后踝关节骨折不同内固定方式的生物力学性能对比

背景：临床对后踝关节骨折患者进行治疗的过程中，可以使用不同的固定物进行内固定治疗，但不同的内固定治疗方式会产生不同的生物力学效果。目的：比较分析后踝关节骨折行微型钢板内固定以及拉力螺钉内固定治疗的生物力学性能。方法：回顾性分析95例后踝关节骨折患者的临床资料，均接受内固定治疗，按照内固定方法分为微型钢板组48例和拉力螺钉组47例。结果与结论：对两组的固定效果进行三维有限元模型模拟和分析，经分析发现，在后踝关节骨折块波及到胫骨远端关节面25%以上的情况下，在内固定失效平均压力方面，拉力螺钉组显著小于微型钢板组(P < 0.05)；而当后踝关节骨折块波及到胫骨远端关节面25%以下的情况下，在内固定失效平均压力方面，拉力螺钉组显著大于微型钢板组(P < 0.05)。拉力螺钉组的踝关节内固定优良率显著高于微型钢板组(P < 0.05)。两组治疗过程中均未出现任何内固定材料相关不良事件。结果表明，临床对后踝关节骨折的患者进行内固定治疗的过程中，予以拉力螺钉内固定可以获得较之微型钢板内固定更好的临床效果，但在后踝关节骨折块波及到胫骨远端关节面25%以上的情况下，更合适使用微型钢板进行内固定治疗。 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Comparison of biomechanical properties of different internal fixation methods for the treatment of posterior ankle fractures

BACKGROUND: Different fixtures can be used for the internal fixation treatment of patients with posterior ankle fractures in clinic, however, different internal fixation methods will produce different biomechanical effect.OBJECTIVE: To compare and analyze the biomechanical properties of mini steel plate internal fixation and tension screw internal fixation in the treatment of posterior ankle fracture.METHODS: The clinical data of 95 patients with posterior ankle fractures were retrospectively analyzed. All patients were treated with internal fixation. Mini steel plate group (n=48 cases) and tension screw group (n=47 cases) were divided according to the internal fixation methods.RESULTS AND CONCLUSION: The fixation effect of these two groups was simulated and analyzed using three-dimensional finite element model. The results showed that when the posterior ankle joint fracture block spreaded to the distal tibial articular surface of more than 25%, the mean pressure of internal fixation failure of tension screw group was significantly less than that of the mini steel plate group (P < 0.05). When the posterior ankle joint fracture block spreaded to the distal tibial articular surface of 25% or less, the mean pressures of internal fixation failure of tension screw group was significantly greater than that of the mini steel plate group    (P < 0.05). The excellent and good rate of ankle joint internal fixation of tension screw group was significantly higher than that of the mini steel plate group (P < 0.05). In these two groups, there were no internal fixation material related adverse events during the treatment. These results demonstrate that the clinical effect of tension screw internal fixation for the treatment of posterior ankle fractures was better than that of the mini steel plate internal fixation, but the use of mini steel plate for internal fixation was more appropriate when the posterior ankle joint fracture block spreaded to the distal tibial articular surface of more than 25%.