锁定加压钢板生物力学原理及置入后的失败分析

背景：锁定加压钢板是结合传统加压钢板技术和支架原理开发出的一种新型支架性钢板系统。与传统钢板相比,锁定加压钢板在骨折治疗方面有着许多优势。目的：分析锁定加压钢板的生物力学原理及锁定加压钢板置入后失败的原因。方法：应用计算机检索CNKI和Pubmed数据库中2004-01/2010-10关于锁定加压钢板的文章,在标题和摘要中以＂锁定加压钢板,骨折,失败,内固定＂或＂Locking Compression Plate,Fracture,Internal fixation,Failure＂为检索词进行检索。选择文章内容与锁定加压钢板有关者,同一领域文献则选择近期发表或发表在权威杂志文章。初检得到126篇文献,根据纳入标准选择关于锁定加压钢板的18篇文献进行综述。结果与结论：锁定加压钢板的固定原理不是依靠钢板与骨皮质之间的摩擦力,而是依靠钢板与锁定螺钉的角稳定性及螺钉与骨皮质之间的把持力来实现对骨折的固定。从大量文献报道中来看,造成内固定失败的原因大多不在钢板本身,而是医源性失误造成的,如选用钢板过短、钢板与骨面间隙过大、钢板偏离骨干轴线、选用不合适螺钉类型等。锁定加压钢板系统相对复杂,术者需要遵循骨折固定的生物力学原则及充分的术前准备,才能尽可能地避免合并症的发生,达到最佳治疗效果。

Biomechanical principle of locking compression plate and the reason for its failure after insertion

BACKGROUND：Locking compression plate （LCP） is a new screw-plate system developed by combining the traditional compression plate techniques with the principles of internal fixator.Compared with traditional plates,LCP system has many advantages in the treatment of fracture.OBJECTIVE：To analyze biomechanical principle of LCP and common causes for its failure.METHODS：The articles related to LCP in CNKI database,Pubmed database from January 2004 to October 2010 were retrieved by computer with the key words of ＂Locking Compression Plate,Fracture,Internal fixation,Failure＂ in Chinese or in English.The articles related to LCP,and recently published or published in authoritative magazines in the same field were selected.A total of 126 literatures were obtained from the computer screen,and 18 documents of them were involved for summarization according to inclusion criteria.RESULTS AND CONCLUSION：The fixation principle of LCP is not rely on the friction between nickelclad and cortical bone,but on angle stability of nickelclad and locking screw and pullout strength of screw and cortical bone to achieve the fixation of fracture.From the large number of literature reports,most of the reason for failure of internal fixation is not on nickelclad itself,but on iatrogenic fault,such as short nickelclad,gap oversized between nickelclad and facies ossea,deviation of nickelclad and backbone axis,and inappropriate selection of screw type.The LCP system is relative complex,patients need to follow the biomechanical principles and adequate preoperative preparation,in order to avoid the occurrence of complications as much as possible,and to achieve the best therapeutic effect.