Zhang Jingwei, Ebraheim Nabil, Li Ming, He Xianfeng, Schwind Joshua, Liu Jiayong, Zhu Limei
Department of Orthopaedic Surgery, Ningbo Sixth Hospital, No. 1059 East Zhongshan Road, Ningbo, 315040, Zhejiang province, China.
Eur J Orthop Surg Traumatol. 2015 Aug;25(6):1099-104. doi: 10.1007/s00590-015-1604-7. Epub 2015 Feb 21.
External fixation of tibial fractures using a locking plate has been reported with favorable results in some selected patients. However, the stability of external plate fixation in this fracture pattern has not been previously demonstrated. We investigated the stability of external plate fixation with different plate-bone distances.
In this study, the computational processing model of external fixation of a distal tibial metaphyseal fracture utilizing the contralateral femoral less invasive stabilization system plate was analyzed. The plate was placed on the anteromedial aspect of tibia with different plate-bone distances: 1, 10, 20, and 30 mm.
Under axial load, the stiffness of construct in all groups was higher than intact tibia. Under axial load with an internal rotational force, the stiffness of construct with 1 and 10 mm plate-bone distances was similar to that of an intact tibia and the stiffness of the construct with 20 and 30 mm distances was lower than that of an intact tibia. Under axial load with an external rotational force, the stiffness of the construct in all groups was lower than that of an intact tibia. The maximum plate stresses were concentrated at the two most distal screws and were highest in the construct with the 10 mm plate-bone distance, and least in the construct with a 1 mm plate-bone distance.
To guarantee a stable external plate fixation in distal tibial fracture, the plate-bone distance should be less than 30 mm.
据报道，使用锁定钢板对胫骨骨折进行外固定在部分特定患者中取得了良好效果。然而，此前尚未证实这种骨折类型中外侧钢板固定的稳定性。我们研究了不同钢板与骨间距的外侧钢板固定的稳定性。
在本研究中，分析了利用对侧股骨微创稳定系统钢板对胫骨远端干骺端骨折进行外固定的计算处理模型。将钢板置于胫骨前内侧，钢板与骨的间距分别为1、10、20和30毫米。
在轴向载荷下，所有组的固定结构刚度均高于完整胫骨。在轴向载荷加内旋力作用下，钢板与骨间距为1和10毫米时固定结构的刚度与完整胫骨相似，而间距为20和30毫米时固定结构的刚度低于完整胫骨。在轴向载荷加外旋力作用下，所有组固定结构的刚度均低于完整胫骨。最大钢板应力集中在最远端的两颗螺钉处，在钢板与骨间距为10毫米的固定结构中最高，在钢板与骨间距为1毫米的固定结构中最低。
为确保胫骨远端骨折外侧钢板固定的稳定性，钢板与骨的间距应小于30毫米。
