Wang Haili, Yang Zhaoxu, Wu Zhanpo, Chen Wei, Zhang Qi, Li Ming, Li Zhiyong, Zhang Yingze
Department of Orthopedics, 3rd Hospital, Hebei Medical University, Shijiazhuang, 050051, China.
J Huazhong Univ Sci Technolog Med Sci. 2012 Aug;32(4):571-575. doi: 10.1007/s11596-012-0098-3. Epub 2012 Aug 11.
The purpose of this study was to compare the biomechanical stability obtained by using our technique featured an anatomical plate and compression bolts versus that of the conventional anatomic plate and cancellous screws in the fixation of intraarticular calcaneal fractures. Eighteen fresh frozen lower limbs of cadavers were used to create a reproductive Sanders type-III calcaneal fracture model by using osteotomy. The calcaneus fractures were randomly selected to be fixed either using our anatomical plate and compression bolts or conventional anatomic plate and cancellous screws. Reduction of fracture was evaluated through X radiographs. Each calcaneus was successively loaded at a frequency of 1 Hz for 1000 cycles through the talus using an increasing axial force 20 N to 200 N and 20 N to 700 N, representing the partial weight bearing and full weight bearing, respectively, and then the specimens were loaded to failure. Data extracted from the mechanical testing machine were recorded and used to test for difference in the results with the Wilcoxon signed rank test. No significant difference was found between our fixation technique and conventional technique in displacement during 20-200 N cyclic loading (P=0.06), while the anatomical plate and compression bolts showed a great lower irreversible deformation during 20-700 N cyclic loading (P=0.008). The load achieved at loss of fixation of the constructs for the two groups had significant difference: anatomic plate and compression bolts at 3839.6±152.4 N and anatomic plate and cancellous screws at 3087.3±58.9 N (P=0.008). There was no significant difference between the ultimate displacements. Our technique featured anatomical plate and compression bolts for calcaneus fracture fixation was demonstrated to provide biomechanical stability as good as or better than the conventional anatomic plate and cancellous screws under the axial loading. The study supports the mechanical viability of using our plate and compression bolts for the fixation of calcaneal fracture.
本研究的目的是比较在关节内跟骨骨折固定中，使用我们具有解剖型钢板和加压螺栓的技术与传统解剖型钢板和松质骨螺钉所获得的生物力学稳定性。使用18具新鲜冷冻的尸体下肢，通过截骨术创建可重复性的Sanders III型跟骨骨折模型。将跟骨骨折随机选择使用我们的解剖型钢板和加压螺栓或传统解剖型钢板和松质骨螺钉进行固定。通过X线片评估骨折复位情况。使用逐渐增加的轴向力20 N至200 N和20 N至700 N，分别代表部分负重和完全负重，通过距骨以1 Hz的频率对每个跟骨连续加载1000个循环，然后将标本加载至破坏。从力学试验机提取的数据进行记录，并使用Wilcoxon符号秩检验来检验结果的差异。在20 - 200 N循环加载期间，我们的固定技术与传统技术在位移方面没有显著差异（P = 0.06），而在解剖型钢板和加压螺栓在20 - 700 N循环加载期间显示出明显更低的不可逆变形（P = 0.008）。两组构建物固定失效时所达到的载荷有显著差异：解剖型钢板和加压螺栓为3839.6±152.4 N，解剖型钢板和松质骨螺钉为3087.3±58.9 N（P = 0.008）。最终位移之间没有显著差异。我们用于跟骨骨折固定的具有解剖型钢板和加压螺栓的技术被证明在轴向加载下能提供与传统解剖型钢板和松质骨螺钉相当或更好的生物力学稳定性。该研究支持了使用我们的钢板和加压螺栓进行跟骨骨折固定的力学可行性。
