四种骨盆后环内固定治疗单侧骶髂关节骨折脱位的生物力学研究

发布时间：2018-06-23 14:52

本文选题：生物力学 + 骶髂关节骨折脱位　；参考：《苏州大学》2015年硕士论文

【摘要】：目的:通过生物力学研究比较单侧骶髂螺钉、后路“门”形张力带接骨板、前路接骨板及“π”棒固定治疗单侧骶髂关节骨折脱位的固定效果。方法:随机选择5具成年人骨盆标本,排除病理性差异,保留第4腰椎和股骨近端1/3,保留双侧髋关节囊及骨盆各主要韧带结构,剥除多余软组织,切断连接同侧骶髂关节的韧带,分离骶髂关节之耳状关节面,切断耻骨联合,制作单侧骶髂关节脱位-耻骨联合分离模型。随机挑选1具骨盆标本,进行预实验,证明单个标本循环行四种内固定方式可行。随机将4具成年防腐骨盆标本分成A、B、C、D组,每组1具,应用随机数字表随机决定每个标本四种内固定物的固定顺序,模拟临床手术方式行四种骨盆后环内固定,耻骨联合予重建接骨板固定(闭环)。应用生物力学实验机,在平台上垂直向下以20N/s的速度施加3次0~650N的垂直负荷,观察标本在100N、200N、300N、400N、500N(模拟自重)下的移位情况,并选取双侧髂后上棘标记1及2,和双侧坐骨结节标记3及4,应用千分游标卡尺测量标记点的加载前后相对载物平台的垂直距离及1/2、3/4间位移,计算出骶髂关节分离的水平及垂直位移。以0.2°/s的角速度对标本加载扭转负荷,使其扭转1°、2°、3°、4°、5°、6°,观察扭转角度及对应的扭矩,重复测量三次,计算平均值。随后,拆除4组标本前路接骨板(开环),选取双侧耻骨结节标记5及6,测得相应1/2、3/4以及5/6位移及扭矩值。重复上述实验步骤测得实验数据,保证每组标本在开闭环状态下后环均完成四种内固定物的数据测定。采用SPSS统计学分析比较各内固定物的固定效果。结果:垂直负荷实验中,四种内固定物均发生弹性形变,稳定性均与加载强度呈反比;闭环条件下,控制水平稳定性后路“门”形张力带接骨板较好,控制垂直稳定性“π”棒固定效果较好;开环条件下,后环控制结论同前,前环水平稳定性控制单侧骶髂螺钉最佳,垂直稳定性控制前路接骨板最佳。整体抗扭稳定性,闭环下后路张力带接骨板最佳,开环下“π”棒最佳。结论:无论前环是否固定,后路“π”棒固定对维持骨盆稳定性均优势明显,微创手术治疗时后路“门”形张力带接骨板较有优势。
[Abstract]:Objective: to compare the effect of unilateral sacroiliac screw, posterior portal tension band plate, anterior plate and 蟺 rod fixation in the treatment of unilateral sacroiliac joint fracture and dislocation by biomechanical study. Methods: five adult pelvic specimens were randomly selected to remove pathological differences, to retain 1 / 3 of the fourth lumbar vertebra and proximal femur, to preserve the structures of the bilateral hip capsule and pelvic major ligaments, and to remove the excess soft tissue. The ligaments connected with the ipsilateral sacroiliac joint were cut off, the auricular articular surface of the sacroiliac joint was separated, and the symphysis pubis was cut off, and the model of unilateral dislocation of sacroiliac joint and symphysis pubis was made. One pelvis specimen was randomly selected, and the results showed that four internal fixation methods were feasible for a single specimen. Four adult anticorrosive pelvis specimens were randomly divided into two groups, one in each group. The fixed order of four internal fixators was randomly determined by random digital table, and four kinds of posterior pelvic ring fixation were performed by simulating clinical operation. The pubic symphysis was fixed with the reconstructed plate (closed loop). Using a biomechanical experiment machine, the vertical loading of 0 ~ 650N was applied three times to the platform vertically downward at the speed of 20 N / s, and the displacement of the specimen was observed under the condition of 100Nm ~ (200) N ~ (3) N ~ (300) N ~ (-1) ~ (400) N ~ (-1) ~ (500) N (simulated deadweight). The marks of bilateral posterior superior iliac spine (1 and 2) and bilateral ischium nodule (3 and 4) were used to measure the vertical distance and 1 / 2 / 3 / 4 displacement of the marker points before and after loading. The horizontal and vertical displacement of sacroiliac joint separation was calculated. The torsional load of the specimen was loaded with the angular velocity of 0.2 掳/ s to make the torsion 1 掳2 掳3 掳3 掳4 掳5 掳5 掳6 掳. The torsion angle and the corresponding torque were observed, the torsion angle was measured three times and the average value was calculated. Then, the anterior plate (open loop) of 4 groups of specimens was removed, and the bilateral pubic nodule was labeled 5 and 6. The displacement and torque values of 1 / 2 / 3 / 4 and 5 / 6 were measured. The experimental data were obtained by repeating the above experimental steps to ensure that the data of four kinds of internal fixators were completed in each group of specimens in the open and closed loop state. SPSS statistical analysis was used to compare the fixation effect of each internal fixator. Results: in the vertical load experiment, the four kinds of internal fixators had elastic deformation, and the stability was inversely proportional to the loading strength, and under the closed loop condition, the "gate" tension band plate was better to control the horizontal stability. Under the open loop condition, the posterior ring control conclusion is the same, the anterior ring horizontal stability control unilateral sacroiliac screw is the best, and the vertical stability control the anterior osseous plate is the best. The overall torsional stability, the closed loop under the tension band plate is the best, open loop "蟺" rod is the best. Conclusion: whether or not the anterior ring is fixed or not, the posterior "蟺" rod fixation has a significant advantage in maintaining pelvic stability, and the posterior "portal" tension band plate is superior in minimally invasive surgery.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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