Kumar Anant, Charlebois Steven J, Cain E Lyle, Smith Richard A, Daniels A U, Crates John M
University of Tennessee-Campbell Clinic, Memphis, Tennessee 38104, USA.
J Bone Joint Surg Am. 2003 Apr;85(4):604-8. doi: 10.2106/00004623-200304000-00003.
The effect of an intact fibula on rotational stability after a distal tibial fracture has, to the best of our knowledge, not been clearly defined. We designed a cadaver study to clarify our clinical impression that fixation of the fibula with a plate increases rotational stability of distal tibial fractures fixed with a Russell-Taylor intramedullary nail.
Seven matched pairs of embalmed human cadaveric legs and sixteen fresh-frozen human cadaveric legs, including one matched pair, were tested. To simulate fractures, 5-mm transverse segmental defects were created at the same level in the tibia and fibula, 7 cm proximal to the ankle joint in each bone. The tibia was stabilized with a 9-mm Russell-Taylor intramedullary nail that was statically locked with two proximal and two distal screws. Each specimen was tested without fibular fixation as well as with fibular fixation with a six-hole semitubular plate. A biaxial mechanical testing machine was used in torque control mode with an initial axial load of 53 to 71 N applied to the tibial condyle. Angular displacement was measured in 0.56-N-m torque increments to a maximal torque of 4.52 N-m (40 in-lb).
Initially, significantly less displacement (p < or = 0.05) was produced in the specimens with fibular plate fixation than in those without fibular plate fixation. The difference in angular displacement between the specimens treated with and without plate fixation was established at the first torque data point measured but did not increase as the torque was increased. No significant difference in the rotational stiffness was found between the specimens treated with and without plate fixation after measurement of the second torque data point (between 1.68 and 4.48 N-m).
Fibular plate fixation increased the initial rotational stability after distal tibial fracture compared with that provided by tibial intramedullary nailing alone. However, there was no difference in rotational structural stiffness between the specimens treated with and without plate fixation as applied torque was increased.
据我们所知，完整腓骨对胫骨远端骨折后旋转稳定性的影响尚未明确界定。我们设计了一项尸体研究，以阐明我们的临床印象，即使用钢板固定腓骨可增加采用罗素 - 泰勒髓内钉固定的胫骨远端骨折的旋转稳定性。
测试了七对经过防腐处理的人类尸体下肢以及十六对新鲜冷冻的人类尸体下肢，其中包括一对匹配的下肢。为模拟骨折，在每根骨头距踝关节近端7厘米处的胫骨和腓骨相同水平创建5毫米的横向节段性缺损。胫骨用9毫米的罗素 - 泰勒髓内钉固定，并通过近端两枚和远端两枚螺钉进行静态锁定。每个标本在未进行腓骨固定以及采用六孔半管状钢板进行腓骨固定的情况下均进行测试。使用双轴机械测试机，采用扭矩控制模式，对胫骨髁施加53至71牛的初始轴向载荷。以0.56牛·米的扭矩增量测量角位移，直至最大扭矩4.52牛·米（40英寸·磅）。
最初，采用腓骨钢板固定的标本产生的位移明显小于未采用腓骨钢板固定的标本（p≤0.05）。在测量的第一个扭矩数据点就确定了采用钢板固定和未采用钢板固定的标本之间的角位移差异，但随着扭矩增加该差异并未增大。在测量第二个扭矩数据点（1.68至4.48牛·米之间）后，采用钢板固定和未采用钢板固定的标本之间在旋转刚度方面未发现显著差异。
与单纯胫骨髓内钉固定相比，腓骨钢板固定增加了胫骨远端骨折后的初始旋转稳定性。然而，随着施加扭矩增加，采用钢板固定和未采用钢板固定的标本在旋转结构刚度方面没有差异。
