锁定重建接骨板治疗髋臼横行骨折的生物力学研究

背景：髋臼横形骨折治疗较为困难，常采用内固定的治疗方法。近年来有学者尝试采用锁定重建接骨板，但对其的研究报道较少。 目的：比较4种不同锁定重建接骨板后方入路内固定方式治疗髋臼横行骨折的生物力学稳定性。 方法：采用成人防腐标本10具，制成髋臼横行骨折模型20个，随机分为4组，每组5个标本。A组：重建接骨板两端各固定3枚螺钉。B组：重建接骨板两端各固定3枚螺钉及距骨折线最近的两侧螺孔各1枚螺钉。C组：锁定重建接骨板两端各3枚单皮质螺钉。D组：锁定重建接骨板两端各3枚单皮质螺钉及距骨折线最近的两侧螺孔各1枚单皮质螺钉。行轴向的加载实验，记录内固定失效时最大负载和轴向刚度。 结果：A、B、C、D组所能承受的最大负载分别为（180.60±11.781）N、（240.80±7.981）N、（243.80±11.755）N和（438.00±23.227）N；轴向刚度分别为（95.21±6.32）N/mm、（123.47±23.95）N/mm、（126.39±18.52）N/mm和（227.35±13.74）N/mm。除B、C两组数据比较无统计学差异（P〉0.05），其余各组的最大负载和轴向刚度差异均有统计学意义（〈0.05）。 结论：髋臼横形骨折采用接骨板后方入路内固定时，锁定重建接骨板固定的稳定性优于重建接骨板，而且距骨折线最近的两侧螺孔给予螺钉固定能增强内固定的稳定性。

Biomechanical study on locking reconstruction plate for acetabular transverse fracture

Background：It is very difficult to treat transverse acetabular fracture and locking reconstruction plates have been used for in-ternal fixation. But there are few literatures on it. 〈br〉 Objective： To compare the biomechanical stability of four different internal fixation with plates and screws for transverse acetabular fractures. 〈br〉 Methods：Ten adult corpses were used to prepare for 20 models of transverse acetabular fractures. Then the fracture models were randomly divided into four groups （n=5）： three screws were fixed at each end of reconstruction plates in group A, three screws were fixed at each end of reconstruction plates and one screw was fixed in the screw holes nearest to the frac-ture line on both sides in group B, three single cortical screws were fixed at each end of locking reconstruction plates in group C, and three single cortical screws were fixed at each end of locking reconstruction plates and one single cortical screw was fixed in the screw holes nearest to the fracture line on both sides in group D. Axial loading experiment was per-formed, and the maximum load and axial stiffness were recorded when internal fixation was failed. 〈br〉 Results：The maximum load was （180.60 ＆#177; 11.781）N, （240.80 ＆#177; 7.981）N, （243.80 ＆#177; 11.755）N and （438.00 ＆#177; 23.227） Nin the four groups in turn;axial stiffness was （95.21 ＆#177; 6.32） N/mm, （123.47 ＆#177; 23.95） N/mm, （126.39 ＆#177; 18.52）N/mm and （227.35 ＆#177; 13.74） N/mm. There was no statistical difference in maximum load and axial stiffness between group B and C （P＆gt;0.05）, while the maximum load and axial stiffness in the rest groups was statistically different （P＆lt;0.05）. 〈br〉 Conclusions：The biomechanical stability of locking reconstruction plate is better than reconstruction plates for transverse acetabular fracture. The screws fixed in the screw holes nearest to the fracture line the on both sides can enhance fixation stability.