摘要
背景：国内外诸多学者致力于研究如何通过内固定材料及设计的改变尽量减少应力遮挡效应,取得了一定的进展。目的：进一步验证镍钛合金天鹅型记忆接骨器固定下的快速高质量的骨愈合,从临床研究角度评价天鹅记忆接骨器的应力遮挡效应。设计、时间及地点：对比观察实验。于2001-03/2003-08在解放军第二军医大学长海医院骨科进行。对象：随机从临床病例中选取采用镍钛形状记忆天鹅接骨器内固定和不锈钢板内固定后骨折完全愈合的上肢骨干骨折患者。天鹅记忆接骨器组20例,男14例,女6例;年龄14-34岁;手术至取出内固定时间（11.2±3.7）个月。不锈钢接骨板组20例,男16例,女4例;年龄16-36岁;手术至取出内固定时间（12.6±4.1）个月。方法：征得患者同意后,在患者行内固定取出时,天鹅记忆接骨器组在鹅体部下和加压枝下取极少量皮质骨;不锈钢板组在钢板下、钢板对侧取极少量皮质骨。进行皮质骨的组织学观察、X射线观察和CT扫描定量。主要观察指标：①光镜下进行骨细胞形态、哈弗氏管等组织学观察。②X射线摄片观察骨折愈合情况。③CT测量骨皮质CT值。结果：①组织学观察：天鹅记忆接骨器组鹅体部下和加压枝下骨皮质中,板层骨结构规整,无明显骨质疏松和吸收;不锈钢接骨板组钢板下骨质疏松、骨质吸收明显,可见含有大小不一吸收腔,哈佛氏管扩大,骨细胞萎缩、骨陷窝增大,而钢板对侧骨质吸收现象轻于板下。②X射线摄片观察：天鹅记忆接骨器组无外骨痂,骨皮质厚度、密度与正常骨质相似;不锈钢接骨板组板下皮质骨吸收变薄,钢板对侧骨皮质厚度与密度多大于板下。③CT扫描定量：组内不同部位比较,天鹅记忆接骨器组中,鹅体部下和加压枝下CT值差异无显著性意义（P〉0.05）;不锈钢接骨板组中,钢板下CT值低于钢板对侧CT值（P〈0.01）;组间比较,不锈钢接骨板组中两部位CT值均低于天鹅记忆接骨器组中两部位CT值（P〈0.05,P〈0.01）。结论：与不锈钢接骨板相比,天鹅记忆接骨器对固定骨段具有较低的应力遮挡效应。
BACKGROUND： The studies about how to reduce stress-shielding effect by modifying the internal design to have achieved certain progress. OBJECTIVE： To further verify the rapid high-quality bone healing under the internal fixation compressive connector （SMC） and to evaluate the stress-shielding effect of SMC from clinical aspects. fixation materials and of swan-like memory DESIGN, TIME AND SETTING： The comparative observation was performed at Department of Orthopedics, Changhai Hospital of Second Military Medical University of Chinese PLA from March 2001 to August 2003. PARTICIPANTS： Patients with fracture healing after SMC internal fixation or stainless steel plate fixation were randomly selected including 20 undergoing SMC internal fixation （14 male, 6 female, aged 14-34 years, time cost from surgery to fixator removal 11.2±3.7 months）, and 20 undergoing steel plate fixation （16 male, 4 female, aged 16-36 years, time cost from surgery to fixator removal 12.6±4.10 months）. METHODS： With the informed consent, when bone healing was achieved, the internal fixators were taken out. In SMC group, minimal cortical bone under the fixator and compressive branch was harvested; in steel plate fixation group, minimal cortical bone under the steel plate, and opposite side to the steel plate was harvested for observation. MAIN OUTCOME MEASURES： Osteocyte morphology, Harversian canal histological observation under light microscope; radiographic observation of fracture healing and CT scanning quantitation of cortical bone. RESULTS： ①Histological observation： Under all parts of SMC group, the cortical bone had regular architecture of lamellar bone and had none bone absorption. While in cortical bone beneath the plate of steel plate group, obvious osteoporosis and bone absorption were observed, and there were large or small absorption cavity, expanded Haversian canal and shrinking osteocyte. The cortical bone of opposite side in steel plate group had less bony absorption than that of the side beneath the steel plate. ② Radiographic observation： SMC group had no external callus. Its cortical thickness and bone density were similar to normal bone While in steel plate group, the cortical thickness became thinner and the opposite side cortical bone in steel plate group had higher thickness and density than the side beneath the steel plate. ③CT scanning quantitation： Between the CT value of cortical bone beneath swan body part and compressing part. there were no statistical differences （P 〉 0.05）, while in steel plate group the CT value of the side beneath plate was lower than that of the opposite side of plate （P 〈 0.01）. Compared with SMC group, CT value in two parts of steel group was significantly lower （P 〈 0.05, P 〈 0.01）. CONCLUSION： SMC has lower stress-shielding effect to fixed bone than steel plate.
出处
《中国组织工程研究与临床康复》
CAS
CSCD
北大核心
2008年第26期5023-5027,共5页
Journal of Clinical Rehabilitative Tissue Engineering Research
