锁骨中段骨折的髓内固定物研制与力学测试

发布时间：2018-03-02 22:19

本文选题：锁骨中段骨折　切入点：新型髓内钉　出处：《四川医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的:锁骨骨折是临床常见的骨折,其中锁骨中段是好发部位,大部分的锁骨中段骨折伴有移位。锁骨中段骨折存在保守治疗和手术治疗两类,随生活节奏加快、患者的需求及医疗技术水平的提高,目前锁骨骨折更倾向于手术治疗。临床手术方式较多,包括有髓内固定,钢板螺钉固定,记忆合金固定,克氏针固定等。目前钢板螺钉固定占主流,但带来一系列问题,诸如:手术剥离过多影响骨折段周围血供,钢板的应力遮挡因素等逐渐引起临床医生的重视。弹性髓内钉固定符合微创理念,但存在尾钉致皮下凸起出现激惹和骨折断端移位导致髓钉迁移,单根弹性髓内钉,无防旋功能。随着对锁骨骨折治疗研究的深入,合适的内固定应满足:微创,恢复锁骨长度,有效固定且术后早期康复训练。本课题设计了一种适应于锁骨中段的新型髓内钉,进行生物力学测试,与弹性髓内钉、接骨板进行生物力学比较,通过各项参数分析,证实新型髓内钉治疗锁骨中段骨折的可行性。方法:24根成年新鲜锁骨标本,所有尸体锁骨均没有锁骨骨折,排除骨质疏松、肿瘤、畸形等异常情况。将其随机分为3组(A、B、C):A组为解剖钢板组,B组为新型锁骨髓内钉组,C组为弹性髓内钉组,将所有标本在锁骨中段相同部位骨锯造成骨折建立模型。分别使用解剖钢板、新型锁骨髓内钉、弹性髓内钉对骨折模型进行固定。将每个标本用牙托粉固定后,并安置在力学实验机和扭转试验机夹具上。试验前进行预实验,消除标本蠕变影响,依次进行四点弯曲试验、扭转试验、拉伸试验。测量结果采用spss21.0进行统计学处理,结果中的试验数据使用x±s表示,采用方差分析统计三组试验数据并相互对比有无差异,p0.05为差异有统计学意义。结果:1、四点弯曲试验中,三种不同固定方式的模型在加载压力从0.01kn-0.10kn范围内,加载压力随着加载负荷的增加,骨折断端的位移逐渐增大,两者线性相关。当加载力为0.10kn时各组的位移值:a组(解剖钢板组)位移值1.104±0.035mm,b组(新型锁骨髓内钉组)位移值1.148±0.032mm,c组(弹性髓内钉组)位移值1.197±0.027mm,三组相互比较均有统计学意义(p0.05)。钢板组抗弯曲能力最优,弹性髓内钉抗弯曲能力最差。2、扭转试验中,三种不同固定方式在扭转角度0-10°范围内,随着扭转角度增加,扭矩也增大,两者呈线性相关,得出的最大扭转角度10°下,各组数据:a组(解剖钢板组)扭矩值0.910±0.066n.m,b组(新型髓内钉组)扭矩值0.849±0.03n.m,c组(弹性髓内钉组)位移值0.794±0.040n.m,三组相互比较有统计学意义(p0.05),新型髓内钉固定抗扭转能力明显优于弹性髓内钉固定。3、拉伸试验中,各组试验锁骨最大拉伸载荷结果:a组(解剖钢板组)1.019±0.053kn,b组(新型髓内钉组)0.963±0.025kn,c组(弹性髓内钉)0.915±0.058kn。三组相互比较有统计学意义(p0.05),钢板组的锁骨拉伸载荷最好,新型髓内钉组次之,弹性髓内钉组最差。结论:新型锁骨髓内钉治疗锁骨中段骨折有以下优势:与钢板比较具有微创、易闭合复位,与弹性髓内钉比较抗旋转能力明显,固定稳定等生物力学优势,且无皮下凸起形成。
[Abstract]:Objective: clavicle fracture is a common clinical fracture of clavicle, which is a good site, most of the clavicle fractures with displacement clavicle fracture. There are two kinds of conservative treatment and surgical treatment, with the quickening pace of life, the level of demand and medical technology of the patients increased, the clavicle fractures tend to more surgery. The clinical surgery, including intramedullary fixation, plate fixation, memory alloy fixation, Kirschner wire fixation plate and screw fixation. At present the mainstream, but brings a series of problems, such as too much influence on the surgical dissection of fracture segment peripheral blood supply, steel stress shielding factors gradually cause the attention of doctors. Elastic intramedullary nail fixation with minimally invasive surgery, but there are screws of subcutaneous bulge appeared irritability and fracture displacement causes intramedullary nail migration, single elastic intramedullary nail, no anti rotation function. With the clavicle bone Study of fracture treatment, appropriate internal fixation should be satisfied: restore the length of clavicle, minimally invasive, effective fixation and early rehabilitation training after operation. This paper designs a new intramedullary nail for clavicle, biomechanical, and elastic intramedullary nail plate for biomechanical comparison, through the analysis of the parameters and confirm the feasibility of treatment of midclavicular fractures with intramedullary nail. Methods: 24 fresh adult clavicle specimens, all the bodies were not excluded clavicular clavicle fracture, osteoporosis, cancer, malformation and other anomalies. The random divided into 3 groups (A, B, C): A group for anatomical plate group. B group is a new locking intramedullary nail group, C group for the elastic intramedullary nail group, all specimens in the same part of clavicle fracture caused by bone saw model. Using anatomical plate, new locking intramedullary nail fixation on fracture model of elastic intramedullary nail for each. A specimen with denture powder after fixation, and placed in the mechanical testing machine and torsion testing machine fixture. The pre experiment test before, eliminate the effects of creep, followed by four point bending test, torsion test, tensile test. The measurement results were analyzed statistically by spss21.0 test results, data representation in using X + S by analysis of variance, three test data statistics and compared the difference of P0.05, the difference was statistically significant. Results: 1, four point bending test, three kinds of different types of fixed model in loading pressure from the 0.01kn-0.10kn range, with the increase of the loading pressure load, the displacement of the fracture broken end increases. The two linear correlation. The displacement when the loading force is 0.10kn when the value of each group: a group (anatomical plate group) displacement value of 1.104 + 0.035mm, group B (lock intramedullary nail group) displacement value of 1.148 + 0.032mm, group C (elastic intramedullary nail group) Displacement of 1.197 + 0.027mm, three groups of comparisons were statistically significant (P0.05). The plate flexural capacity optimal elastic intramedullary nail anti bending capacity of the worst.2 torsion test, three kinds of different fixation methods in torsion angle within 0-10 degrees, with torsion angle increases, the torque is increased, a linear correlation the two groups of data, the maximum torsion angle of 10 degrees, a group (anatomical plate group) torque value 0.910 + 0.066n.m, group B (intramedullary nail group) torque value 0.849 + 0.03n.m, group C (elastic intramedullary nail group) displacement value of 0.794 + 0.040n.m, three group comparison was statistically significant (P0.05), a new intramedullary nail fixed torsion fixation of.3 was obviously better than that of elastic intramedullary nail, tensile test, all test results: the maximum tensile load of clavicle group A (anatomical plate group) 1.019 + 0.053kn, group B (intramedullary nail group) 0.963 + 0.025kn, group C (elastic intramedullary nail 0.915 + 0.058) The kn. between the three groups was statistically significant (P0.05), clavicle plate group had the best tensile load, intramedullary nail group, elastic intramedullary nail group is the worst. Conclusion: the new locking intramedullary nail treatment of clavicle fracture with steel plate has the following advantages: compared with minimally invasive, easy closed reduction, and elastic intramedullary nail anti rotation ability, stable fixation and biomechanical advantage, no subcutaneous bulge formation.

【学位授予单位】：四川医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

【参考文献】