五种内固定方式用于DayⅡ型骨盆新月形骨折脱位的生物力学和临床对比研究

发布时间：2018-04-21 23:10

本文选题：骨盆骨折 + 新月形骨折脱位　；参考：《南方医科大学》2017年博士论文

【摘要】：研究背景骨盆新月形骨折脱位作为侧方压缩型损伤的一种亚型,其中Day Ⅱ型损伤累及骶髂关节的中1/3,但对于采用何种手术入路及固定方式,目前在临床上仍有争议。我们创新性的提出闭合复位、微创经皮交叉螺钉内固定的方式治疗DayⅡ型骨盆新月形骨折脱位,为明确其生物力学性能及临床应用疗效,设计了本课题的研究。目的:1.比较5种内固定方式用于Day Ⅱ型骨盆新月形骨折脱位的生物力学稳定性,为临床应用提供理论依据。2.探讨经皮交叉螺钉内固定治疗Day Ⅱ型骨盆新月形骨折脱位的临床疗效。方法:1.建立螺钉穿过髂骨后部通道的数字化模型。计算其与不同平面的角度,测量相关的距离。2.建立5种不同内固定用于Day Ⅱ型骨盆新月形骨折脱位的有限元模型。在S1椎体上终板施加600N的应力,比较骨盆、新月形骨块及内固定的应力及位移分布。3.按前述建立5种骨盆标本模型并测试,施加载荷的速度为15N/s,范围为0-600N,记录位移-应力数据并制作曲线图。4.回顾行手术治疗的Day Ⅱ型骨盆新月形骨折脱位病例共56例。其中35例行经皮交叉螺钉内固定,21例行切开复位内固定,记录两组病例术中及住院期间情况;术后行Matta评分,末次随访时记录骨盆Majeed功能评分。结果:1.空心螺钉分别与水平面、冠状面及矢状面所成的角度在性别间的差异均无统计学意义(P0.05);在空心螺钉理论上的最长长度,其走形方向骶髂关节髂骨侧的最窄距离,进针点到骶髂关节髂骨侧最窄处的距离及到骶髂关节前缘的距离等方面,女性均小于男性,差异均有统计学意义(P0.05)。2.各有限元模型的骨盆最大位移比较为:模型E模型D模型A模型C模型B,新月形骨块的最大位移比较为:模型E模型B模型D模型A模型C;骨盆标本模型的位移-应力曲线斜率比较为:模型E模型D模型A模型C模型B。3.经皮固定组在手术时间、出血量、手术切口长度及平均住院时间等方面均有优势,各项差异均有统计学意义(P0.01)。两组在术后Matta评分及末次随访时Majeed评分比较差异均无统计学意义(P0.05)。结论:1.3枚螺钉交叉固定方式的生物力学性能最佳,其与2枚螺钉交叉固定方式在骨盆整体力学稳定性上相近;但1枚螺钉固定新月形骨块的稳定性不如2枚。2.同时固定髂骨骨折和骶髂关节相对于固定其中之一有更好的生物力学性能;单独固定骶髂关节的稳定性优于单独固定髂骨骨折。3.对经典文献推荐的从后路切开复位单独固定髂骨骨折的方式,因其生物力学性能较差,我们不推荐采用。4.经皮交叉螺钉内固定治疗Day Ⅱ型新月形骨折脱位可取得良好的临床疗效,但需要一定的学习曲线,值得推广应用。
[Abstract]:Background crescent fracture dislocation of the pelvis is a subtype of lateral compression injury, in which Day type II injury involves the middle 1/3 of the sacroiliac joint, but it is still in dispute for the surgical approach and fixation. We propose a closed reduction and minimally invasive percutaneous cross screw internal fixation for the treatment of Da. Y II type crescent crescent fracture dislocation, in order to clarify its biomechanical properties and clinical application effect, designed the study of this subject. Objective: 1. compare the biomechanical stability of 5 internal fixation methods for Day II type crescent fracture dislocation, and provide a theoretical basis for the clinical application of.2. to explore the treatment of Day II by percutaneous cross screw fixation. The clinical effect of type pelvic crescent shaped fracture and dislocation. Method: 1. to establish a digital model of the posterior channel of the screw through the iliac bone. To calculate the angle of the different planes and measure the relative distance.2. to establish the finite element model of the 5 different internal fixation for the Day type crescent fracture dislocation of the pelvis. The stress of the 600N on the S1 vertebral body endplate was applied. The stress and displacement distribution of pelvis, crescent bone mass and internal fixation.3. were established according to the previous 5 pelvic specimen models and tested. The velocity of the load was 15N/s, the range was 0-600N, the displacement stress data were recorded and the curve map was made. 56 cases of the Day II type of new pelvic fracture dislocation of the Day II type were retrospectively reviewed. Of them, 35 cases were treated by skin. Cross screw internal fixation, 21 routine open reduction and internal fixation, recorded two groups of cases during and during hospitalization; after the operation, Matta score was performed, and the pelvic Majeed function score was recorded at the last follow-up. Results: there was no statistical difference between 1. hollow screws and horizontal planes, and the differences between the coronal and sagittal planes were not statistically significant (P0.05). The longest length of cardiac screw theory, the narrowest distance of the iliac joint in the sacroiliac joint, the distance between the needle point to the sacroiliac joint, and the distance to the anterior margin of the sacroiliac joint were less than that of the male, and the difference was statistically significant (P0.05) the maximum displacement of the pelvis in the finite element model of.2. was: model E model. The D model A model C model B, the maximum displacement of the crescent bone block is as follows: the model E model B model D model A model C, the slope of the displacement stress curve of the pelvis specimen model is compared with the model E model D model A model, and has the advantage in the operation time, the bleeding volume, the length of the operation incision and the average length of hospital. All the differences were statistically significant (P0.01). There was no significant difference in the Majeed score between the two groups after the operation and the final follow-up (P0.05). Conclusion: the biomechanical properties of the 1.3 screw intersecting methods were the best, and the 2 screw intersecting methods were similar to the mechanical stability of the pelvis, but 1 screws were fixed. The stability of the bone mass is not as good as that of 2.2. fixed iliac fractures and one of the sacroiliac joints. The stability of the sacroiliac joint is better than that of the iliac bone fracture alone, which is recommended by the classical literature on the fracture of the iliac bone from the posterior open reduction and the single fixation of the iliac bone, because of its biological force. With poor performance, we do not recommend.4. transdermal cross screw internal fixation for the treatment of Day type crescent fracture dislocation, which can achieve good clinical efficacy, but it needs a certain learning curve and is worthy of application.

【学位授予单位】：南方医科大学
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R687.3

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