切换至 "中华医学电子期刊资源库"

中华损伤与修复杂志(电子版) ›› 2022, Vol. 17 ›› Issue (04) : 330 -335. doi: 10.3877/cma.j.issn.1673-9450.2022.04.008

论著

基于成人掌骨形态学数据设计的掌骨弹性髓内针治疗掌骨骨折的生物力学研究
邓玖征1, 袁野1, 朱剑津1, 何大炜1, 赵喆1, 赵锋2, 孔德敬3, 潘勇卫1,()   
  1. 1. 102218 清华大学附属北京清华长庚医院骨科,清华大学临床医学院
    2. 101300 北京威高亚华人工关节开发有限公司
    3. 264203 威海,山东威高骨科材料股份有限公司
  • 收稿日期:2022-05-11 出版日期:2022-08-01
  • 通信作者: 潘勇卫
  • 基金资助:
    北京市科学技术委员会医药协同科技创新研究(科研)(Z181100001918030)

Biomechanical study of metacarpal elastic intramedullary needle based on adult metacarpal morphological data for the treatment of metacarpal fractures

Jiuzheng Deng1, Ye Yuan1, Jianjin Zhu1, Dawei He1, Zhe Zhao1, Feng Zhao2, Dejing Kong3, Yongwei Pan1,()   

  1. 1. Department of Orthopaedics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China
    2. Beijing Weigao Yahua Artificial Joint Development Co., Ltd., Beijing 101300, China
    3. Shandong Weigao Orthopaedic Device CO., Ltd., Weihai 264203, China
  • Received:2022-05-11 Published:2022-08-01
  • Corresponding author: Yongwei Pan
引用本文:

邓玖征, 袁野, 朱剑津, 何大炜, 赵喆, 赵锋, 孔德敬, 潘勇卫. 基于成人掌骨形态学数据设计的掌骨弹性髓内针治疗掌骨骨折的生物力学研究[J]. 中华损伤与修复杂志(电子版), 2022, 17(04): 330-335.

Jiuzheng Deng, Ye Yuan, Jianjin Zhu, Dawei He, Zhe Zhao, Feng Zhao, Dejing Kong, Yongwei Pan. Biomechanical study of metacarpal elastic intramedullary needle based on adult metacarpal morphological data for the treatment of metacarpal fractures[J]. Chinese Journal of Injury Repair and Wound Healing(Electronic Edition), 2022, 17(04): 330-335.

目的

探讨基于成人掌骨形态学数据设计的掌骨弹性髓内针的生物力学性能,为临床应用提供基础。

方法

选用成人新鲜冰冻手掌标本12例,取第2~5掌骨共计48根,按照随机数字表法将切取的掌骨分为3组,钢板螺丝钉内固定组、交叉克氏针内固定组和弹性髓内针内固定组,每组包含第2~5掌骨各4根,共16根掌骨;其中8根用于悬臂折弯测试,8根用于扭转测试。用骨刀距掌骨远端20 mm处横行截骨,制作简单横行骨折模型。钢板螺丝钉内固定组以直列4孔掌骨锁定接骨板,以骨折线为中心,在骨折线远端、近端各采用2枚2.0 mm双皮质锁定螺钉固定;交叉克氏针内固定组采用1.0 mm不锈钢克氏针以骨折线为中心交叉固定;弹性髓内针内固定组使用笔者团队设计的直径2.0 mm的掌骨弹性髓内针,配合把持器和开髓器,自掌骨基底部顺行穿入髓腔,经骨折线到达掌骨头关节面下固定。使用生物力学测试机对3组进行悬臂折弯和扭转测试,计算3组的最大折弯力、折弯刚度和最大扭矩、扭转刚度。数据比较采用单因素方差分析、SNK法。

结果

(1)在悬臂折弯测试中,钢板螺丝钉内固定组、交叉克氏针内固定组和弹性髓内针内固定组的最大折弯力分别为(126.3±53.9)、(48.7±18.2)、(88.4±13.9) N, 3组比较差异有统计学意义(F=10.530,P=0.001);组间两两比较差异均有统计学意义(P<0.05)。钢板螺丝钉内固定组、交叉克氏针内固定组和弹性髓内针内固定组的折弯刚度分别为(12.33±4.90)、(5.86±5.02)、(10.49±2.05) N/mm,3组比较差异有统计学意义(F=4.988,P=0.017);交叉克氏针内固定组分别与另2组比较,差异均有统计学意义(P<0.05),钢板螺丝钉内固定组和弹性髓内针内固定组比较差异无统计学意义(P>0.05)。(2)扭转测试中,钢板螺丝钉内固定组、交叉克氏针内固定组和弹性髓内针内固定组的最大扭矩分别为(1.98±0.42)、(0.61±0.39)、(0.50±0.34) N·m,3组比较差异有统计学意义(F=36.635,P<0.05);钢板螺丝钉内固定组分别与另2组比较,差异均有统计学意义(P<0.05),交叉克氏针内固定组与弹性髓内针内固定组比较差异无统计学意义(P>0.05)。钢板螺丝钉内固定组、交叉克氏针内固定组和弹性髓内针内固定组的扭转刚度分别为(0.093±0.040)、(0.022±0.021)、(0.032±0.029) N·m/°,3组比较差异有统计学意义(F=12.554,P<0.05);钢板螺丝钉内固定组分别与另2组比较,差异均有统计学意义(P<0.05),弹性髓内针内固定组和交叉克氏针内固定组比较差异无统计学意义(P>0.05)。

结论

应用笔者团队基于成人掌骨形态学数据设计的弹性髓内针,最大折弯力,折弯刚度在钢板和交叉克氏针之间,且明显优于交叉克氏针;而最大扭矩和扭转刚度与交叉克氏针相当。该新型弹性髓内针能够满足掌骨骨折内固定术后早期功能康复需求。

Objective

To explore the biomechanical properties of metacarpal elastic intramedullary needle designed based on adult metacarpal morphological data, and provide the basis for clinical application.

Methods

The 2nd to 5th metacarpal bones were selected from 12 fresh frozen palm specimens of adults and the forty-eight metacarpal bones were divided into 3 groups: the plate fixation group, the K-wire fixation group, and the elastic intramedullary needle fixation group according to the random number table method. Each group contained 16 metacarpal bones from the 2nd to 5th metacarpals, 8 of them were used for cantilever banding tests and 8 of them were used for torque tests. A simple transverse fracture model was made by making a transverse osteotomy with an osteotome at a distance of 20 mm from the distal end of the metacarpal bone. In the plate fixation group, the fracture was fixed with a four-holes locking plate, the fracture line as the center, and four 2.0 mm bicortical locking screws were used at the distal and proximal ends of the fracture line; in the K-wire fixation group, the fracture was fixed with 1.0 mm stainless steel Kirschner wire with the fracture line as the center for cross fixation; in the elastic intramedullary needle fixation group, the fracture was fixed with antegrade 2.0 mm metacarpal elastic intramedullary needle which was designed by author’s team, cooperated with the handle and pulp opener, and penetrated the medullary cavity antegradely from the base of the metacarpal bone, and then reached the subarticular surface of the metacarpal head through the fracture line for fixation. The biomechanical testing machine was used to test the cantilever bending and torsion of the three groups, and the maximum bending force, bending stiffness, maximum torque and torsion stiffness of the three groups were calculated. Data were compared with one-way ANOVA and SNK method.

Results

(1) In the cantilever bending test, the maximum bending loads of the plate fixation group, the K-wire fixation group, and the elastic intramedullary needle fixation group were (126.3±53.9), (48.7±18.2), (88.4±13.9) N, and the difference among the three groups was statistically significant (F=10.530, P=0.001); the difference between each two groups was statistically significant (P<0.05). The bending stiffnesses of the plate fixation group, the K-wire fixation group, and the elastic intramedullary needle fixation group were (12.33±4.90), (5.86±5.02), (10.49±2.05) N/mm, and the difference among the three groups was statistically significant (F=4.988, P=0.017); the K-wire fixation group was different from the other two groups, the differences were statistically significant (P<0.05), and the difference between the plate fixation group and the elastic intramedullary needle fixation group was not statistically significant (P>0.05). (2) In the torsion test, the maximum torques of the plate fixation group, the K-wire fixation group, and the elastic intramedullary needle fixation group were (1.98±0.42), (0.61±0.39), (0.50±0.34) N·m, and the difference among the three groups was statistically significant (F=36.635, P<0.05); the differences between the plate fixation group and the other two groups were statistically significant (P<0.05), and there was no statistically significant difference between the K-wire fixation group and the elastic intramedullary needle fixation group (P>0.05). The torsional stiffnesses of the plate fixation group, the K-wire fixation group, and the elastic intramedullary needle fixation group were (0.093±0.040), (0.022±0.021), (0.032±0.029) N·m/°, and the difference among the three groups was statistically significant (F=12.554, P<0.05); the differences between the plate fixation group and the other two groups were statistically significant (P<0.05), and there was no statistically significant difference between the K-wire fixation group and the elastic intramedullary needle fixation group(P>0.05).

Conclusions

The maximum bending load and bending stiffness of the elastic intramedullary needle that designed by author′s team based on the morphological data of adult metacarpal bones are less than plate, and significantly better than K-wire; while the maximum torsional moment and torsional stiffness of the elastic intramedullary needle are comparable to K-wire. The novel elastic intramedullary needle could meet the needs of early functional rehabilitation after internal fixation of metacarpal fractures.

图1 基于成人掌骨形态学数据设计的掌骨弹性髓内针及置入辅助器械
图2 掌骨干骨折钢板螺丝钉内固定
图3 掌骨干骨折交叉克氏针内固定
图4 掌骨干骨折弹性髓内针内固定
表1 悬臂折弯测试中3组最大折弯力和折弯刚度比较(±s)
表2 扭转测试中3组最大扭矩和扭转刚度比较(±s)
[1]
Chung KC, Spilson SV. The frequency and epidemiology of hand and forearm fractures in the United States[J]. J Hand Surg Am, 2001, 26(5): 908-915.
[2]
Cepni SK, Aykut S, Bekmezci T, et al. A minimally invasive fixation technique for selected patients with fifth metacarpal neck fracture[J]. Injury, 2016, 47(6): 1270-1275.
[3]
Hussain MH, Ghaffar A, Choudry Q, et al. Management of Fifth Metacarpal Neck Fracture (Boxer′s Fracture): A Literature Review[J]. Cureus, 2020, 12(7): e9442.
[4]
潘勇卫,栗鹏程,朱瑾,等. 顺行髓内针内固定术治疗第五掌骨颈和头下骨折[J]. 中华外科杂志2006, 44(24): 1689-1692.
[5]
邓玖征,赵喆,朱剑津,等. 基于CT三维重建的成人第5掌骨的形态学及临床意义[J]. 解剖学报2020, 51(3): 411-415.
[6]
Downing ND, Davis TR. Intramedullary fixation of unstable metacarpal fractures[J]. Hand Clin, 2006, 22(3): 269-277.
[7]
张立山,潘勇卫,田光磊,等. 顺行髓内针内固定术治疗掌骨骨折的生物力学研究[J]. 中华外科杂志2010, 48(8): 606-609.
[8]
Oh JR, Kim DS, Yeom JS, et al. A Comparative Study of Tensile Strength of Three Operative Fixation Techniques for Metacarpal Shaft Fractures in Adults: A Cadaver Study[J]. Clin Orthop Surg, 2019, 11(1): 120-125.
[9]
Galbraith JG, Huntington LS, Borbas P, et al. Biomechanical comparison of intramedullary screw fixation, dorsal plating and K-wire fixation for stable metacarpal shaft fractures[J]. J Hand Surg Eur Vol, 2022, 47(2): 172-178.
[10]
Gick S, Oppermann J, Owerst I, et al. Biomechanical comparison of six different fixation techniques for treatment of metacarpal neck fractures[J]. Unfallchirurg, 2019, 122(8): 587-595.
[11]
Chiu YC, Tsai MT, Hsu CE, et al. New fixation approach for transverse metacarpal neck fracture: a biomechanical study[J]. J Orthop Surg Res, 2018, 13(1): 183.
[12]
Beutel BG, Ayalon O, Kennedy OD, et al. Crossed K-Wires Versus Intramedullary Headless Screw Fixation of Unstable Metacarpal Neck Fractures: A Biomechanical Study[J]. Iowa Orthop J, 2018, 38: 153-157.
[13]
An KN, Chao EY, Cooney WP, et al. Forces in the normal and abnormal hand[J]. J Orthop Res, 1985, 3(2): 202-211.
[14]
Fischer KJ, Bastidas JA, Provenzano DA, et al. Low-profile versus conventional metacarpal plating systems: a comparison of construct stiffness and strength[J]. J Hand Surg Am, 1999, 24(5): 928-934.
[15]
Schuind F, Garcia-Elias M, Cooney WP 3rd, et al. Flexor tendon forces: in vivo measurements[J]. J Hand Surg Am, 1992, 17(2): 291-298.
[16]
Tannenbaum EP, Burns GT, Oak NR, et al. Comparison of 2-dimensional and 3-dimensional metacarpal fracture plating constructs under cyclic loading[J]. J Hand Surg Am, 2017, 42(3): e159-e165.
[17]
Eu-Jin, Cheah A, Behn AW, et al. A biomechanical analysis of 2 constructs for metacarpal spiral fracture fixation in a cadaver model: 2 large screws versus 3 small screws[J]. J Hand Surg Am, 2017, 42(12): 1033.e1-1003.e6.
[18]
方杰,张文龙. 第5掌骨颈骨折临床治疗研究进展[J]. 中华创伤杂志2018, 34(9): 843-847.
[1] 齐伟亚, 方杰, 吴衡, 刘波. 掌侧小切口联合腕关节镜治疗AO-C型桡骨远端骨折[J]. 中华关节外科杂志(电子版), 2023, 17(04): 577-582.
[2] 郭璐琦, 赵雅琦, 李霁欣, 周兰, 林金鹏, 张子砚, 李俊杰, 王少白. 免荷矫形器对膝骨关节炎的生物力学影响的研究进展[J]. 中华关节外科杂志(电子版), 2023, 17(04): 560-565.
[3] 莫亮, 熊贤梅, 马超, 刘予豪, 陈镇秋, 何伟, 周驰. 股骨颈骨折内固定术后因素与股骨头坏死关系的分析[J]. 中华关节外科杂志(电子版), 2022, 16(06): 735-744.
[4] 唐小花, 孙建霞, 王君, 王美青. 预测老年股骨粗隆间骨折术后并发症的列线图模型构建[J]. 中华关节外科杂志(电子版), 2022, 16(06): 677-682.
[5] 周晓强, 孙超, 李志强, 徐人杰, 佘远时, 张向鑫, 陈广祥, 虞宵. 动力抗旋交叉钉治疗不稳定股骨颈骨折的早期疗效[J]. 中华关节外科杂志(电子版), 2022, 16(06): 670-676.
[6] 张起尧, 刘子文. 复杂腹壁疝的解剖和生物力学基础[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 674-676.
[7] 宗宇宁, 薛海鹏, 韩天宇, 张昊, 王帅, 马翔宇, 纪振钢, 周大鹏. 解剖状骨水泥占位器在治疗内侧柱缺失型肱骨近端骨折中的实用性的有限元分析[J]. 中华肩肘外科电子杂志, 2023, 11(03): 242-251.
[8] 潘超, 张博, 韩磊, 刘俊阳, 崔鹏, 闫兵山, 田旭, 刘林涛, 东靖明. 肩锁关节脱位治疗的研究进展[J]. 中华肩肘外科电子杂志, 2023, 11(02): 186-191.
[9] 张琳袁, 吴佳俊, 崔煦, 沈超, 付备刚, 崔崟, 王秀会, 蔡攀. 大结节解剖钢板与PHILOS内固定治疗伴肩关节脱位的Mutch I/II型肱骨大结节骨折的疗效差异[J]. 中华肩肘外科电子杂志, 2023, 11(02): 139-145.
[10] 王晨, 潘海乐. 肩袖三维有限元模型建立及力学分析[J]. 中华肩肘外科电子杂志, 2022, 10(03): 221-225.
[11] 陈奇, 沈子龙, 温向伟, 王晨, 高奥飞, 丁明强, 余嘉文, 潘海乐. 自体髌骨股四头肌肌腱治疗家兔巨大肩袖损伤的实验研究[J]. 中华肩肘外科电子杂志, 2022, 10(03): 214-220.
[12] 崔梦凡, 贺瑞, 李晓娜, 陈维毅, 宋耀文. 角膜生物力学评估参数的应用进展[J]. 中华眼科医学杂志(电子版), 2023, 13(04): 236-240.
[13] 刘佳, 贺瑞, 李晓娜. 断层扫描生物力学指数应用于屈光手术术前早期圆锥角膜筛查的临床研究[J]. 中华眼科医学杂志(电子版), 2022, 12(06): 341-346.
[14] 张子砚, 曾红, 许苑晶, 郭璐琦, 王金武, 王少白, 任富超, 缪伟强, 戴尅戎, 王茹. 膝关节生物力学标志物预测膝关节炎研究进展[J]. 中华老年骨科与康复电子杂志, 2023, 09(05): 315-320.
[15] 金宇杰, 虞宵, 周晓强, 李志强, 徐人杰, 张向鑫, 陈广祥. 动力交叉钉系统治疗股骨颈骨折其内固定位置与临床疗效的相关性研究[J]. 中华老年骨科与康复电子杂志, 2023, 09(04): 193-200.
阅读次数
全文


摘要