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用于评估骨折修复的生物力学方法。

Biomechanical methods for the assessment of fracture repair.

作者信息

Augat P, Faschingbauer M, Seide K, Tobita K, Callary S A, Solomon L B, Holstein J H

机构信息

Institute of Biomechanics, Trauma Center Murnau, Prof. Kuentscher-Str. 8, 82418 Murnau, Germany; Institute of Biomechanics, Paracelsus Medical University Salzburg, Strubergasse 21, Salzburg, Austria.

Berufsgenossnschaftliches Unfallkrankenhaus Hamburg, Bergedorfer Straße 10, 21033 Hamburg, Germany.

出版信息

Injury. 2014 Jun;45 Suppl 2:S32-8. doi: 10.1016/j.injury.2014.04.006.

Abstract

The progress of fracture healing is directly related to an increasing stiffness and strength of the healing fracture. Similarly the weight bearing capacity of a bone directly relates to the mechanical stability of the fracture. Therefore, assessing the progress of fracture repair can be based on the measurement of the mechanical stability of the healing fracture. However, fracture stability is difficult to assess directly due to various obstacles of which shielding of the mechanical properties by the fracture fixation construct is the most relevant one. Several assessment methods have been proposed to overcome these obstacles and to obtain some sort of mechanical surrogate describing the stability of the fracture. The most direct method is the measurement of the flexibility of a fracture under a given external load, which comprises the challenge of accurately measuring the deformation of the bone. Alternative approaches include the measurement of load share between implant and bone by internal or by external sensors. A direct 3 dimensional measurement of bone displacement is provided by radiostereometric analysis which can assess fracture migration and can detect fracture movement under load. More indirect mechanical methods induce cyclic perturbations within the bone and measure the response as a function of healing time. At lower frequencies the perturbations are induced in the form of vibration and at higher frequencies in the form of ultrasonic waves. Both methods provide surrogates for the mechanical properties at the fracture site. Although biomechanical properties of a healing fracture provide a direct and clinically relevant measure for fracture healing, their application will in the near future be limited to clinical studies or research settings.

摘要

骨折愈合的进程与愈合中骨折的刚度和强度增加直接相关。同样,骨骼的承重能力直接与骨折的机械稳定性相关。因此,评估骨折修复进程可基于对愈合中骨折机械稳定性的测量。然而,由于各种障碍,骨折稳定性难以直接评估,其中骨折固定结构对力学性能的屏蔽是最相关的障碍之一。已经提出了几种评估方法来克服这些障碍,并获得某种描述骨折稳定性的力学替代指标。最直接的方法是测量在给定外部载荷下骨折的柔韧性,这包括准确测量骨骼变形的挑战。替代方法包括通过内部或外部传感器测量植入物与骨骼之间的载荷分担。放射立体分析提供了骨位移的直接三维测量,它可以评估骨折移位,并能检测载荷作用下的骨折移动。更间接的力学方法是在骨骼内引发周期性扰动,并测量作为愈合时间函数的响应。在较低频率下,扰动以振动形式引发,在较高频率下以超声波形式引发。这两种方法都提供了骨折部位力学性能的替代指标。尽管愈合中骨折的生物力学性能为骨折愈合提供了直接且与临床相关的测量方法,但在不久的将来,它们的应用将仅限于临床研究或研究环境。

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