三种内固定器械固定中足损伤的生物力学比较
Biomechanical analysis in using three different implants for midfoot injury
目的 评价新型镍钛记忆合金三角固定器在治疗中足损伤中的固定稳定性，通过比较3 种内固定在中足外侧柱移位性损伤中对前足足底压力分布的影响并对其生物力学进行分析，为选择内固定提供实验参考。 方法 取6只成人下肢尸体冷冻标本。制成第4、5跗跖关节骨折脱位模型，对4、5跗跖关节进行记忆合金三角固定器固定，H型接骨板固定，2.0 mm克氏针固定，克氏针分别从4、5跖骨打入骰骨。经加载600 N 后，通过Tekscan压力传感器，测量前足足底压力的变化，应用ElectroForce®3510高精度生物材料试验系统机进行轴向压缩力学测试，分别计算刚度值，并进行统计学分析。 结果 第4、5跗跖关节分别用三角固定器、钢板、克氏针固定后，第4、5跖骨头下的峰值压力则较骨折脱位状态有所增大，第2、3跖骨头下的峰值压力较骨折脱位状态下都有所减小，差异有统计学意义（P<0.05）。三角固定器组第4、5跖骨头下压力峰值与正常组相近。钢板固定组、记忆合金三角固定器、克氏针固定组组对外侧柱脱位固定后与正常组相比足部总体压缩刚度值无显著差异（P>0.05），疲劳试验后克氏针固定组静态压缩刚度较疲劳试验前明显减少，差异有统计学意义。 结论 记忆合金三角固定器治疗跗跖关节外侧柱损伤其恢复足底压力的能力及生物力学稳定性良好，为镍钛记忆合金三角固定器内固定器的临床应用提供生物力学依据。
Objective To evaluate the stability of new Nickel titanium memory alloy three-corner fixator in treatment of midfoot injury and measure the changes of plantar pressure of the lateral column dislocation by three different implants to provide experimental reference in selecting implants and evaluate the biomechanical properties of those implants．Methods Six fresh foot specimens were made into the models of the lateral column dislocation，which were fixed with Nickel titanium memory alloy three-corner fixator，the bridge plate and 2mm K-wire in turn. After the loading of 600 N，the changes of the plantar pressure in forefoot were measured by the method of the Tekscan Evolution handle pressure system．During the experiment, axial compression was performed with ElectroForce®3510 series test instruments. The compression stiffness of each bone-fixation combination was calculated and statistically analyzed. Results While the tarsometatarsal joint fracture dislocation was fixated by those there different kind of implants, the pressure under the fourth and fifth tarsometatarsal joints would all increased; the peak pressure under the second and third metatarsal head would all decrease, and differences were statistically significant（P＜0.05）．Nickel titanium memory alloy three-corner showed the statistical significant difference compared with the normal state（P>0.05）. There was no statistically significance between the compression stiffness of the three implants before fatigue test. The compression stiffness of K-wire group was decreased with significance. Conclusion Nickel titanium memory alloy three-corner fixator would help plantar pressure of the forefoot return to the normal state. The stability of the Nickel titanium memory alloy three-corner fixator is favored to meet the special biomechanical needs, which lays the foundation for its clinical use.
Nickel titanium memory alloy three-corner fixator / Midfoot injury； Biomechanical；Plantar pressure
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