外侧锁定钢板内侧克氏针在肱骨远端骨折的应用研究
发布时间：2018-12-19 11:49
【摘要】：目的本研究拟通过生物力学研究和临床病例分析,探讨简化肱骨远端简单骨折的治疗方式,分析外侧解剖锁定钢板内侧克氏针技术治疗肱骨远端简单骨折的临床疗效和生物力学方面的可行性。方法临床研究：回顾性分析2006年3月～2012年3月,我科治疗的47例肱骨远端简单骨折,按照A0分型：肱骨髁上骨折23例,肱骨髁间骨折C1型24例。男29例,女18例,年龄18岁～53岁,(平均36.5岁)。双钢板内固定技术(简称双钢板组)治疗22例,外侧锁定钢板内侧克氏针技术(简称外侧钢板内侧克氏针组)治疗25例。观察指标包括：手术时间,术中肱骨远端的骨膜剥离范围,骨折的愈合时间,术后肘关节的功能。术后所有患者均采用可调式支具固定肘关节于屈曲90。,术后早期肘关节个性化功能锻炼。生物力学研究：成人尸体肱骨标本6例,左侧3例,右侧3例。去除肱骨周围软组织,制成肱骨远端骨折内固定模型。①肱骨髁上骨折外侧锁定钢板内侧克氏针固定模型,②肱骨髁上骨折双钢板固定模型,③肱骨髁间骨折外侧锁定钢板内侧克氏针固定模型(C1型),④肱骨髁间骨折双钢板固定模型(C1型)。实验机器为岛津(AGS-X10KN)生物力学电子万能试验机。将上述标本分别坚强固定于自制的标本固定板上,每一个标本先进行模拟肱骨远端伸直位压缩载荷测试,再进行模拟肱骨远端屈曲位压缩载荷测试。分别测定各个标本的模拟载荷行程中的载荷力学参数,并记录相关的行程图。结果临床研究：所有病例均随访12月以上,骨折均在12～18周内愈合。手术时间,双钢板组139.09±17.63分钟,外侧钢板内侧克氏针组112.60±13.70分钟,t=4.619,p=0.001,P0.05认为差异有统计学意义,外侧钢板内侧克氏针组手术时间明显少于双钢板组。术中骨膜剥离的范围：双钢板组手术中骨膜剥离的面积为32.90±2.24cm2,外侧钢板内侧克氏针组为28.48±2.19cm2, t=3.434, p=0.001, P0.05认为差异有显著性。双钢板组的骨膜剥离面积多于外侧钢板内侧克氏针组。骨折愈合时间：双钢板组骨折愈合时间16.27±2.58周,外侧钢板内侧克氏针组骨折愈合时间13.16±1.10周,t=5.241,P=0.001,P0.05认为差异有统计学意义。外侧钢板内侧克氏针组骨折愈合时间优于双钢板组。肘关节功能(Cassebaum评分),双钢板组优14例,良7例。外侧钢板内侧克氏针组优16例,良7例,两组无显著性差异。双钢板组术后2例术后出现尺神经激惹表现,后自行恢复。生物力学研究：在肱骨髁上骨折的两种固定方式中,模拟伸直位压缩行程中,双钢板组的固定强度均值为327.47±14.80,外侧钢板内侧克氏针组的均值303.80±11.60N,p0.05,两组间无显著性差异。模拟屈曲位压缩行程中,双钢板固定的强度均值为311.56±18.92N,而外侧钢板内侧克氏针组的均值为277.23±17.45N,p0.05,两组间有显著性差异。在肱骨髁间骨折(C1型)的两种固定方式中,在模拟伸直位压缩行程中,双钢板组的固定强度均值为267.18±15.22N,外侧钢板内侧克氏针组的固定强度均值为241.51±12.08,p0.05,两组间有显著性差异。在屈曲位压缩行程中,双钢板固定的强度均值为213.19±10.34N,而外侧钢板内侧克氏针组的均值为182.42±14.04N,p0.05,两组间有显著性差异。结论通过临床病例分析,应用外侧解剖锁定钢板内侧克氏针技术治疗肱骨远端简单骨折,结合恰当的个性化术后功能锻炼方案,取得了较好的临床效果。较双钢板固定技术相比,外侧锁定钢板内侧克氏针组,手术时间较短,骨折愈合时间较短,术后肘关节的功能无明显差距,费用更低。肱骨远端骨折生物力学研究发现,外侧锁定钢板内侧克氏针固定技术与双钢板固定技术相比较,远侧骨折端的内固定物的固定强度,在模拟髁上骨折伸直位压缩行程试验中,无明显差异。在肱骨髁上骨折屈曲位和髁间骨折压缩行程中,有显著性差异,但是其强度均数差值不足15%,通过有效的外固定辅助,也可以取得良好的冶疗效果,本试验为此类骨折的手术方式选择提供了有力的理论依据。
[Abstract]:Objective To study the clinical and biomechanical aspects of the treatment of the distal simple fracture of the humerus by means of the biomechanical study and the clinical case analysis. Methods: From March 2006 to March 2012, 47 cases of distal simple fracture of the humerus were retrospectively analyzed. According to the classification of A0, there were 23 cases of supracondylar fracture of the humerus, and 24 cases of the intercondylar fracture of the humerus. There were 29 males and 18 females. The age was 18 to 53 years (average 36. 5 years). Twenty-two cases were treated with double-plate internal fixation (double-plate group), and 25 cases were treated with the inner g-needle technique of the lateral locking steel plate (the inner side of the lateral plate of the lateral plate). The observation index included: the time of operation, the extent of the periosteum of the distal end of the humerus, the healing time of the fracture, and the function of the elbow joint after operation. All patients after operation were fixed with the adjustable branch to the flexion of 90. At the early stage of the operation, the functional exercise of the elbow joint was performed. Biomechanical study: 6 cases of the adult cadavers, 3 in the left and 3 on the right. The soft tissue surrounding the humerus was removed and a fixed model of the distal humeral fracture was made. The inner g-pin fixed model of the lateral locking steel plate on the supracondylar fracture of the humerus, the double-plate fixed model for the supracondylar fracture of the humerus, the fixed model of the inner g-pin of the lateral locking steel plate on the lateral humeral intercondylar fracture (type C1) and the double-plate fixed model (type C1) for the intercondylar fracture of the humerus. The experimental machine is an AGS-X10KN biomechanics electronic universal testing machine. The specimens are respectively and firmly fixed on the self-made specimen fixing plate, and each specimen is used for simulating the compression load test of the distal extension position of the humerus, and then the compression load test of the distal flexion position of the humerus is simulated. The load mechanics parameters in the simulated load stroke of each specimen were measured, and the related travel chart was recorded. Results: All the cases were followed up for more than 12 months and the fracture healed within 12-18 weeks. The operation time, the double-plate group was 139. 09-17. 63 minutes, the inner g-needle group of the lateral steel plate was 112. 60-13.70 minutes, t = 4.619, p = 0.001, P0.05), the difference was statistically significant, and the operation time of the inner g-needle group of the lateral steel plate was significantly lower than that of the double-plate group. The range of periosteum dissection during operation: the area of the periosteum in the operation of the double-plate group was 32.90-2.24cm2, the inner g-needle group of the lateral steel plate was 28. 48-2.19cm2, t = 3.434, p = 0.001, P <0.05, the difference was significant. The area of the periosteum of the double-plate group is more than that of the inner g-group of the lateral steel plate. The time of fracture healing: the fracture healing time of the two-plate group was 16.27-2.58 weeks, and the fracture healing time of the inner g-needle group of the lateral steel plate was 13. 16-1. 10 weeks, t = 5.241, P = 0.001, P <0.05, and the difference was of statistical significance. The fracture healing time was better than that of the double-plate group. The elbow joint function (Cassaebaum score), the double-plate group was excellent in 14 cases, and the good in 7 cases. There were 16 cases, good in 7, and no significant difference between the two groups. 2 cases after the operation of the double-plate group, the appearance of the ulnar nerve in 2 cases after operation, and the self-recovery of the ulnar nerve after the operation. Biomechanical study: In the two fixation modes of the supracondylar fracture of the humerus, the mean value of the fixation strength of the double-plate group was 32.7. 47-14.80, the mean value of the inner g-pin group of the lateral steel plate was 303.80, 11.60N, p0.05, and there was no significant difference between the two groups. In the simulated buckling position, the mean value of the double-plate fixation was 311.56-18.92N, while the mean value of the inner g-pin group of the lateral steel plate was 277.23-175.45N, p0.05, and there was a significant difference between the two groups. In the two fixation modes of the intercondylar fracture of the humerus (type C1), the mean value of the fixation strength of the double-plate group was 267.18-15.22N in the simulated straight-position compression stroke, and the mean value of the fixed intensity of the inner g-pin group of the lateral steel plate was 241.51-12.08, p0.05, and there was a significant difference between the two groups. In the compression stroke of the buckling position, the average strength of the double-plate fixation was 213.19-10.34N, while the mean value of the inner g-pin group of the lateral steel plate was 182.42-14.04N, p0.05, and there was a significant difference between the two groups. Conclusion Through the analysis of the clinical cases, the treatment of the distal simple fracture of the distal humerus by using the medial g-needle technique of the external anatomic locking steel plate and the proper individualized postoperative functional exercise program have achieved a good clinical effect. Compared with the double-plate fixation technology, the lateral locking steel plate has the advantages of short operation time, short fracture healing time and no significant difference in the function of the elbow joint after the operation, and the cost is lower. The biomechanical study of the distal end of the humerus found that the fixed strength of the internal fixation in the distal end of the lateral fracture was compared with that of the double-plate fixation technique, and there was no significant difference in the test of the extension and compression stroke of the fracture of the simulated condyle. in that compression stroke of the flexion position and the intercondylar fracture of the supracondylar fracture of the humerus, there is a significant difference, but the difference of the intensity mean difference is less than 15%, This test provides a powerful theoretical basis for the choice of surgical methods for such fractures.
【学位授予单位】：广西医科大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R687.3
[Abstract]:Objective To study the clinical and biomechanical aspects of the treatment of the distal simple fracture of the humerus by means of the biomechanical study and the clinical case analysis. Methods: From March 2006 to March 2012, 47 cases of distal simple fracture of the humerus were retrospectively analyzed. According to the classification of A0, there were 23 cases of supracondylar fracture of the humerus, and 24 cases of the intercondylar fracture of the humerus. There were 29 males and 18 females. The age was 18 to 53 years (average 36. 5 years). Twenty-two cases were treated with double-plate internal fixation (double-plate group), and 25 cases were treated with the inner g-needle technique of the lateral locking steel plate (the inner side of the lateral plate of the lateral plate). The observation index included: the time of operation, the extent of the periosteum of the distal end of the humerus, the healing time of the fracture, and the function of the elbow joint after operation. All patients after operation were fixed with the adjustable branch to the flexion of 90. At the early stage of the operation, the functional exercise of the elbow joint was performed. Biomechanical study: 6 cases of the adult cadavers, 3 in the left and 3 on the right. The soft tissue surrounding the humerus was removed and a fixed model of the distal humeral fracture was made. The inner g-pin fixed model of the lateral locking steel plate on the supracondylar fracture of the humerus, the double-plate fixed model for the supracondylar fracture of the humerus, the fixed model of the inner g-pin of the lateral locking steel plate on the lateral humeral intercondylar fracture (type C1) and the double-plate fixed model (type C1) for the intercondylar fracture of the humerus. The experimental machine is an AGS-X10KN biomechanics electronic universal testing machine. The specimens are respectively and firmly fixed on the self-made specimen fixing plate, and each specimen is used for simulating the compression load test of the distal extension position of the humerus, and then the compression load test of the distal flexion position of the humerus is simulated. The load mechanics parameters in the simulated load stroke of each specimen were measured, and the related travel chart was recorded. Results: All the cases were followed up for more than 12 months and the fracture healed within 12-18 weeks. The operation time, the double-plate group was 139. 09-17. 63 minutes, the inner g-needle group of the lateral steel plate was 112. 60-13.70 minutes, t = 4.619, p = 0.001, P0.05), the difference was statistically significant, and the operation time of the inner g-needle group of the lateral steel plate was significantly lower than that of the double-plate group. The range of periosteum dissection during operation: the area of the periosteum in the operation of the double-plate group was 32.90-2.24cm2, the inner g-needle group of the lateral steel plate was 28. 48-2.19cm2, t = 3.434, p = 0.001, P <0.05, the difference was significant. The area of the periosteum of the double-plate group is more than that of the inner g-group of the lateral steel plate. The time of fracture healing: the fracture healing time of the two-plate group was 16.27-2.58 weeks, and the fracture healing time of the inner g-needle group of the lateral steel plate was 13. 16-1. 10 weeks, t = 5.241, P = 0.001, P <0.05, and the difference was of statistical significance. The fracture healing time was better than that of the double-plate group. The elbow joint function (Cassaebaum score), the double-plate group was excellent in 14 cases, and the good in 7 cases. There were 16 cases, good in 7, and no significant difference between the two groups. 2 cases after the operation of the double-plate group, the appearance of the ulnar nerve in 2 cases after operation, and the self-recovery of the ulnar nerve after the operation. Biomechanical study: In the two fixation modes of the supracondylar fracture of the humerus, the mean value of the fixation strength of the double-plate group was 32.7. 47-14.80, the mean value of the inner g-pin group of the lateral steel plate was 303.80, 11.60N, p0.05, and there was no significant difference between the two groups. In the simulated buckling position, the mean value of the double-plate fixation was 311.56-18.92N, while the mean value of the inner g-pin group of the lateral steel plate was 277.23-175.45N, p0.05, and there was a significant difference between the two groups. In the two fixation modes of the intercondylar fracture of the humerus (type C1), the mean value of the fixation strength of the double-plate group was 267.18-15.22N in the simulated straight-position compression stroke, and the mean value of the fixed intensity of the inner g-pin group of the lateral steel plate was 241.51-12.08, p0.05, and there was a significant difference between the two groups. In the compression stroke of the buckling position, the average strength of the double-plate fixation was 213.19-10.34N, while the mean value of the inner g-pin group of the lateral steel plate was 182.42-14.04N, p0.05, and there was a significant difference between the two groups. Conclusion Through the analysis of the clinical cases, the treatment of the distal simple fracture of the distal humerus by using the medial g-needle technique of the external anatomic locking steel plate and the proper individualized postoperative functional exercise program have achieved a good clinical effect. Compared with the double-plate fixation technology, the lateral locking steel plate has the advantages of short operation time, short fracture healing time and no significant difference in the function of the elbow joint after the operation, and the cost is lower. The biomechanical study of the distal end of the humerus found that the fixed strength of the internal fixation in the distal end of the lateral fracture was compared with that of the double-plate fixation technique, and there was no significant difference in the test of the extension and compression stroke of the fracture of the simulated condyle. in that compression stroke of the flexion position and the intercondylar fracture of the supracondylar fracture of the humerus, there is a significant difference, but the difference of the intensity mean difference is less than 15%, This test provides a powerful theoretical basis for the choice of surgical methods for such fractures.
【学位授予单位】：广西医科大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R687.3
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