跖跗关节骨折脱位内固定方法的生物力学实验研究

通过用9只新鲜人体脚制作成分歧型脱位标本模型。解剖复位后分别采用钢丝环扎、二根克氏针、四根交叉克氏针和松质骨螺钉共四种方法做内固定并进行生物力学测验,发现各种内固定方法必须使第一、二、三跖跗关节组成一个整体,使中足成为坚固的弓形结构,可防止足弓塌陷和畸形。应用克氏针或松质骨螺钉内固定时,必须在第一跖跗关节稳定的基础上,经第一、二跖骨基底和第三楔骨交叉穿一克氏针或螺钉,使第二跖骨基底得两点固定。第一、二、三、四跖骨基底的横向骨间韧带牵拉,可阻止其向外侧移位。跖跗关节的外侧柱用一根或二枚克氏针或螺钉即可起到固定作用。骨折脱位的内侧柱必须用二枚克氏针或螺钉固定。

A Comparative Biomechanical Study of Four Internal Fixations to Fracture and Dislocation of Tarsometatarsal Joint

The article reported the results of biomechanical study in treatment of fractures and dislocation of tar-sometatarsal joint.The model of divergent type was made from nine fresh-frozen human feet. After anatomic reducation each speciment was randomly fixed with one of four methods (two crossed Kirschner pins, four crossed Kirschner pins, stainless steel wire suture and cancellous screws) and tested. It was found for each of the fixation methods, it must be tak-en into consideration of the first, second and third tarsoumetatarsal joints act as a whole when one Kirschner pins or can-cellous screw were applied to the base of first tarsometatarsal joint, another Kirschner wire or screw passed through first, second metatarsal base and third cuneiform, thus the second metatarsal base was stabilized for two points fixation, and by means of the interosseous ligments at the four lateral metatarsal base the metatarsal can not move laterally. Lateral column stabilization can be achived with one or two K-wires and screws fixation. Medial column of Lisfranc joint must be fixed with two crossed Kirschner pins or one screw.