自制髓内钉系统固定锁骨中段骨折的生物力学研究

Biomechanical study of a self-developed intramedullary nailing system for midclavicular fracture

摘要:

目的 探讨自制短节段新型髓内固定装置固定锁骨中段骨折的可行性。 方法 选取24根成年男性新鲜锁骨标本，制作成锁骨中段横型骨折模型，随机分3组：解剖钢板组（A组）、新型锁骨髓内钉组（B组）、弹性髓内钉组（C组）。依此完成四点弯曲试验、扭转试验、拉伸试验等力学测试。 结果 新型锁骨髓内固定系统固定锁骨中段骨折在抗四点弯曲、抗扭转稳定性方面皆优于弹性髓内钉固定（P < 0.05），接近接骨板固定强度（P＞0.05）；新型锁骨髓内钉抗拉伸稳定性，优于弹性髓内钉固定强度（P < 0.05），但比接骨板固定稳定性差（P < 0.05）。 结论 新型锁骨髓内钉系统固定成人锁骨中段骨折可提供抗弯曲、抗扭转及抗拉伸的可靠力学稳定性，理论上可以满足临床治疗该类型骨折的需要，同时具有操作简单、微创、抗旋转等优势。

Abstract:

Objective To analyze the feasibility of a new type of short-segment intramedullary nailing system for the fixation of a midclavicular fracture model. Methods Twenty-four fresh clavicle specimens from male adults were selected to establish a transverse midclavicular fracture model，and were randomly divided into group A （fixation with an anatomical plate），group B （fixation with the novel intramedullary nail），and group C （fixation with an elastic intramedullary nail），followed by four-point bending testing，torsion testing，and tensile testing in turn. Results In four-point bending testing and torsion testing，the new intramedullary nailing system had significantly better stability than the elastic intramedullary nail （P < 0.05），and showed similar stability to the anatomical plate （P >0.05）. In tensile testing，the stability of the new intramedullary nailing system was significantly better than that of the elastic intramedullary nail （P < 0.05），but worse than that of the anatomical plate （P < 0.05）. Conclusion The new intramedullary nailing system can provide reliable mechanical stability against bending，torsion，and tension in fixing adult midclavicular fractures. It can theoretically meet the treatment requirements for this type of fracture. At the same time，it is simple in operation and minimally invasive，and has the advantage of anti-rotation.