多种锁定接骨板组合固定过伸型胫骨平台骨折的生物力学研究
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1.镇江市第一人民医院;2.江苏大学医学院

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国家自然科学基金面上项目(NO.82472436);2023年江苏省科技计划专项资金(重点研发计划社会发展)项目(BE2023756);江苏省卫生健康委员会高层次卫生人才“六个一工程”拔尖人才科研项目(LGY2020062)


Biomechanical research of combined multiple locking plate osteosynthesis for hyperextension tibial plateau fractures
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General Program of the National Natural Science Foundation of China(NO. 82472436);Special fund of Science and Technology Program of Jiangsu Province(BE2023756);Jiangsu Provincial Health Commission High-Level Health Talents "Six-One Project" Top-Talent Research Project (LGY2020062)

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    摘要:

    目的:评估多种锁定接骨板组合固定过伸型胫骨平台骨折的生物力学效能差异。 方法:使用标准化人工仿生胫骨构建过伸型胫骨平台骨折模型,分别装配六种接骨板固定方案(1.前外侧组;2.前内侧组;3.前外侧+前内侧组;4.前内侧+后内侧组;5.前外侧+后内侧组;6.三块接骨板固定组)。9个模型于胫骨平台上表面施加250 N、500 N、1000 N及1500 N的纵向载荷,通过三维摄像系统计算不同固定方案时的综合位移。9个模型以0.5°/s的角速度匀速扭转近端骨块,记录内旋10°及外旋10°时不同固定方案所需的扭矩。采用重复测量方差分析评价固定方式与压缩/旋转及其交互作用对内固定的影响。采用配对 t 检验进行组间两两比较,并采用 Bonferroni 法校正多重比较的检验水准,计算配对标准化效应量Cohen''s d及其95%置信区间。 结果:纵向加压试验中,载荷越大综合位移量越大,纵向载荷为1500 N时,各固定方案组的综合位移排序为:前外侧组(5.16±2.39 mm)>前内侧组(4.04±1.40 mm)>前外侧+前内侧组(2.56±0.57 mm)>前内侧+后内侧组(1.75±0.71 mm)>前外侧+后内侧组(0.70±0.27 mm)>三块接骨板固定组(0.34±0.10 mm)。水平扭转试验中,旋转10°时的平均扭矩排序为:前外侧组(9.87±2.07 N·m)<前内侧组(10.61±1.91 N·m)<前内侧+后内侧组(24.72±4.75 N·m)<前外侧+前内侧组(27.61±3.06 N·m)<前外侧+后内侧组(32.81±6.62 N·m)<三块接骨板固定组(43.95±8.23 N·m)。1500 N载荷下,双板固定方案中,第3、4组的综合位移值显著高于第5组(P < 0.05)。针对平均扭矩,双板固定方案中,第3组与第4组、第3组与第5组间扭矩无显著差异(P > 0.05);第5组的扭矩值显著高于第4组(P < 0.05)。 结论:对于关节面完整的过伸型胫骨平台骨折,锁定接骨板的固定效能随接骨板数量的增加而提升。在本研究模型和加载条件下,双板方案中,前外侧+后内侧固定表现出较小的位移,抗扭转能力在数值上较高,其固定效能可能更具优势。但尚不能据此证明其整体力学性能或临床疗效显著优于其他双板方案。

    Abstract:

    Objective: To evaluate the biomechanical effects of using locking plate osteosynthesis to treat hyperextension tibial plateau fractures. Methods: The hyperextension tibial plateau fracture model was constructed using the standardized artificial biomimetic tibia, and six groups of plate fixation schemas (1. Anterolateral, 2. Anteromedial, 3. Anterolateral + Anteromedial, 4. Anteromedial + Posteromedial, 5. Anterolateral + Posteromedial, and 6. Tri-plate Schema) were assembled for each model. Nine models were subjected to longitudinal loads of 250 N, 500 N, 1000 N, and 1500 N applied to the superior surface of the tibial plateau. The comprehensive displacement for each fixation schema was calculated using a three-dimensional camera system. Nine models were subjected to a uniform rotation of the proximal bone segment at a constant angular velocity of 0.5°/s. The torque required to achieve 10° of internal rotation and 10° of external rotation was recorded for each fixation schema. A repeated-measures analysis of variance was employed to assess the effects of fixation modality, compression (rotation), and their interaction on internal fixation outcomes. Pairwise comparisons were performed via paired t-tests, with multiple comparison adjustments implemented using the Bonferroni correction. Additionally, the paired standardized effect size (Cohen’s d) and its 95% confidence interval were calculated. Results: The axial load tests revealed that the greater the applied pressure, the larger the overall displacement. When the axial load was 1,500 N, the comprehensive displacement values of the groups of fixation schemas were as follows: Anterolateral (5.16±2.39 mm) > Anteromedial (4.04±1.40 mm) > Anterolateral + Anteromedial (2.56±0.57 mm) > Anteromedial + Posteromedial (1.75±0.71 mm) > Anterolateral + Posteromedial (0.70±0.27 mm) > Tri-plate Schema (0.34±0.10 mm). The horizontal rotation tests revealed that the average torque for a ±10° rotation was as follows: Anterolateral (9.87±2.07 N·m) < Anteromedial (10.61±1.91 N·m) < Anteromedial + Posteromedial (24.72±4.75 N·m) < Anterolateral + Anteromedial (27.61±3.06 N·m) < Anterolateral + Posteromedial (32.81±6.62 N·m) < Tri-plate Schema (43.95±8.23 N·m). At a load of 1500 N, within the dual-plate fixation schemas, the comprehensive displacement values of Groups 3 and 4 were significantly higher than that of Group 5 (P < 0.05). For the average torque, within the dual-plate fixation schemas, no significant differences in torque were detected between Group 3 and Group 4, or between Group 3 and Group 5 (P > 0.05); by contrast, the torque value of Group 5 was significantly higher than that of Group 4 (P < 0.05). Conclusion: For hyperextension tibial plateau fractures with intact articular surfaces, the fixation efficacy of locking plates increases with the number of plates used. Under the model and loading conditionsof this study, the dual-plate schema combining anterolateral and posteromedial plates exhibited smaller displacement and numerically higher torsional resistance, indicating a potential advantage in fixation performance. However, this does not provide sufficient evidence to conclude that its overall mechanical properties or clinical efficacy are significantly superior to those of other dual-plate schemas.

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  • 收稿日期:2026-07-07
  • 最后修改日期:2026-10-09
  • 录用日期:2026-11-02
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