骶髂關(guān)節(jié)骨折脫位的固定效果。方法:隨機(jī)選擇5具成年人骨盆標(biāo)本,排除病理性差異,保留第4腰椎和股骨近端1/3,保留雙側(cè)髖關(guān)節(jié)囊及骨盆各主要韌帶結(jié)構(gòu),剝除多余軟組織,切斷連接同側(cè)骶髂關(guān)節(jié)的韌帶,分離骶髂關(guān)節(jié)之耳狀關(guān)節(jié)面,切斷恥骨聯(lián)合,制作單側(cè)骶髂關(guān)節(jié)脫位-恥骨聯(lián)合分離模型。隨機(jī)挑選1具骨盆標(biāo)本,進(jìn)行預(yù)實(shí)驗(yàn),證明單個標(biāo)本循環(huán)行四種內(nèi)固定方式可行。隨機(jī)將4具成年防腐骨盆標(biāo)本分成A、B、C、D組,每組1具,應(yīng)用隨機(jī)數(shù)字表隨機(jī)決定每個標(biāo)本四種內(nèi)固定物的固定順序,模擬臨床手術(shù)方式行四種骨盆后環(huán)內(nèi)固定,恥骨聯(lián)合予重建接骨板固定(閉環(huán))。應(yīng)用生物力學(xué)實(shí)驗(yàn)機(jī),在平臺上垂直向下以20N/s的速度施加3次0~650N的垂直負(fù)荷,觀察標(biāo)本在100N、200N、300N、400N、500N(模擬自重)下的移位情況,并選取雙側(cè)髂后上棘標(biāo)記1及2,和雙側(cè)坐骨結(jié)節(jié)標(biāo)記3及4,應(yīng)用千分游標(biāo)卡尺測量標(biāo)記點(diǎn)的加載前后相對載物平臺的垂直距離及1/2、3/4間位移,計算出骶髂關(guān)節(jié)分離的水平及垂直位移。以0.2°/s的角速度對標(biāo)本加載扭轉(zhuǎn)負(fù)荷,使其扭轉(zhuǎn)1°、2°、3°、4°、5°、6°,觀察扭轉(zhuǎn)角度及對應(yīng)的扭矩,重復(fù)測量三次,計算平均值。隨后,拆除4組標(biāo)本前路接骨板(開環(huán)),選取雙側(cè)恥骨結(jié)節(jié)標(biāo)記5及6,測得相應(yīng)1/2、3/4以及5/6位移及扭矩值。重復(fù)上述實(shí)驗(yàn)步驟測得實(shí)驗(yàn)數(shù)據(jù),保證每組標(biāo)本在開閉環(huán)狀態(tài)下后環(huán)均完成四種內(nèi)固定物的數(shù)據(jù)測定。采用SPSS統(tǒng)計學(xué)分析比較各內(nèi)固定物的固定效果。結(jié)果:垂直負(fù)荷實(shí)驗(yàn)中,四種內(nèi)固定物均發(fā)生彈性形變,穩(wěn)定性均與加載強(qiáng)度呈反比;閉環(huán)條件下,控制水平穩(wěn)定性后路“門”形張力帶接骨板較好,控制垂直穩(wěn)定性“π”棒固定效果較好;開環(huán)條件下,后環(huán)控制結(jié)論同前,前環(huán)水平穩(wěn)定性控制單側(cè)骶髂螺釘最佳,垂直穩(wěn)定性控制前路接骨板最佳。整體抗扭穩(wěn)定性,閉環(huán)下后路張力帶接骨板最佳,開環(huán)下“π”棒最佳。結(jié)論:無論前環(huán)是否固定,后路“π”棒固定對維持骨盆穩(wěn)定性均優(yōu)勢明顯,微創(chuàng)手術(shù)治療時后路“門”形張力帶接骨板較有優(yōu)勢。
[Abstract]:Objective: to compare the effect of unilateral sacroiliac screw, posterior portal tension band plate, anterior plate and 蟺 rod fixation in the treatment of unilateral sacroiliac joint fracture and dislocation by biomechanical study. Methods: five adult pelvic specimens were randomly selected to remove pathological differences, to retain 1 / 3 of the fourth lumbar vertebra and proximal femur, to preserve the structures of the bilateral hip capsule and pelvic major ligaments, and to remove the excess soft tissue. The ligaments connected with the ipsilateral sacroiliac joint were cut off, the auricular articular surface of the sacroiliac joint was separated, and the symphysis pubis was cut off, and the model of unilateral dislocation of sacroiliac joint and symphysis pubis was made. One pelvis specimen was randomly selected, and the results showed that four internal fixation methods were feasible for a single specimen. Four adult anticorrosive pelvis specimens were randomly divided into two groups, one in each group. The fixed order of four internal fixators was randomly determined by random digital table, and four kinds of posterior pelvic ring fixation were performed by simulating clinical operation. The pubic symphysis was fixed with the reconstructed plate (closed loop). Using a biomechanical experiment machine, the vertical loading of 0 ~ 650N was applied three times to the platform vertically downward at the speed of 20 N / s, and the displacement of the specimen was observed under the condition of 100Nm ~ (200) N ~ (3) N ~ (300) N ~ (-1) ~ (400) N ~ (-1) ~ (500) N (simulated deadweight). The marks of bilateral posterior superior iliac spine (1 and 2) and bilateral ischium nodule (3 and 4) were used to measure the vertical distance and 1 / 2 / 3 / 4 displacement of the marker points before and after loading. The horizontal and vertical displacement of sacroiliac joint separation was calculated. The torsional load of the specimen was loaded with the angular velocity of 0.2 擄/ s to make the torsion 1 擄2 擄3 擄3 擄4 擄5 擄5 擄6 擄. The torsion angle and the corresponding torque were observed, the torsion angle was measured three times and the average value was calculated. Then, the anterior plate (open loop) of 4 groups of specimens was removed, and the bilateral pubic nodule was labeled 5 and 6. The displacement and torque values of 1 / 2 / 3 / 4 and 5 / 6 were measured. The experimental data were obtained by repeating the above experimental steps to ensure that the data of four kinds of internal fixators were completed in each group of specimens in the open and closed loop state. SPSS statistical analysis was used to compare the fixation effect of each internal fixator. Results: in the vertical load experiment, the four kinds of internal fixators had elastic deformation, and the stability was inversely proportional to the loading strength, and under the closed loop condition, the "gate" tension band plate was better to control the horizontal stability. Under the open loop condition, the posterior ring control conclusion is the same, the anterior ring horizontal stability control unilateral sacroiliac screw is the best, and the vertical stability control the anterior osseous plate is the best. The overall torsional stability, the closed loop under the tension band plate is the best, open loop "蟺" rod is the best. Conclusion: whether or not the anterior ring is fixed or not, the posterior "蟺" rod fixation has a significant advantage in maintaining pelvic stability, and the posterior "portal" tension band plate is superior in minimally invasive surgery.
【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R687.3

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