自主研制胸锁关节解剖锁定钢板的生物力学对比研究
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1.三六三医院;2.泸州市人民医院;3.宜宾市第一人民医院;4.西南医科大学附属医院

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四川省科技计划项目(2014JY0248)、泸州市科技计划项目[2016-S-67(14/23)]、西南医科大学基金项目(2013ZRQN069)、西南医科大学附属医院基金项目(2017-PT-47)


Biomechanical comparative study of self-developed sternoclavicular joint anatomical locking plate
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1.363 hospital;2.People'3.'4.s Hospital of Luzhou;5.First People'6.s Hospital of Yibin;7.Affiliated Hospital of Southwest Medical University

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    摘要:

    目的:将自主研制的胸锁关节解剖锁定钢板与桡骨远端斜T型锁定钢板及胸锁钩钢板进行生物力学对比分析,观察其生物力学方面的特点及优势。方法:选择9具防腐、湿润成人尸体,其中男性6具,女性3具。完整取下胸锁关节标本造成胸锁关节全脱位模型。将9具标本模型的两侧胸锁关节随机编号并配对分组:A组(实验组,胸锁关节解剖锁定钢板)、B组(对照组1,桡骨远端斜T型锁定钢板)和C组(对照组2,胸锁钩钢板),每组6个胸锁关节。将所有标本两侧安置钢板后固定于万能力学试验机上,分别进行锁骨远端负载、锁骨远端扭转及胸骨柄部螺钉抗拔出等三项生物力学实验。连接终端电脑绘制对应的应力-形变曲线。P<0.05表示差异有统计学意义。结果:(1)锁骨远端负载实验:三组标本载荷量-位移均呈线性关系。当垂直向后位移量为20mm时,A、B、C组锁骨远端负载点的载荷量平均为(30.31±0.86)N、(27.51±0.72)N、(25.10±1.10)N;三组间差异有统计学意义(P<0.05)。实验组的抗压缩形变性能强于两个对照组。(2)锁骨远端扭转实验:扭角与扭矩之间均呈线性关系。顺时针扭转实验中,A、B、C三组扭转刚度分别为0.288N.m/°、0.217N.m/°及0.180N.m/°,除了B组与C组扭转刚度比较无明显差异(F=2.95,P=0.185),A组与B组、A组与C组之间比较有统计学意义(P<0.05)。逆时针扭转实验中,A、B、C三组扭转刚度分别为0.205N.m/°、0.159N.m/°及0.080N.m/°,两两比较均有统计学意义(P<0.05)。实验组的抗扭转形变性能强于两个对照组。(3)胸骨柄部螺钉抗拔出实验:A、B、C组胸骨柄部螺钉最大抗拔出力分别为(210.62±17.66)N、(154.89±15.71)N、(184.05±17.50)N。三组间差异有统计学意义( P<0.05)。实验组胸骨柄部螺钉抗拔出性能强于两个对照组。结论:自主研制胸锁关节解剖锁定钢板在抗压缩、抗扭转、胸骨柄部螺钉抗拔出等生物力学性能方面显著优于斜T型锁定钢板及胸锁钩钢板,能够为临床上治疗胸锁关节骨折脱位提供一款较为理想的内固定器械。

    Abstract:

    Objective:Comparative biomechanical analysis of the self-developed sternoclavicular joint anatomical locking plate,the radial distal oblique T-shaped locking plate and the plate of sternoclavicular hook were carried out,to observe the characteristics and advantages of biomechanics. Methods:Selection of 9 anticorrosive and moist adult cadavers,of these,6 were male and 3 were female.The thoracoclavicular joint specimens were removed completely and the irrelevant soft tissues were removed.The anterior and posterior sternoclavicular ligaments and joint capsules were cut off on both sides,resulting in the complete dislocation model of the sternoclavicular joint.The bilateral sternoclavicular joints of 9 specimen models were randomly numbered and matched and grouped:Group A(Experimental group,sternoclavicular joint anatomical locking plate)、Group B(Control group 1,oblique T-shaped locking plate of distal radius) and Group C(Control group 2,sternoclavicular hook plate),6 sternoclavicular joints in each group.All specimens were placed with steel plates on both sides and fixed on the Universal Ability Test Machine,and three biomechanical experiments were carried out,including loading of distal clavicle,torsion of distal clavicle and anti-pull-out of sternum handle screw.The terminal computer is connected with the universal mechanical tester to derive the data and draw the corresponding stress-deformation curve.The difference was statistically significant (P<0.05). Results:(1)Distal clavicle loading test: The load-displacement of the three groups of specimens showed a linear relationship.When the vertical backward displacement is 20 mm,the average load of the distal clavicle load point of group A,B,and C was(30.31±0.86)N,(27.51±0.72)N,(25.10±1.10)N;there was significant difference among the three groups (P<0.05).The compressive deformation resistance in the experimental group was stronger than that in the two control groups.(2)Distal clavicle torsion test:The relationship between torque and torsion angle is linear.In clockwise torsion experiment,torsional rigidity of A,B,C three groups respectively is 0.288 N.m/°,0.217 N.m/°and 0.180N.m/°,in addition to torsional rigidity of group B and group C was no significant difference (F=2.95,P=0.185),that of group A and group B,that of group A and group C between comparison was statistically significant (P<0.05).In anticlockwise torsion experiment,torsional rigidity of A,B,C three groups respectively is 0.205 N.m/°,0.159 N.m/°and 0.080N.m/°,both two comparison in three sets of the torsional rigidity has statistical significance (P<0.05).The torsional deformation resistance in the experimental group was stronger than that in the two control groups.(3)Anti-pullout test of sternum handle screw:The maximum anti-pullout force of sternum handle screw in group A,B and C was (210.62±17.66)N,(154.89±15.71)N,(184.05±17.50)N;there was a significant difference among the three groups (P<0.05).The anti-pullout performance of the sternum handle screw in the experimental group was better than that in the two control groups.Conclusion:The self-developed sternoclavicular joint anatomical locking plate is superior to the oblique T-shaped locking plate of distal radius and the plate of sternoclavicular hook in terms of anti-compression,anti-torsion and anti-pullout of sternoclavicular screw.It may provide an ideal internal fixation device for the treatment of fracture and dislocation of sternoclavicular joint.

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  • 收稿日期:2019-10-14
  • 最后修改日期:2019-12-29
  • 录用日期:2019-12-31
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