胫骨髁间嵴撕脱骨折不同固定方式的生物力学及临床研究

发布时间：2018-05-25 21:16

本文选题：胫骨髁间嵴撕脱骨折 + 固定方式生物力学　；参考：《中国人民解放军医学院》2015年硕士论文

【摘要】：目的比较胫骨髁间嵴撕脱骨折不同固定方式的生物力学性能及评估关节镜下编织线领带结套扎固定法的临床疗效。方法1、取猪膝关节48只,随机分为缝线领带结套扎组、缝线固定组、空心螺钉组、单缝合锚钉组、双缝合锚钉组及生物无结锁定锚钉组,每组8例。统一制作胫骨髁间嵴撕脱骨折模型,分别用上述六种固定方式造模。生物力学测试包括疲劳试验及单次拔出试验。每例标本先行200周期疲劳试验,再行拔出试验,直至拔出失败。比较各组最大失败载荷、失效载荷、刚度及位移。2、总结编织线领带结套扎固定治疗胫骨髁间嵴骨折病例,并对其临床疗效进行评估。结果1、失败载荷：编织线领带结套扎组生物无结锁定锚钉组双缝合锚钉组缝线固定组空心螺钉组单缝合锚钉组,组间差异具有统计学意义(P0.01)；2、失效载荷：生物无结锁定锚钉组编织线领带结套扎组双缝合锚钉组缝线固定组空心螺钉组缝合锚钉组,组间差异具有统计学意义(P0.05)；3、刚度：生物无结锁定锚钉组编织线领带结套扎组、双缝合锚钉组、缝线固定组、空心螺钉组及缝合锚钉组,差异具有统计学意义(P0.05),编织线领带结套扎组、双缝合锚钉组、缝线固定组、空心螺钉组及缝合锚钉组组间无显著性差异(P0.05);4、循环位移：编织线领带结套扎组生物无结锁定锚钉组双缝合锚钉组空心螺钉组缝合锚钉组缝线固定组,差异具有统计学意义(P0.05);5、临床采用编织线领带结套扎法治疗60例病人,随访时间4月-12年,平均5.6年。术后切口皆一期愈合,无感染及血管、神经损伤等并发症。末次随访患肢膝关节功能恢复良好,主动屈伸活动范围均可达1300-00-00,Lachman试验及前抽屉试验均阴性。术后lysholm评分(93.8±3.6)较术前(31.0±4.2)明显改善,差异具有统计学意义(P0.05),临床疗效良好。结论1、编织线领带结套扎固定、生物无结锁定锚钉固定或双缝合锚钉固定治疗胫骨髁间嵴撕脱骨折稳定性优于缝线固定、空心螺钉固定及缝合锚钉固定。2、关节镜下编织线领带结套扎固定治疗胫骨髁间嵴撕脱骨折方法简便,经济实用,临床疗效可靠。
[Abstract]:Objective to compare the biomechanical properties of different fixation methods for avulsion fracture of tibial intercondylar ridge and to evaluate the clinical effect of arthroscopic tie fixation. Methods 1.Forty eight pig knee joints were randomly divided into suture tie ligation group, suture fixation group, hollow screw group, single suture anchor nail group, double suture anchor nail group and biological no-knot locking anchor group, with 8 cases in each group. The avulsion fracture model of tibial intercondylar crest was made by using the above six fixation methods. Biomechanical tests include fatigue tests and single pull-out tests. Each specimen was subjected to 200 cycles of fatigue test, and then to pull-out test until the pull-out failed. The maximum failure load, stiffness and displacement of each group were compared. The cases of tibial intercondylar crest fracture were summarized and the clinical effect was evaluated. Results 1. Failure load: no knot locking anchor group, double suture anchor screw group, hollow screw group single suture anchor group, knit tie ligation group, no knot locking anchor nail group, double suture anchor screw group, single suture anchor screw group; The difference between the two groups was statistically significant (P 0.01) and the failure load was as follows: biological no-knot locking anchor group, knit thread tie knot ligation group, double suture anchor nail group, hollow screw fixation group, hollow screw group, suture anchor nail group, The difference between the two groups was statistically significant (P 0.05). The stiffness of the two groups was as follows: no locking anchor nail group, knit tie ligation group, double suture anchor nail group, suture fixation group, hollow screw group and suture anchor nail group. The difference was statistically significant (P 0.05), tie binding group, double suture anchor nail group, suture fixation group, There was no significant difference between the hollow screw group and the suture anchor group. There was no significant difference between the two groups (P 0.05). The circular displacement: the biological no knot locking anchor group, the double suture anchor nail group, the double suture anchor group, the hollow screw group, the suture anchor group, the suture fixation group. The difference was statistically significant (P 0.05). 60 patients were treated with weaving tie ligation. The follow-up time was from 4 months to 12 years, with an average of 5.6 years. All the incisions healed at the first stage without complications such as infection and injury of blood vessels and nerves. At the last follow-up, the knee function of the affected limb recovered well, and the active flexion and extension activities were all negative in the Lachman test and the anterior drawer test. The postoperative lysholm score (93.8 卤3.6) was significantly improved than that before operation (31.0 卤4.2). The difference was statistically significant (P 0.05). Conclusion 1. The stability of tibial intercondylar avulsion fracture treated by tie knot ligation, biological locking anchor fixation or double suture anchor fixation is superior to suture fixation. The treatment of avulsion fracture of tibial intercondylar crest with hollow screw fixation, suture anchor nail fixation and arthroscopic tie fixation was simple, economical and practical, and the clinical effect was reliable.
【学位授予单位】：中国人民解放军医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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