【作者】 黄亮亮；

【导师】 张朝跃；

【作者基本信息】 中南大学 ， 外科学， 2011， 硕士

【摘要】 目的：通过可吸收髌骨网兜对髌骨骨折模型固定的初步研制,并与克氏针张力带(AO法)固定术的生物力学进行比较,期待为今后临床治疗髌骨骨折提供一种新的方法。方法：(1)选用聚乙交酯-丙交酯(PGLA)可吸收线,按髌骨形状编织成网兜。(2)取10具成人尸体20个膝关节湿标本,男、女双侧膝关节各10例,于髌骨中点用钢锯锯开,做成横行骨折模型,随机分成A、B两组：A组为可吸收髌骨网兜固定组,B组为克氏针张力带固定组,屈膝90度、110度后摄X线片(3)将A、B两组标本固定于力学测试仪(MTS)上,模拟人体膝关节伸、屈进行力学加载测试。(4)生物力学实验加载完成后将所有标本取出,测量关节面骨折端台阶距离。(5)A、B两组数据采用两组间t检验进行统计学分析比较。结果：(1)做成手工编织长方形可吸收髌骨网兜,用4号PGLA线10根,按编网样编织成长4cm,宽3cm的网,网眼大小约0.8cmx0.7cm,每排5个网眼,编成4排,与髌骨大小近似,网之线尾不剪断,尾线长6cm,带针。(2)A、B两组屈膝90度、110度,摄X线片,均显示骨折对位、对线好,无移位、分离,内固定无松动。(3)可吸收髌骨网兜固定组和克氏针张力带固定组,在10--100N负荷下进行力学测试,结果显示：在10---100N之间,两者固定髌骨骨折端分离的距离：可吸收髌骨网兜固定组(A组)10N时为：0.0280±0.0063mm,50N时为：2.4200±0.4814mm,70N时为：5.2540±0.1556mm,100N时为：11.261±0.5874mm,克氏针张力带术固定组(B组)10N时为：0.0290±0.0074mm、50N时为：2.7420±0.4707mm,70N时为：5.4020±0.2009mm,100N时为：11.1617±0.4788mm。其分离距离的完全随机设计两均数比较的t检验分析结果表明,A、B两组间分离距离统计学分析,P值均大于0.05,无统计学差异。(4)生物力学加载完成后A、B两组关节面骨折端台阶距离：A组为：1.310±0.191 mm,B组为1.440±0.158mm。其台阶距离的完全随机设计两均数比较的t检验分析结果表明,两组间台阶距离统计学分析,P值均大于0.05,无统计学差异。结论：本实验初步显示所研制的可吸收髌骨网兜符合髌骨骨折内固定生物力学原理,与AO张力带固定髌骨骨折标本效果相近。更多还原

【Abstract】 Objective:A method about using absorbable patella net(APN) to fix petella fracture model is researched by preliminary study of APN. With biomechanical comparison to AO method, this method is expected to a new approach to clinically treat petella fracture in the future.Methods:1. Choose PGLA absorbable line to braid a net according to the shape of petella.2. Take out 20 wet speciments knees from 10 adult cadavers,10 for each sex or each side. Then cut the petella at the midpoint with a hacksaw, make them into transverse fracture models and fix the models with two methods using absorbable petella net and K-wire tension band (KWTB). Divide these models randomly into two groups:A is absorbable petella net group, and B is K-wire tension band gruop. Bend them to eighty angle and irradiate with X-ray.3. Fix the AB groups on the mechanical tester (MTS), make a mechanical loading test.4. After mechanical loading test all the specimens are removed.Different separation distances between fracture ends are got.5.Using t test to analyse all the date.Results: 1. As weaving fishing nets, the APN are braided manually to a rectangular form, with 10 PGLA lines of 4th. And the APN, whose size approximates to patella, is 4cms long and 3cms wide, arranging into 4 rows in which each row contains 5 mesh with a size of 0.8X0.7cm. The net line leaves a 6cm tail with a needle.2. Bend knee to eighty angle and irradiate with X-ray.The results show that fractures are unseparated and unshifted with good alignment an, and the internal fixations are not loosing.3. Make machanical tests of APN group and KWTB group under 0-100N loading. The results show that the distances of fracture ends fixed by both methods. The distance in A group shows 0.0280±0.0063mm when the loading is I0N.While 50N the distance is 2.4200±0.4814mm, 70N is 5.2540±0.1556mm, and when the loading is 100N the distances is 11.261±0.5874mm.The distance in B group shows 0.0290±0.0074mm when the loading is 10N.While 50N the distance is 2.7420±0.4707mm,70N is 5.4020±0.2009mm, and when the loading is 100N the distances is 11.1617±0.4788mm.The results show that the distances of fracture ends fixed by both methods have no obvious statistical significance(P>0.05).4. Make machanical tests of APN group and KWTB group undermechanical loading.A group is 1.310±0.19mm and B group is 1.440±0.158mm. The results show that the distances of fracture ends fixed by both methods have no obvious statistical significance (P>0.05).Conclusion:These experiments preliminaryly indicate that APN is consistent with biomechanical principles, with effect approximated to the AO method.更多还原