外側(cè)鎖定鋼板內(nèi)側(cè)克氏針在肱骨遠(yuǎn)端骨折的應(yīng)用研究
發(fā)布時(shí)間：2018-12-19 11:49
【摘要】：目的本研究擬通過生物力學(xué)研究和臨床病例分析,探討簡化肱骨遠(yuǎn)端簡單骨折的治療方式,分析外側(cè)解剖鎖定鋼板內(nèi)側(cè)克氏針技術(shù)治療肱骨遠(yuǎn)端簡單骨折的臨床療效和生物力學(xué)方面的可行性。方法臨床研究：回顧性分析2006年3月～2012年3月,我科治療的47例肱骨遠(yuǎn)端簡單骨折,按照A0分型：肱骨髁上骨折23例,肱骨髁間骨折C1型24例。男29例,女18例,年齡18歲～53歲,(平均36.5歲)。雙鋼板內(nèi)固定技術(shù)(簡稱雙鋼板組)治療22例,外側(cè)鎖定鋼板內(nèi)側(cè)克氏針技術(shù)(簡稱外側(cè)鋼板內(nèi)側(cè)克氏針組)治療25例。觀察指標(biāo)包括：手術(shù)時(shí)間,術(shù)中肱骨遠(yuǎn)端的骨膜剝離范圍,骨折的愈合時(shí)間,術(shù)后肘關(guān)節(jié)的功能。術(shù)后所有患者均采用可調(diào)式支具固定肘關(guān)節(jié)于屈曲90。,術(shù)后早期肘關(guān)節(jié)個(gè)性化功能鍛煉。生物力學(xué)研究：成人尸體肱骨標(biāo)本6例,左側(cè)3例,右側(cè)3例。去除肱骨周圍軟組織,制成肱骨遠(yuǎn)端骨折內(nèi)固定模型。①肱骨髁上骨折外側(cè)鎖定鋼板內(nèi)側(cè)克氏針固定模型,②肱骨髁上骨折雙鋼板固定模型,③肱骨髁間骨折外側(cè)鎖定鋼板內(nèi)側(cè)克氏針固定模型(C1型),④肱骨髁間骨折雙鋼板固定模型(C1型)。實(shí)驗(yàn)機(jī)器為島津(AGS-X10KN)生物力學(xué)電子萬能試驗(yàn)機(jī)。將上述標(biāo)本分別堅(jiān)強(qiáng)固定于自制的標(biāo)本固定板上,每一個(gè)標(biāo)本先進(jìn)行模擬肱骨遠(yuǎn)端伸直位壓縮載荷測(cè)試,再進(jìn)行模擬肱骨遠(yuǎn)端屈曲位壓縮載荷測(cè)試。分別測(cè)定各個(gè)標(biāo)本的模擬載荷行程中的載荷力學(xué)參數(shù),并記錄相關(guān)的行程圖。結(jié)果臨床研究：所有病例均隨訪12月以上,骨折均在12～18周內(nèi)愈合。手術(shù)時(shí)間,雙鋼板組139.09±17.63分鐘,外側(cè)鋼板內(nèi)側(cè)克氏針組112.60±13.70分鐘,t=4.619,p=0.001,P0.05認(rèn)為差異有統(tǒng)計(jì)學(xué)意義,外側(cè)鋼板內(nèi)側(cè)克氏針組手術(shù)時(shí)間明顯少于雙鋼板組。術(shù)中骨膜剝離的范圍：雙鋼板組手術(shù)中骨膜剝離的面積為32.90±2.24cm2,外側(cè)鋼板內(nèi)側(cè)克氏針組為28.48±2.19cm2, t=3.434, p=0.001, P0.05認(rèn)為差異有顯著性。雙鋼板組的骨膜剝離面積多于外側(cè)鋼板內(nèi)側(cè)克氏針組。骨折愈合時(shí)間：雙鋼板組骨折愈合時(shí)間16.27±2.58周,外側(cè)鋼板內(nèi)側(cè)克氏針組骨折愈合時(shí)間13.16±1.10周,t=5.241,P=0.001,P0.05認(rèn)為差異有統(tǒng)計(jì)學(xué)意義。外側(cè)鋼板內(nèi)側(cè)克氏針組骨折愈合時(shí)間優(yōu)于雙鋼板組。肘關(guān)節(jié)功能(Cassebaum評(píng)分),雙鋼板組優(yōu)14例,良7例。外側(cè)鋼板內(nèi)側(cè)克氏針組優(yōu)16例,良7例,兩組無顯著性差異。雙鋼板組術(shù)后2例術(shù)后出現(xiàn)尺神經(jīng)激惹表現(xiàn),后自行恢復(fù)。生物力學(xué)研究：在肱骨髁上骨折的兩種固定方式中,模擬伸直位壓縮行程中,雙鋼板組的固定強(qiáng)度均值為327.47±14.80,外側(cè)鋼板內(nèi)側(cè)克氏針組的均值303.80±11.60N,p0.05,兩組間無顯著性差異。模擬屈曲位壓縮行程中,雙鋼板固定的強(qiáng)度均值為311.56±18.92N,而外側(cè)鋼板內(nèi)側(cè)克氏針組的均值為277.23±17.45N,p0.05,兩組間有顯著性差異。在肱骨髁間骨折(C1型)的兩種固定方式中,在模擬伸直位壓縮行程中,雙鋼板組的固定強(qiáng)度均值為267.18±15.22N,外側(cè)鋼板內(nèi)側(cè)克氏針組的固定強(qiáng)度均值為241.51±12.08,p0.05,兩組間有顯著性差異。在屈曲位壓縮行程中,雙鋼板固定的強(qiáng)度均值為213.19±10.34N,而外側(cè)鋼板內(nèi)側(cè)克氏針組的均值為182.42±14.04N,p0.05,兩組間有顯著性差異。結(jié)論通過臨床病例分析,應(yīng)用外側(cè)解剖鎖定鋼板內(nèi)側(cè)克氏針技術(shù)治療肱骨遠(yuǎn)端簡單骨折,結(jié)合恰當(dāng)?shù)膫�(gè)性化術(shù)后功能鍛煉方案,取得了較好的臨床效果。較雙鋼板固定技術(shù)相比,外側(cè)鎖定鋼板內(nèi)側(cè)克氏針組,手術(shù)時(shí)間較短,骨折愈合時(shí)間較短,術(shù)后肘關(guān)節(jié)的功能無明顯差距,費(fèi)用更低。肱骨遠(yuǎn)端骨折生物力學(xué)研究發(fā)現(xiàn),外側(cè)鎖定鋼板內(nèi)側(cè)克氏針固定技術(shù)與雙鋼板固定技術(shù)相比較,遠(yuǎn)側(cè)骨折端的內(nèi)固定物的固定強(qiáng)度,在模擬髁上骨折伸直位壓縮行程試驗(yàn)中,無明顯差異。在肱骨髁上骨折屈曲位和髁間骨折壓縮行程中,有顯著性差異,但是其強(qiáng)度均數(shù)差值不足15%,通過有效的外固定輔助,也可以取得良好的冶療效果,本試驗(yàn)為此類骨折的手術(shù)方式選擇提供了有力的理論依據(jù)。
[Abstract]:Objective To study the clinical and biomechanical aspects of the treatment of the distal simple fracture of the humerus by means of the biomechanical study and the clinical case analysis. Methods: From March 2006 to March 2012, 47 cases of distal simple fracture of the humerus were retrospectively analyzed. According to the classification of A0, there were 23 cases of supracondylar fracture of the humerus, and 24 cases of the intercondylar fracture of the humerus. There were 29 males and 18 females. The age was 18 to 53 years (average 36. 5 years). Twenty-two cases were treated with double-plate internal fixation (double-plate group), and 25 cases were treated with the inner g-needle technique of the lateral locking steel plate (the inner side of the lateral plate of the lateral plate). The observation index included: the time of operation, the extent of the periosteum of the distal end of the humerus, the healing time of the fracture, and the function of the elbow joint after operation. All patients after operation were fixed with the adjustable branch to the flexion of 90. At the early stage of the operation, the functional exercise of the elbow joint was performed. Biomechanical study: 6 cases of the adult cadavers, 3 in the left and 3 on the right. The soft tissue surrounding the humerus was removed and a fixed model of the distal humeral fracture was made. The inner g-pin fixed model of the lateral locking steel plate on the supracondylar fracture of the humerus, the double-plate fixed model for the supracondylar fracture of the humerus, the fixed model of the inner g-pin of the lateral locking steel plate on the lateral humeral intercondylar fracture (type C1) and the double-plate fixed model (type C1) for the intercondylar fracture of the humerus. The experimental machine is an AGS-X10KN biomechanics electronic universal testing machine. The specimens are respectively and firmly fixed on the self-made specimen fixing plate, and each specimen is used for simulating the compression load test of the distal extension position of the humerus, and then the compression load test of the distal flexion position of the humerus is simulated. The load mechanics parameters in the simulated load stroke of each specimen were measured, and the related travel chart was recorded. Results: All the cases were followed up for more than 12 months and the fracture healed within 12-18 weeks. The operation time, the double-plate group was 139. 09-17. 63 minutes, the inner g-needle group of the lateral steel plate was 112. 60-13.70 minutes, t = 4.619, p = 0.001, P0.05), the difference was statistically significant, and the operation time of the inner g-needle group of the lateral steel plate was significantly lower than that of the double-plate group. The range of periosteum dissection during operation: the area of the periosteum in the operation of the double-plate group was 32.90-2.24cm2, the inner g-needle group of the lateral steel plate was 28. 48-2.19cm2, t = 3.434, p = 0.001, P <0.05, the difference was significant. The area of the periosteum of the double-plate group is more than that of the inner g-group of the lateral steel plate. The time of fracture healing: the fracture healing time of the two-plate group was 16.27-2.58 weeks, and the fracture healing time of the inner g-needle group of the lateral steel plate was 13. 16-1. 10 weeks, t = 5.241, P = 0.001, P <0.05, and the difference was of statistical significance. The fracture healing time was better than that of the double-plate group. The elbow joint function (Cassaebaum score), the double-plate group was excellent in 14 cases, and the good in 7 cases. There were 16 cases, good in 7, and no significant difference between the two groups. 2 cases after the operation of the double-plate group, the appearance of the ulnar nerve in 2 cases after operation, and the self-recovery of the ulnar nerve after the operation. Biomechanical study: In the two fixation modes of the supracondylar fracture of the humerus, the mean value of the fixation strength of the double-plate group was 32.7. 47-14.80, the mean value of the inner g-pin group of the lateral steel plate was 303.80, 11.60N, p0.05, and there was no significant difference between the two groups. In the simulated buckling position, the mean value of the double-plate fixation was 311.56-18.92N, while the mean value of the inner g-pin group of the lateral steel plate was 277.23-175.45N, p0.05, and there was a significant difference between the two groups. In the two fixation modes of the intercondylar fracture of the humerus (type C1), the mean value of the fixation strength of the double-plate group was 267.18-15.22N in the simulated straight-position compression stroke, and the mean value of the fixed intensity of the inner g-pin group of the lateral steel plate was 241.51-12.08, p0.05, and there was a significant difference between the two groups. In the compression stroke of the buckling position, the average strength of the double-plate fixation was 213.19-10.34N, while the mean value of the inner g-pin group of the lateral steel plate was 182.42-14.04N, p0.05, and there was a significant difference between the two groups. Conclusion Through the analysis of the clinical cases, the treatment of the distal simple fracture of the distal humerus by using the medial g-needle technique of the external anatomic locking steel plate and the proper individualized postoperative functional exercise program have achieved a good clinical effect. Compared with the double-plate fixation technology, the lateral locking steel plate has the advantages of short operation time, short fracture healing time and no significant difference in the function of the elbow joint after the operation, and the cost is lower. The biomechanical study of the distal end of the humerus found that the fixed strength of the internal fixation in the distal end of the lateral fracture was compared with that of the double-plate fixation technique, and there was no significant difference in the test of the extension and compression stroke of the fracture of the simulated condyle. in that compression stroke of the flexion position and the intercondylar fracture of the supracondylar fracture of the humerus, there is a significant difference, but the difference of the intensity mean difference is less than 15%, This test provides a powerful theoretical basis for the choice of surgical methods for such fractures.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2015
【分類號(hào)】：R687.3
[Abstract]:Objective To study the clinical and biomechanical aspects of the treatment of the distal simple fracture of the humerus by means of the biomechanical study and the clinical case analysis. Methods: From March 2006 to March 2012, 47 cases of distal simple fracture of the humerus were retrospectively analyzed. According to the classification of A0, there were 23 cases of supracondylar fracture of the humerus, and 24 cases of the intercondylar fracture of the humerus. There were 29 males and 18 females. The age was 18 to 53 years (average 36. 5 years). Twenty-two cases were treated with double-plate internal fixation (double-plate group), and 25 cases were treated with the inner g-needle technique of the lateral locking steel plate (the inner side of the lateral plate of the lateral plate). The observation index included: the time of operation, the extent of the periosteum of the distal end of the humerus, the healing time of the fracture, and the function of the elbow joint after operation. All patients after operation were fixed with the adjustable branch to the flexion of 90. At the early stage of the operation, the functional exercise of the elbow joint was performed. Biomechanical study: 6 cases of the adult cadavers, 3 in the left and 3 on the right. The soft tissue surrounding the humerus was removed and a fixed model of the distal humeral fracture was made. The inner g-pin fixed model of the lateral locking steel plate on the supracondylar fracture of the humerus, the double-plate fixed model for the supracondylar fracture of the humerus, the fixed model of the inner g-pin of the lateral locking steel plate on the lateral humeral intercondylar fracture (type C1) and the double-plate fixed model (type C1) for the intercondylar fracture of the humerus. The experimental machine is an AGS-X10KN biomechanics electronic universal testing machine. The specimens are respectively and firmly fixed on the self-made specimen fixing plate, and each specimen is used for simulating the compression load test of the distal extension position of the humerus, and then the compression load test of the distal flexion position of the humerus is simulated. The load mechanics parameters in the simulated load stroke of each specimen were measured, and the related travel chart was recorded. Results: All the cases were followed up for more than 12 months and the fracture healed within 12-18 weeks. The operation time, the double-plate group was 139. 09-17. 63 minutes, the inner g-needle group of the lateral steel plate was 112. 60-13.70 minutes, t = 4.619, p = 0.001, P0.05), the difference was statistically significant, and the operation time of the inner g-needle group of the lateral steel plate was significantly lower than that of the double-plate group. The range of periosteum dissection during operation: the area of the periosteum in the operation of the double-plate group was 32.90-2.24cm2, the inner g-needle group of the lateral steel plate was 28. 48-2.19cm2, t = 3.434, p = 0.001, P <0.05, the difference was significant. The area of the periosteum of the double-plate group is more than that of the inner g-group of the lateral steel plate. The time of fracture healing: the fracture healing time of the two-plate group was 16.27-2.58 weeks, and the fracture healing time of the inner g-needle group of the lateral steel plate was 13. 16-1. 10 weeks, t = 5.241, P = 0.001, P <0.05, and the difference was of statistical significance. The fracture healing time was better than that of the double-plate group. The elbow joint function (Cassaebaum score), the double-plate group was excellent in 14 cases, and the good in 7 cases. There were 16 cases, good in 7, and no significant difference between the two groups. 2 cases after the operation of the double-plate group, the appearance of the ulnar nerve in 2 cases after operation, and the self-recovery of the ulnar nerve after the operation. Biomechanical study: In the two fixation modes of the supracondylar fracture of the humerus, the mean value of the fixation strength of the double-plate group was 32.7. 47-14.80, the mean value of the inner g-pin group of the lateral steel plate was 303.80, 11.60N, p0.05, and there was no significant difference between the two groups. In the simulated buckling position, the mean value of the double-plate fixation was 311.56-18.92N, while the mean value of the inner g-pin group of the lateral steel plate was 277.23-175.45N, p0.05, and there was a significant difference between the two groups. In the two fixation modes of the intercondylar fracture of the humerus (type C1), the mean value of the fixation strength of the double-plate group was 267.18-15.22N in the simulated straight-position compression stroke, and the mean value of the fixed intensity of the inner g-pin group of the lateral steel plate was 241.51-12.08, p0.05, and there was a significant difference between the two groups. In the compression stroke of the buckling position, the average strength of the double-plate fixation was 213.19-10.34N, while the mean value of the inner g-pin group of the lateral steel plate was 182.42-14.04N, p0.05, and there was a significant difference between the two groups. Conclusion Through the analysis of the clinical cases, the treatment of the distal simple fracture of the distal humerus by using the medial g-needle technique of the external anatomic locking steel plate and the proper individualized postoperative functional exercise program have achieved a good clinical effect. Compared with the double-plate fixation technology, the lateral locking steel plate has the advantages of short operation time, short fracture healing time and no significant difference in the function of the elbow joint after the operation, and the cost is lower. The biomechanical study of the distal end of the humerus found that the fixed strength of the internal fixation in the distal end of the lateral fracture was compared with that of the double-plate fixation technique, and there was no significant difference in the test of the extension and compression stroke of the fracture of the simulated condyle. in that compression stroke of the flexion position and the intercondylar fracture of the supracondylar fracture of the humerus, there is a significant difference, but the difference of the intensity mean difference is less than 15%, This test provides a powerful theoretical basis for the choice of surgical methods for such fractures.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2015
【分類號(hào)】：R687.3
【參考文獻(xiàn)】
相關(guān)期刊論文 前10條
1 張喜海;徐楊博;卓乃強(qiáng);陳歌;魯曉波;;復(fù)雜肱骨遠(yuǎn)端骨折內(nèi)固定失敗相關(guān)因素分析及對(duì)策[J];中國骨與關(guān)節(jié)損傷雜志;2010年02期
2 吳英華,楊明富,金碩,魏萬富,馬寶通;雙克氏針張力帶組合固定治療肱骨髁間骨折[J];天津醫(yī)藥;2005年08期
3 魏萬富;張鐵良;辛景義;李楠;;克氏針張力帶內(nèi)固定治療肱骨遠(yuǎn)端骨折生物力學(xué)研究[J];天津醫(yī)藥;2007年11期
4 程煜方;魏忠民;黃方敏;張克良;李子熙;;Y型鎖定鋼板置入治療成人肱骨髁間骨折36例[J];中國組織工程研究與臨床康復(fù);2011年43期
5 姚學(xué)東;肱骨髁間嚴(yán)重粉碎骨折的內(nèi)固定治療[J];中華創(chuàng)傷骨科雜志;2004年09期
6 王友華;劉t，
本文編號(hào)：2386879
本文鏈接：http://sikaile.net/yixuelunwen/waikelunwen/2386879.html
最近更新
教材專著
