摘要
目的比较踝关节前路融合解剖钢板与双钛合金重建钢板应用于踝关节融合术的生物力学性能,为复杂踝关节融合术中固定钢板的选择提供生物力学依据。方法选取新鲜成人小腿-足踝标本16具,其中男8具、女8具,年龄36~60岁、平均45岁。16具标本按数字表法随机分为A组、B组,每组8具。对2组标本的踝关节面用骨凿进行破坏,制备成踝关节创伤标本。A组使用自主研发的踝关节前路融合解剖钢板行踝关节前路融合固定术,B组使用传统的双钛合金重建钢板行踝关节前路融合固定术。术后检测2组标本在1.0、2.0、3.0、4.0、5.0 N·m扭矩下的抗扭转性能;检测标本在中立位、背伸位时,压力为100、200、300、400、500、600、700 N下的轴向压缩性能;检测标本在700 N压力时,加压1000和30000次的抗疲劳性能,同时行X线透视检查并拆开标本缝线,观察踝关节固定钢板有无变形,有无螺钉松动、断裂等情况。结果在4、5 N·m扭矩时,A组扭转的角度分别为3.39°±0.33°、4.20°±0.20°,小于B组的3.85°±0.42°、4.64°±0.38°,差异均有统计学意义(t=2.44、2.87,P=0.028、0.012);在5 N·m扭矩时,A组的扭转刚度为(1.69±0.27)N·m/°,高于B组的(1.45±0.39)N·m/°,差异无统计学意义(t=1.67,P=0.118)。在100、200、300、400 N压力时,2组中立位、背伸位轴向压缩位移差异均无统计学意义(P值均>0.05);在500、600、700 N压力时,A组中立位、背伸位轴向压缩位移均小于B组,差异均有统计学意义(P值均<0.05)。在700 N压力时,A组轴向压缩刚度(244.38±26.60)N/mm,大于B组的(207.88±18.95)N/mm,差异有统计学意义(t=3.16,P=0.007)。抗疲劳性能组内比较,加压1000次和30000次时,2组轴向压缩位移差异均无统计学意义(P值均>0.05);组间比较,加压1000次和30000次时,A组的轴向压缩位移均小于B组,差异均有统计学意义(P值均<0.05)。A组未发现螺钉松动、断裂及钢板变形;B组在加压30000次时,1例模型出现钢板折弯变形,2例模型出现锁定螺钉松动。结论踝关节前路融合解剖钢板生物力学性能明显优于双钛合金重建钢板,为踝关节前路融合解剖钢板在临床的应用提供了生物力学的数据支持。
Objective Biomechanical comparative analysis was carried out between anterior ankle fusion anatomic plate and double titanium reconstruction plate for ankle fusion to provide biomechanical basis for complex ankle joint fusion.Methods Sixteen fresh adult calf-ankle specimens were selected,including eight males and eight females aged 36-60 years with a mean age of 45 years.The specimens were randomly divided into groups A and B by numerical table method with eight specimens in each group.The ankle surfaces of the two groups were destroyed to prepare traumatic ankle specimens.Group A used the self-developed ankle anterior fusion anatomical plate for anterior ankle fusion fixation,whereas group B used the traditional double titanium reconstruction plate for anterior ankle fusion fixation.Postoperatively,the torsional resistance of the two groups of specimens was tested at the torques of 1.0,2.0,3.0,4.0,and 5.0 N·m.The axial compression properties of the specimens were tested in the neutral and dorsal extension positions at the pressures of 100,200,300,400,500,600,and 700 N.The anti-fatigue performance of the specimens was tested at 700 N pressure for 1000 and 30000 times.X-ray fluoroscopy was performed,and the suture of the specimen was removed to observe whether the ankle joint fixation plate was deformed and whether the screw was loosened or broken.Results At 4 and 5 N·m torques,the torsion angles in group A(3.39°±0.33°,4.20°±0.20°)were less than those in group B(3.85°±0.42°,4.64°±0.38°),with statistically significant differences(t=2.44,2.87;P=0.028,0.012).The torsional stiffness of group A was(1.69±0.27)N·m/°at 5 N·m torque,which was higher than that([1.45±0.39]N·m/°)of group B,but the difference was not statistically significant(t=1.67,P=0.118).The axial compression displacements between the two groups in neutral and dorsal extension positions had no significant differences at 100,200,300,and 400 N pressure(all P values>0.05).The axial compression displacements in neutral and dorsal extension positions in group A were smaller than those in group B at 500,600,and 700 N pressure,and the differences were statistically significant(all P values<0.05).At 700 N pressure,the axial compression stiffness of group A(244.38±26.60)N/mm was greater than that of group B(207.88±18.95)N/mm,and the difference was statistically significant(t=3.16,P=0.007).For the intragroup comparison of fatigue resistance,the differences in axial compression displacement between the two groups were not statistically significant at 1000 and 30000 compressions(all P value>0.05).For the intergroup comparison,the axial compression displacement of group A was smaller than that of group B at 1000 and 30000 compressions,and the differences were statistically significant(all P value<0.05).In group A,no screw loosening,fracture,and plate deformation were found,whereas in group B,plate bending deformation occurred in one case and locking screw loosening occurred in two cases after 30000 times of compression.Conclusion The biomechanical properties of the ankle anterior fusion anatomical plate are remarkably better than those of the double titanium reconstruction plate,which provides biomechanical data support for the clinical application of the anterior ankle fusion anatomical plate.
作者
林需枰
刘庆军
刘思杰
丁真奇
林斌
林伟煌
谢玮娜
Lin Xuping;Liu Qingjun;Liu Sijie;Ding Zhenqi;Lin Bin;Lin Weihuang;Xie Weina(Department of Orthopedic,the 909th Hospital of Joint Service Support Force of PLA(the Affiliated Dongnan Hospital of Xiamen University),Zhangzhou 363000,China;Department of Radiology,the 909th Hospital of Joint Service Support Force of PLA(the Affiliated Dongnan Hospital of Xiamen University),Zhangzhou 363000,China;Department of Orthopedic Surgery,Xiamen Haicang Hospital,Xiamen 361000,China;Department of Anesthesiology,the 909 th Hospital of Joint Service Support Force of PLA(the Affiliated Dongnan Hospital of Xiamen University),Zhangzhou 363000,China)
出处
《中华解剖与临床杂志》
2022年第12期843-849,共7页
Chinese Journal of Anatomy and Clinics
基金
军队卫勤保障能力创新与生成专项计划(21WQ043)
漳州市“双创之星”专项基金。
关键词
关节融合术
踝关节
创伤性
内固定物
解剖钢板
双钛合金重建钢板
生物力学
实验研究
Arthrodesis
Ankle joint
Traumatic
Internal fixation
Anatomical plate
Double titanium reconstruction plate
Biomechanics
Experimental study
