胫骨中髓内钉与锁定加压钢板分期修复胫骨开放性骨折的生物力学特点

背景：髓内钉固定和锁定加压钢板相比在开放性骨折中更具优势，具有锁定和加压双重功能，能够较高的保护骨折端的血供，组织创伤少，弹性固定牢，感染率低等优点。 目的：探讨胫骨中髓内钉与锁定加压钢板在分期治疗胫骨开放性骨折中的临床疗效及生物力学性能。 方法：选取于2012年1月至2014年1月潍坊医学院附属青岛市胶州中心医院骨科收治的胫骨开放性骨折患者100例。采用随机对照方法根据患者进行的手术方式分为胫骨中髓内钉组57例，锁定加压钢板组43例。选取潍坊医学院附属青岛市胶州中心医院提供的10具尸体胫骨开放性骨折模型，随机分2组，分别采用胫骨中髓内钉固定和锁定加压钢板固定后，进行三点弯曲实验、轴向压缩实验以及扭转强度实验。 结果与结论：胫骨中髓内钉组患者手术时间、术中出血量显著少于锁定加压钢板组(P < 0.05)。两组患者在切口感染、固定物松动、不愈合等固定后并发症方面差异无显著性意义，均无切口感染。胫骨中髓内钉组标本弯曲实验偏移量、轴向压缩实验偏移量、扭转实验扭转角度，显著小于锁定加压钢板组(P < 0.05)。结果证实，胫骨中髓内钉与锁定加压钢板在分期治疗胫骨开放性骨折中均能获得预期治疗效果，但胫骨中髓内钉生物力学更加稳定，更加符合人体生物力学特性，具有固定坚强、能早期活动，应力遮挡小优点，治疗时根据患者症状、骨折位置等选择合适的材料能够提高疗效。  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

Tibial intramedullary nail and locking compression plate repair open tibial fractures by stages: biomechanical characteristics

BACKGROUND: Intramedullary nail fixation has more advantages in open fractures compared with the locking compression plate, such as the dual functions of lock and compression, highly protecting the blood supply in fracture end, less tissue trauma, firm elastic fixation and low infection rate. OBJECTIVE: To investigate the clinical efficacy and biomechanical properties of tibial intramedullary nail and locking compression plate in treatment of open tibial fractures by stages. METHODS: Totally 100 patients with open tibial fractures who received treatment at the Department of Orthopedics, Jiaozhou Central Hospital of Qingdao Affiliated to Weifang Medical College from January 2012 to January 2014 were enrolled. Patients were divided into tibial intramedullary nail group (n=57) and locking  compression plate group (n=43) according to the surgical procedures using randomized controlled method. Ten corpses models of open tibial fractures provided by Jiaozhou Central Hospital of Qingdao Affiliated to Weifang Medical College were selected, and then randomly divided into 2 groups. Three-point bending test, axial compression test and torsional strength test were conducted after the fixation with tibial intramedullary nail and locking compression plate. RESULTS AND CONCLUSION: The operative time and per-operative blood loss of patients in the tibial intramedullary nail group was significantly less than those in the locking compression plate group (P < 0.05). There were no significant differences in wound infection, fixtures loosening, not healing and other complications after fixation between these two groups. There were no incision infection in these two groups. The specimens bending test offset, axial compression experiments offset and torsion test torsion angle in tibial intramedullary nail group were significantly less than those in the locking compression plate group (P < 0.05). These results demonstrate that tibial intramedullary nail and locking compression plate for treatment of open tibial fractures by stages can achieve the desired therapeutic effect, however, the biomechanics of tibial intramedullary nail is more stable, and more in line with the biomechanical properties of human body, with the advantages of firm fixation, doing exercises in early stage and small stress shielding. Choosing the appropriate materials according to patient’s symptoms and fracture location during treatment can improve the curative effect.