發(fā)布時(shí)間：2018-03-02 22:19

  本文選題：鎖骨中段骨折　切入點(diǎn)：新型髓內(nèi)釘　出處：《四川醫(yī)科大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:鎖骨骨折是臨床常見(jiàn)的骨折,其中鎖骨中段是好發(fā)部位,大部分的鎖骨中段骨折伴有移位。鎖骨中段骨折存在保守治療和手術(shù)治療兩類,隨生活節(jié)奏加快、患者的需求及醫(yī)療技術(shù)水平的提高,目前鎖骨骨折更傾向于手術(shù)治療。臨床手術(shù)方式較多,包括有髓內(nèi)固定,鋼板螺釘固定,記憶合金固定,克氏針固定等。目前鋼板螺釘固定占主流,但帶來(lái)一系列問(wèn)題,諸如:手術(shù)剝離過(guò)多影響骨折段周圍血供,鋼板的應(yīng)力遮擋因素等逐漸引起臨床醫(yī)生的重視。彈性髓內(nèi)釘固定符合微創(chuàng)理念,但存在尾釘致皮下凸起出現(xiàn)激惹和骨折斷端移位導(dǎo)致髓釘遷移,單根彈性髓內(nèi)釘,無(wú)防旋功能。隨著對(duì)鎖骨骨折治療研究的深入,合適的內(nèi)固定應(yīng)滿足:微創(chuàng),恢復(fù)鎖骨長(zhǎng)度,有效固定且術(shù)后早期康復(fù)訓(xùn)練。本課題設(shè)計(jì)了一種適應(yīng)于鎖骨中段的新型髓內(nèi)釘,進(jìn)行生物力學(xué)測(cè)試,與彈性髓內(nèi)釘、接骨板進(jìn)行生物力學(xué)比較,通過(guò)各項(xiàng)參數(shù)分析,證實(shí)新型髓內(nèi)釘治療鎖骨中段骨折的可行性。方法:24根成年新鮮鎖骨標(biāo)本,所有尸體鎖骨均沒(méi)有鎖骨骨折,排除骨質(zhì)疏松、腫瘤、畸形等異常情況。將其隨機(jī)分為3組(A、B、C):A組為解剖鋼板組,B組為新型鎖骨髓內(nèi)釘組,C組為彈性髓內(nèi)釘組,將所有標(biāo)本在鎖骨中段相同部位骨鋸造成骨折建立模型。分別使用解剖鋼板、新型鎖骨髓內(nèi)釘、彈性髓內(nèi)釘對(duì)骨折模型進(jìn)行固定。將每個(gè)標(biāo)本用牙托粉固定后,并安置在力學(xué)實(shí)驗(yàn)機(jī)和扭轉(zhuǎn)試驗(yàn)機(jī)夾具上。試驗(yàn)前進(jìn)行預(yù)實(shí)驗(yàn),消除標(biāo)本蠕變影響,依次進(jìn)行四點(diǎn)彎曲試驗(yàn)、扭轉(zhuǎn)試驗(yàn)、拉伸試驗(yàn)。測(cè)量結(jié)果采用spss21.0進(jìn)行統(tǒng)計(jì)學(xué)處理,結(jié)果中的試驗(yàn)數(shù)據(jù)使用x±s表示,采用方差分析統(tǒng)計(jì)三組試驗(yàn)數(shù)據(jù)并相互對(duì)比有無(wú)差異,p0.05為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:1、四點(diǎn)彎曲試驗(yàn)中,三種不同固定方式的模型在加載壓力從0.01kn-0.10kn范圍內(nèi),加載壓力隨著加載負(fù)荷的增加,骨折斷端的位移逐漸增大,兩者線性相關(guān)。當(dāng)加載力為0.10kn時(shí)各組的位移值:a組(解剖鋼板組)位移值1.104±0.035mm,b組(新型鎖骨髓內(nèi)釘組)位移值1.148±0.032mm,c組(彈性髓內(nèi)釘組)位移值1.197±0.027mm,三組相互比較均有統(tǒng)計(jì)學(xué)意義(p0.05)。鋼板組抗彎曲能力最優(yōu),彈性髓內(nèi)釘抗彎曲能力最差。2、扭轉(zhuǎn)試驗(yàn)中,三種不同固定方式在扭轉(zhuǎn)角度0-10°范圍內(nèi),隨著扭轉(zhuǎn)角度增加,扭矩也增大,兩者呈線性相關(guān),得出的最大扭轉(zhuǎn)角度10°下,各組數(shù)據(jù):a組(解剖鋼板組)扭矩值0.910±0.066n.m,b組(新型髓內(nèi)釘組)扭矩值0.849±0.03n.m,c組(彈性髓內(nèi)釘組)位移值0.794±0.040n.m,三組相互比較有統(tǒng)計(jì)學(xué)意義(p0.05),新型髓內(nèi)釘固定抗扭轉(zhuǎn)能力明顯優(yōu)于彈性髓內(nèi)釘固定。3、拉伸試驗(yàn)中,各組試驗(yàn)鎖骨最大拉伸載荷結(jié)果:a組(解剖鋼板組)1.019±0.053kn,b組(新型髓內(nèi)釘組)0.963±0.025kn,c組(彈性髓內(nèi)釘)0.915±0.058kn。三組相互比較有統(tǒng)計(jì)學(xué)意義(p0.05),鋼板組的鎖骨拉伸載荷最好,新型髓內(nèi)釘組次之,彈性髓內(nèi)釘組最差。結(jié)論:新型鎖骨髓內(nèi)釘治療鎖骨中段骨折有以下優(yōu)勢(shì):與鋼板比較具有微創(chuàng)、易閉合復(fù)位,與彈性髓內(nèi)釘比較抗旋轉(zhuǎn)能力明顯,固定穩(wěn)定等生物力學(xué)優(yōu)勢(shì),且無(wú)皮下凸起形成。
[Abstract]:Objective: clavicle fracture is a common clinical fracture of clavicle, which is a good site, most of the clavicle fractures with displacement clavicle fracture. There are two kinds of conservative treatment and surgical treatment, with the quickening pace of life, the level of demand and medical technology of the patients increased, the clavicle fractures tend to more surgery. The clinical surgery, including intramedullary fixation, plate fixation, memory alloy fixation, Kirschner wire fixation plate and screw fixation. At present the mainstream, but brings a series of problems, such as too much influence on the surgical dissection of fracture segment peripheral blood supply, steel stress shielding factors gradually cause the attention of doctors. Elastic intramedullary nail fixation with minimally invasive surgery, but there are screws of subcutaneous bulge appeared irritability and fracture displacement causes intramedullary nail migration, single elastic intramedullary nail, no anti rotation function. With the clavicle bone Study of fracture treatment, appropriate internal fixation should be satisfied: restore the length of clavicle, minimally invasive, effective fixation and early rehabilitation training after operation. This paper designs a new intramedullary nail for clavicle, biomechanical, and elastic intramedullary nail plate for biomechanical comparison, through the analysis of the parameters and confirm the feasibility of treatment of midclavicular fractures with intramedullary nail. Methods: 24 fresh adult clavicle specimens, all the bodies were not excluded clavicular clavicle fracture, osteoporosis, cancer, malformation and other anomalies. The random divided into 3 groups (A, B, C): A group for anatomical plate group. B group is a new locking intramedullary nail group, C group for the elastic intramedullary nail group, all specimens in the same part of clavicle fracture caused by bone saw model. Using anatomical plate, new locking intramedullary nail fixation on fracture model of elastic intramedullary nail for each. A specimen with denture powder after fixation, and placed in the mechanical testing machine and torsion testing machine fixture. The pre experiment test before, eliminate the effects of creep, followed by four point bending test, torsion test, tensile test. The measurement results were analyzed statistically by spss21.0 test results, data representation in using X + S by analysis of variance, three test data statistics and compared the difference of P0.05, the difference was statistically significant. Results: 1, four point bending test, three kinds of different types of fixed model in loading pressure from the 0.01kn-0.10kn range, with the increase of the loading pressure load, the displacement of the fracture broken end increases. The two linear correlation. The displacement when the loading force is 0.10kn when the value of each group: a group (anatomical plate group) displacement value of 1.104 + 0.035mm, group B (lock intramedullary nail group) displacement value of 1.148 + 0.032mm, group C (elastic intramedullary nail group) Displacement of 1.197 + 0.027mm, three groups of comparisons were statistically significant (P0.05). The plate flexural capacity optimal elastic intramedullary nail anti bending capacity of the worst.2 torsion test, three kinds of different fixation methods in torsion angle within 0-10 degrees, with torsion angle increases, the torque is increased, a linear correlation the two groups of data, the maximum torsion angle of 10 degrees, a group (anatomical plate group) torque value 0.910 + 0.066n.m, group B (intramedullary nail group) torque value 0.849 + 0.03n.m, group C (elastic intramedullary nail group) displacement value of 0.794 + 0.040n.m, three group comparison was statistically significant (P0.05), a new intramedullary nail fixed torsion fixation of.3 was obviously better than that of elastic intramedullary nail, tensile test, all test results: the maximum tensile load of clavicle group A (anatomical plate group) 1.019 + 0.053kn, group B (intramedullary nail group) 0.963 + 0.025kn, group C (elastic intramedullary nail 0.915 + 0.058) The kn. between the three groups was statistically significant (P0.05), clavicle plate group had the best tensile load, intramedullary nail group, elastic intramedullary nail group is the worst. Conclusion: the new locking intramedullary nail treatment of clavicle fracture with steel plate has the following advantages: compared with minimally invasive, easy closed reduction, and elastic intramedullary nail anti rotation ability, stable fixation and biomechanical advantage, no subcutaneous bulge formation.

【學(xué)位授予單位】：四川醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R687.3

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本文編號(hào)：1558357