摘要
背景：踝关节骨折术后早期能否负重目前没有达成共识。目的：采用尸体模型模拟早期负重来评估骨折有无移位和移位发生的时间。方法方法：将24具下肢尸体标本分为3组。第一组：双踝骨折（n=6）;第二组：未固定后踝骨折的三踝骨折（n=9）;第三组：固定了后踝骨折的三踝骨折（n=9）。并以3 Hz频率从0到1000 N,25万次的轴向压力负载来测试,用以模拟5周的全负重。用可变磁阻测量传感器来测量是否移位、移位侧程度。结果结果：三组中所有骨折部位的平均移动均显著地小于1 mm（P〈0.05）。第一组：内、外踝骨折的移位分别是（0.4±0.4）mm和（0.1±0.1）mm;第二组：外踝、内踝、后踝骨折的移位分别是（0.6±0.4）mm,（0.5±0.4）mm,（0.5±0.6）mm;第三组：外踝、内踝、后踝的骨折移位分别是（0.1±0.1）mm,（0.5±0.7）mm,（0.5±0.4）mm。大多数（64.0%-92.3%）的移位发生在前50000个周期中。在每组中的骨折部位处,骨折位移和骨密度间没有相关性（P〉0.05）。结论结论：经过切开复位内固定的踝关节骨折尸体模型中,早期负重过程中没有明显的骨折移位和新发骨折,固定材料未断裂。本研究进一步支持踝关节骨折切开复位内固定手术后可以早期负重。
Background： There is still no consensus regarding the timing of weight bearing after surgical fixation of unstable traumatic ankle fractures. Objective： To evaluate the fracture displacement and the time of displacement after early weight bearing in a cadaveric model. Methods： Twenty-four fresh-frozen lower extremities were assigned to group 1（bimalleolar ankle fracture,n=6）,group 2（trimalleolar ankle fracture with unfixed small posterior malleolar fracture,n=9）,or group 3（trimalleolar ankle fracture with fixed large posterior malleolar fracture,n=9）. The models were tested with axial compressive load at 3 Hz from 0 to 1000 N for 250 000 cycles to simulate 5-week full weight bearing. Displacement was measured by differential variable reluctance transducer. Results： The average motion at all fracture sites in all groups were significantly less than 1 mm（P〉0.05）. The displacement of the lateral and medial malleolus fracture was（0.1±0.1） mm and（0.4±0.4） mm,respectively in group 1. The displacement of lateral,medial,and posterior malleolar fracture was（0.6 ± 0.4） mm,（0.5±0.4） mm,and（0.5±0.6） mm,respectively in group 2. The displacement of the lateral,medial,and posterior malleolar fracture was（0.1±0.1） mm,（0.5±0.7） mm,and（0.5±0.4） mm,respectively group 3. The majority of displacement（64.0% to92.3%） occurred in the first 50 000 cycles. There was no correlation between fracture displacement and bone mineral density. Conclusions： No obvious fracture displacement,fixator breakage or new fractures occurred in a cadaveric model of early weight bearing in unstable ankle fracture after open reduction and internal fixation in this study,which supports further investigation of early weight bearing protocols after fixation of unstable ankle fractures.
出处
《中国骨与关节外科》
2016年第6期515-519,共5页
Chinese Journal of Bone and Joint Surgery
基金
新疆自治区科技支疆项目(项目编号:201491190
踝关节骨折手术方法选择的生物力学基础研究)
关键词
踝关节骨折
早期负重
骨折移位
固定材料断裂
术后康复
Traumatic Ankle Fracture
Early Weight Bearing
Fracture Displacement
Breakage
Fixator
Postoperative Rehabilitation
