趾关节移植重建手指关节不同内固定方法的生物力学性能比较

研究足趾关节移植重建手指关节时常用的4种内固定方法,比较并选择最简便、可靠的1种方法。方法:新鲜手足标本各8只,制成以跖趾关节重建掌指关节模型。分别用微型钢板、克氏针、钢丝和可吸收内固定棒加U形钉作内固定。用模拟掌指关节运动的加载装置和三维运动测定法测定,比较4种内固定方法的力学性能。结果:可吸收内固定棒加U形钉与钢板固定两种方法对趾(指)骨两断端的成角、位移和扭转控制效果最好;钢丝固定次之;克氏针交叉固定相对较弱。结论:可吸收内固定棒加U形钉是跖趾关节移植重建掌指关节时,骨关节固定中最简便、可靠的方法,术后适宜于早期进行功能锻炼。

Comparison of the mechanical efficacy of different internal fixation devices in metacarpophalangeal joint reconstruction with metatarsophalangeal joint transplantation

Objective:Four internal fixation devices used in metacarpophalangeal joint (MPJ) reconstruction werestudied and compared to select a simple and reliable fixation method. Methods: Fresh specimens of 8 adult hands and foots were divided into 4 groups for comparative study. Models of MPJ reconstruction by metatarsophalangeal joint transplantation were set up. The joints were fixed in each group with micro-steel plate, steel wire, cross Kirschner wires, and Biofix absorbable rods combined with U-shaped nail. Mimic metacarpophalangeal joint movement and three dimensional motion examinations were taken to compare the biomechanical characteristics. Results: Micro-steel plate and Biofix absorbable rods combined with U-shaped nail gave the strongest fixation against shift, angulation and torsion. Steel wire was the second best. The efficacy of cross Kirschner wire fixation was relatively poor. Conclusions: Biofix absorbable rods combined with U-shaped nail is an optimal internal fixation method in MPJ reconstruction by metatarsophalangeal joint transplantation. It is easily manipulated, reliable and suitable for early rehabilitation.