【作者】 潘振华；

【导师】 冯文岭；

【作者基本信息】 河北医科大学 ， 外科学（专业学位）， 2015， 硕士

【摘要】 目的:由于交通事故与工伤事故的日渐增多,髋臼骨折的发生率也逐步增多,高能量创伤常引发髋臼骨折。髋臼后壁骨折是髋臼骨折最常见的一种,大约占全部髋臼骨折的1/4~1/3。如果在发生事故时,髋关节处在屈曲、内收、内旋位,极大的高能量暴力通过膝关节传导极易造成髋关节脱位,如果下肢的内收角度偏小,会造成股骨头撞击髋臼后缘,极易发生髋臼后唇撕裂骨折或股骨颈骨折等并发症。现在治疗髋臼后壁骨折的内固定物较多,而且取得了较好的结果,但研究合并髋臼唇损伤的修复研究尚且较少,尤其是内固定修复治疗髋臼后壁骨折合并髋臼后唇撕裂损伤未见相关资料报告。本实验通过生物力学比较与研究,对冯文岭教授设计的新型髋臼后壁可塑形解剖板治疗髋臼后壁骨折合并髋臼唇损伤提供试验依据。该新型髋臼后壁可塑形解剖板用于解决在髋臼骨折接骨时使用多块接骨板时结构繁杂、连接不稳固、应用不方便、不能修复髋臼唇的缺点,其设计原理是:它为薄金属板体,板的主体为长条形接骨板,长条接骨板的两侧边向外延伸成侧孔,其靠近髋臼唇一侧可以通过可吸收缝合线修复髋臼盂唇,另外一侧可以拧入螺钉,加强解剖板的固定强度。该弧形板面外形与坐骨结节外形相匹配,弯曲弧度与髋臼外面弧形外形相匹配,可能成为治疗髋臼后壁骨折合并髋臼唇损伤更完美的内固定材料。方法:选取9具经福尔马林溶液浸泡的新鲜成人骨盆标本,包括近端1/3股骨干,大体观察及X线片排除先天发育畸形、骨质疏松、骨骼疾病等。用双层保鲜袋密封保存在-20℃冰箱备用,实验前1天取出,在室温下自然解冻后使用。自正中矢状面锯开骶骨及耻骨联合,将骨盆分成左右两个新鲜半骨盆标本,去除周围的软组织,将标本编号备用,使骨盆处于单足站立体位,模拟人体屈髋90°、内收外展及旋转中立位。参照Olson等的实验方法,以站立位髋臼顶点与髋臼中心连线开始,沿髋臼盂缘向下40°弧为截骨上缘线,至90°弧为截骨下缘线,将此50°弧的后壁关节面纵向3等分,取中外1/3为截骨内缘线。先用克氏针按预定截骨线连续钻孔(注意不要钻深),再用骨凿将其带髋臼盂唇截断,制成髋臼后壁1/3骨折合并髋臼唇损伤模型备用,分三组:A组:新型髋臼后壁可塑形解剖板固定并以可吸收缝合线加强缝合髋臼唇固定,B组:新型髋臼后壁可塑形解剖板固定,C组:普通髋臼接骨板钢板固定。进行生物力学实验,包括轴向压缩试验和载荷脱位试验,测量骨折的纵向位移、内固定失效时的载荷及轴向刚度和在髋关节增加内收20度时,髋关节发生脱位时的载荷值,比较各组的稳定性。结果:在同一载荷下,三组骨折的纵向位移为A组<B组<C组,有统计学差异,体现了各组稳定性A组>B组>C组。在此基础上,各组失效时的载荷分别为A组(991.72±4.47)N、B组(884.90±3.35)N、C组(729.67±2.91)N。A组>B组>C组,有统计学差异(P<0.05),各组内固定的轴向刚度分别为A组(330.57±1.49)N/mm、B组(294.96±1.11)N/mm、C组(243.22±0.97)N/mm。A组>B组>C组,有统计学差异(P<0.05)。由于内固定失效时的载荷值越大,轴向刚度越大,内固定抵抗形变能力越强,髋关节越稳定,所以进一步说明了稳定性A组>B组>C组。同时为验证各组的最大载荷值,我们设计标本在原有基础上髋关节增加内收20度,进行载荷脱位试验,各组股骨头发生脱位时的载荷值分别为:A组(1171.50±23.26)N、B组(1067.00±19.65)N、C组(980.17±13.01)N。A组>B组>C组,有统计学差异(P<0.05)。结论:本实验通过建立髋臼后壁骨折合并髋臼唇损伤模型,并分别以新型髋臼后壁可塑形解剖板固定以可吸收缝合线加强缝合髋臼唇固定及普通接骨板固定,通过生物力学试验,对比分析了新型髋臼后壁可塑形解剖板单纯固定、以可吸收缝合线加强缝合髋臼唇固定和普通接骨板固定治疗髋臼后壁骨折合并髋臼唇损伤的稳定性,明确了新型髋臼后壁可塑形解剖板的优点及修复髋臼盂唇对于髋臼后壁骨折稳定性的意义,并得出结论:以新型髋臼后壁可塑形解剖板固定以可吸收缝合线加强缝合髋臼唇可治疗髋臼后壁骨折合并髋臼唇损伤,且效果良好。更多还原

【Abstract】 Objective: With the increase of traffic and industrial accidents, acetabular fracture incidence is increasing gradually, and acetabular fractures were always caused by high-energy trauma. Acetabular posterior wall fracture is the most common kind of the acetabular fractures caused by flexion injury, 1/4 ~ 1/3 of all acetabular fractures approximately. When the hip joint under the flexion, adduction, internal rotation position,the violence from the knee was extremely easily to cause the dislocation, when the adduction angle of the legs was small, the femoral head could impact the acetabular posterior edge to cause posterior lip of acetabulum avulsion fracture or femoral neck fractures. Many internal fixation materials have been used to treat acetabular posterior wall fractures at present, and have achieved good results. But there are few reports on the acetabular labrum injury repair study,especially internal fixation treatment of the acetabular posterior wall fractures incorporate with acetabular labral tear injurys. The new type posterior wall plasticity plate designed by Professor Feng Wenling is used to solve the disadvantages of the multi block plate,for example: complex structure, the insecure connection, the inconvenient use, and can not repair the acetabular labrum,Its technical scheme is:it has a thin metal plate body,which is a long strip shaped plate, two sides of each strip plate edge extending outwards into the side hole, the side near the acetabular lip can use absorbable suture to sew up the acetabular labral tear, the other side can be screwed into the screw fixation to strengthen the anatomical plate. The curved surface shape can be matched with the ischial tuberosity. Its bend radian can be matched with acetabulum outside arc shape matched with the acetabular labrum injury. It may be become a more ideal method of the internal fixation for the treatment of the acetabular posterior wall fractures incorporate with acetabular labral tear injurys. This experiment is to provide the experimental basis of the new type posterior wall plasticity plate designed by Professor Feng Wenling for acetabular posterior wall fractures incorporate with acetabular labral tear injurys through the biomechanical comparison and research on the model.Methods: This experiment chooses 9 formalin solution soaking fresh adult pelvis specimens, including 1/3 proximal femoral shaft, with the help of the gross observation and X-ray to exclude congenital deformity, osteoporosis and bone disease. The specimens were sealed at the temperature of-20 ℃refrigerator with the double preservation bags, and taken out 24 hours before the experiment, and natural thawed at room temperature,and then sawed sacral and pubic symphysis pelvis since the median sagittal plane, and divided into about two fresh semi pelvis specimens, eliminated the soft tissue of surrounding specimens,and numbered the specimens. Then made the pelvis in the single foot standing position, then imitate the human hip flexion 90°, adduction and abduction and rotation in neutral position. According to the experimental methods of Olson, start with the line between standing top of acetabulum and acetabular center line, along the acetabular labrum, down the arc of 40°for osteotomy on the edge, to the arc of 90°for osteotomy lower margin line, took the arc of 50°of articular surface of the posterior wall longitudinally into 3 equal parts, take the foreign 1/3 as the osteotomy edge line. First, use the Kirschner wire to drill continuously according to the predetermined osteotomy line(be careful not to drill deep), and then use chisel to truncate the acetabular labrum, make the model of acetabular posterior wall 1/3 fractures incorporate with acetabular labral tear injurys, and then divided into three groups randomly, The fractures were fixed with new type posterior wall plasticity plate in A and B group, and use absorbable suture to sew up the acetabular labral tear in A group, and with common fracture plate in C group. Then conduct the biomechanical experiment, including axial compression test and load test of dislocation. The longitudinal displacements, loading of failed internal fixation and axial stiffness,and the loadings when the femoral heads dislocated of hip joint adduction 20° were measured by axial loading experiments and compared between groups.Results: In the axial compression test,under the same loading, longitudinal displacements of B group were shorter than that of C group, longitudinal displacements of A group were shorter than that of B group(P<0.05). There is significant difference, shows the stability of A group >B group >C group. On this basis, each loading of failed internal fixation respectively in A group(991.72 + 4.47) N, B group(884.90 + 3.35) N, C group(729.67 + 2.91) N. A group >B group >C group, there is significant difference(P < 0.05). The fixed axial stiffness in each group were group A(330.57 + 1.49) N/mm, B group(294.96 + 1.11) N/mm, C group(243.22 + 0.97) N/mm. A group >B group >C group, there is significant difference(P < 0.05). Because when the loading of failed internal fixation is larger, the axial stiffness is bigger, the ability of internal fixation of resistance to deformation is stronger,the hip is more stable, so further illustrates the stability of A group >B group >C group. At the same time to test and verify the maximum load of each group, we design the specimen when the femoral heads dislocated of hip joint adduction 20° on the basis of the original, conduct the load test of dislocation, the loadings when the femoral heads dislocated of each group were: A group(1171.50 + 23.26) N, B group(1067 + 19.65) N, C group(980.17 + 13.01) N. A group >B group >C group, there is significant difference(P < 0.05).Conclusions: This experiment is to establish the model of acetabular posterior wall fractures incorporate with acetabular labral tear injurys, and be fixed with common fracture plate and new type posterior wall plasticity plate which use absorbable suture to sew up the acetabular labral tear respectively,to compare and analyse the stability of the acetabular posterior wall fractures incorporate with acetabular labral tear injurys were fixed with new type posterior wall plasticity plate, and use absorbable suture to sew up the acetabular labral tear, and with common fracture plate through the method of the biomechanics,to make clear the advantage of new type posterior wall plasticity plates and the significance of repairing the acetabular labrum for the stability of the acetabular posterior wall fracture. This experiment draws the conclusion at last: new type posterior wall plasticity plate can be used for internal fixation management of the posterior wall acetabular fractures incorporate with acetabular labral tear injurys, and the effect is favorable.更多还原