下胫腓弹性钩钢板的研制及生物力学比较

发布时间：2018-04-17 17:13

本文选题：下胫腓弹性钩钢板 + 损伤　；参考：《南昌大学》2014年硕士论文

【摘要】：目的：本实验对一种新型下胫腓弹性钩钢板进行生物力学分析，应用生物力学试验方法比较运用不同内固定方式固定下胫腓分离模型对下胫腓关节微动特性的影响，为下胫腓弹性钩钢板的临床推广提供理论依据。方法：取8具下胫腓联合完整的新鲜冰冻尸体小腿标本，在各小腿标本的内踝和外踝最高点分别安装两个激光扫描仪探测端子，将各小腿标本分为四种状态在BOSE材料试验机上进行测试，四种状态分别为下胫腓联合完整（对照组）及破坏下胫腓联合后，，依次使用下胫腓弹性钩钢板（组）、胫腓钩（组）、AO螺钉（组）固定下胫腓联合，各状态下使用BOSE材料试验机在小腿近端加载类似于生理负荷的轴向负载，逐级加载至500N，实验过程保持标本的新鲜湿润，正式实验前进行小量程负载预加载，以利于减小骨的松弛及蠕变时间效应影响。通过3D激光扫描仪测量以上各状态下踝关节在中立位、背伸45°、跖屈20°、内翻30°及外翻30°等不同位置下腓骨远端相对于胫骨远端的探测端子相对位置变化，通过三维笛卡儿坐标系描述，原点位于踝关节处于中立位时的中心位置。Z轴沿着胫骨长轴通过内外踝之间的中点，X轴为冠状面与Z轴垂直，Y轴为矢状面与Z轴垂直，遵守右手法则。3D激光扫描仪自动捕捉内外踝处的探测端子的位置变化并记录，探测端子运动点云图通过geomagic studio5.0软件计算并转换成腓骨远端相对于胫骨远端在X、Y、Z轴上的相对位移（单位：mm）及Z轴上的相对旋转角度（单位：°）。结果：①踝关节各体位下腓骨远端与胫骨远端X、Y轴相对位移比较：对照组与弹性钩钢板组比较P0.05，无显著性统计学差异；对照组与胫腓钩组、对照组与AO螺钉组，组间两两对比P0.05，存在显著性统计学差异。②踝关节各体位下腓骨远端与胫骨远端Z轴相对位移及旋转角度比较：对照组、弹性钩钢板组、胫腓钩组，组间两两比较P0.05无显著性统计学差异，对照组与AO螺钉组对比P0.05，存在显著性统计学差异。结论：生物力学测试结果表明下胫腓弹性钩钢板是一种动态的内固定器械符合正常下胫腓关节的生物力学特点，既可使踝穴得到可靠的固定又可最大限度的保留了下胫腓关节的微动，有利于早期功能锻炼、促进下胫腓韧带及软组织的修复。因此下胫腓弹性钩钢板生物力学性能优于其他内固定方式，是一种治疗下胫腓联合分离的理想内固定器械。
[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 掳extension, 20 掳plantar flexion, 30 掳varus and 30 掳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: 掳).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.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R318.01

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