NICE结固定锁骨中段骨折的生物力学研究
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作者简介:

范振环,临床医学研究生在读,研究方向:创伤骨科,(电话)15553583179,(电子信箱)Fanzh0805@163.com

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R683.41


Biomechanical test of NICE knot fixation for mid- shaft clavicle fracture
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    摘要:

    [目的]探讨 NICE 结固定锁骨中段骨折的生物力学特性。[方法]将 60 例人体锁骨标本随机分为 4 组,使用骨科摆锯制作锁骨中段骨折 (OTA /AO 分型 15-A2) 模型,分别行拉力螺钉固定,以及 2-0 线 NICE 结固定、1-0 线 NICE 结固定和 1#线 NICE 结固定。采用 Instron 生物力学测试机进行三点弯曲实验,测量各组不同固定方式骨折模型的失效载荷、最大位移及屈服刚度。[结果]1#线 NICE 组与拉力螺钉组在失效载荷 [(98.4±0.7)N vs (99.0±1.7)N, P>0.05]、最大位移 [(10.1±0.4)mm vs (10.0± 0.4)mm, P>0.05], 以及屈服刚度 [(24.4±0.4)N/mm vs (24.5±0.5)N/mm, P>0.05] 差异无统计学意义。拉力螺钉组在失效载荷 [(99.0± 1.7)N, (45.2±0.5)N, (64.8±0.7)N, P<0.05]、最大位移 [(10.0±0.4)mm, (9.4±0.6)mm, (5.6±0.5)mm, P<0.05] 及屈服刚度 [(24.5±0.5)N/mm, (5.0±0.3)N/mm, (12.5±0.3)N/mm, P<0.05] 均显著大于 2-0 线 NICE 组和 1-0 线 NICE 组。1-0 线 NICE 组失效载荷 [(64.8±0.7)N vs (45.2±0.5)N, P<0.05]、屈服刚度 [(12.5±0.3)N/mm vs (5.0±0.3)N/mm, P<0.05] 均显著大于 2-0 线 NICE 组,而前者的最大位移 [(5.6± 0.5)mm vs (9.4±0.6)mm, P<0.05] 显著小于后者。[结论]使用 1#线进行 NICE 结环绕捆扎固定锁骨中段骨折,与使用拉力螺钉固定方式的生物力学性能相当。

    Abstract:

    [Objective] To investigate the biomechanical properties of NICE knot fixation for mid-shaft clavicle fracture. [Methods] A total of 60 human clavicle specimens were randomly divided into 4 groups. The mid-shaft clavicle fracture models (OTA /AO type 15-A2) were made with an oscillating saw. After that, the fracture was fixed with lag screw, 2-0 suture NICE knot, 1-0 suture NICE knot and 1# su- ture NICE knot, respectively. Failure load, maximum displacement and yield stiffness of fracture models were measured by Instron biome- chanical machine. [Results] There were no significant differences between the lag screw group and 1 # suture NICE knot group in terms of failure load [(98.4±0.7)N vs (99.0±1.7)N, P>0.05], the maximal displacement [(10.1±0.4)mm vs (10.0±0.4)mm, P<0.05] and yield stiffness [(24.4±0.4)N/mm vs (24.5±0.5)N/mm, P>0.05]. However, the lag screw proved significantly superior to 2-0 suture NICE group and 1-0 su- ture NICE group in terms of the failure load [(99.0±1.7)N vs (45.2±0.5)N and (64.8±0.7)N, P<0.05], the maximal displacement [(10.0±0.4) mm vs (9.4±0.6)mm and (5.6±0.5)mm, P<0.05] and yield stiffness [(24.5±0.5)N/mm vs (5.0±0.3)N/mm and (12.5±0.3)N/mm, P<0.05]. In ad- dition, the 1-0 suture group was significantly superior to the 2-0 suture NICE group regarding failure load [(64.8±0.7)N vs (45.2±0.5)N, P< 0.05] and yield stiffness [(12.5±0.3)N/mm vs (5.0±0.3)N/mm, P<0.05], despite that the former had significantly less maximum displacement than the latter [(5.6±0.5)mm vs (9.4±0.6)mm, P<0.05]. [Conclusion] The biomechanical performance of NICE knot with 1# suture for fixa- tion of mid-shaft clavicle fractures is comparable to that of lag screw fixation.

    参考文献
    [1] Postacchini F,Gumina S,De Santis P,et al.Epidemiology of clavi? cle fractures [J].J Shoulde Elbow Surg,2002,11(5):452-456.
    [2] Zlowodzki M,Zelle BA,Cole PA,et al.Treatment of acute mid? shaft clavicle fractures:systematic review of 2144 fractures:on be? half of the Evidence-Based Orthopaedic Trauma Working Group [J].J Orthop Trauma,2005,19(7):504-507.
    [3] Ropars M,Thomazeau H,Huten D.Clavicle fractures [J].Orthop Traumatol Surg Res,2017,103(1S):S53-S59.
    [4] Preston CF,Egol KA.Midshaft clavicle fractures in adults [J].Bull NYU Hosp Jt Dis,2009,67(1):52-57.
    [5] 赵燕鹏,唐佩福.锁骨中 1/3 骨折钢板固定方式的选择策略 [J].中国矫形外科杂志,2013,21(16):1620-1624.
    [6] Axelrod DE,Ekhtiari S,Bozzo A,et al.What is the best evidence for management of displaced midshaft clavicle fractures?A system?atic review and network Meta-analysis of 22 randomized con? trolled trials [J].Clin Orthop Relat Res,2020,478(2):392-402.
    [7] Liu J,Srivastava K,Washington T,et al.Cost-effectiveness of op? erative versus nonoperative treatment of displaced midshaft clavi? cle fractures:a decision analysis [J].J Bone Joint Surg Am,2019,101(1):35-47.
    [8] 王富明,陈小华,隆晓涛,等.保守治疗和切开复位钢板内固定治疗锁骨中段骨折的荟萃分析 [J].中国矫形外科杂志,2019,28(8):712-716.
    [9] Chen CH,Chen JC,Wang C,et al.Semitubular plates for acutely displaced midclavicular fractures:a retrospective study of 111 pa? tients followed for 2.5 to 6 years [J].J Orthop Trauma,2008,22(7):463-466.
    [10] Hislop P,Sakata K,Ackland DC,et al.Acromioclavicular joint sta? bilization:a biomechanical study of bidirectional stability and strength [J].Orthop J Sports Med,2019,7(4):1810884175.
    [11] Vannabouathong C,Chiu J,Patel R,et al.An Evaluation of treat? ment options for medial,midshaft,and distal clavicle fractures:a systematic review and Meta-analysis [J].JSES Int,2020,4(2):256-271.
    [12] Boileau P,Saliken D,Gendre P,et al.Arthroscopic Latarjet:su? ture-button fixation is a safe and reliable alternative to screw fixa? tion [J].Arthroscopy,2019,35(4):1050-1061.
    [13] Westberg SE,Acklin YP,Hoxha S,et al.Is suture comparable to wire for cerclage fixation?A biomechanical analysis [J].Shoulder Elbow,2019,11(3):225-232.
    [14] 杨飞,付中国.尼斯结联合解剖锁定钢板治疗成人锁骨中段粉碎骨折疗效分析 [J].中华肩肘外科电子杂志,2018,6(3):171-176.
    [15] 陈圣,常小波,危涛,等.Fiberwire 缝线Nice结技术治疗掌骨干长斜形骨折的临床疗效 [J].实用手外科杂志,2022,36(1):3-6.
    [16] 吴刚,谭伦,罗晓中,等.尼斯结与螺钉固定治疗下胫腓联合损伤的比较 [J].中国矫形外科杂志,2020,28(8):682-687.
    [17] 危杰.骨折治疗的AO原则 [M].2 版.上海:上海科学技术出版社,2010:421-427.
    [18] 杨帆,王东,孙海钰,等.锁骨骨折植入物内固定与保守治疗效果比较的Meta分析 [J].中国组织工程研究,2014,18(22):3567-3573.
    [19] 李国珅,查晔军,蒋协远.锁骨中段骨折的治疗现状 [J].中国矫形外科杂志,2017,25(16):1486-1489.
    [20] Wu G,Chen YQ,Chen CY,et al.Clinical outcomes of doubled-su? ture Nice knot augmented plate fixation in the treatment of commi? nuted midshaft clavicle fracture [J].BMC Surg,2021,21(1):270.
    [21] 陈健,马剑雄,马信龙,等.Nice 结辅助复位技术与传统复位技术在移位粉碎性锁骨中段骨折中的应用比较 [J].中华肩肘外科电子杂志,2020,8(3):220-225.
    [22] Boileau P,Alami G,Rumian A,et al.The doubled-suture Nice knot [J].Orthopedics,2017,40(2):e382-e386.
    [23] Meyer DC,Bachmann E,Ladermann A,et al.The best knot and su? ture configurations for high-strength suture material.an in vitro biomechanical study [J].Orthop Traumatol Surg Res,2018,104(8):1277-1282.
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范振环,于振海,赵廷宝,等. NICE结固定锁骨中段骨折的生物力学研究[J]. 中国矫形外科杂志, 2023, 31 (10): 912-916. DOI:10.3977/j. issn.1005-8478.2023.10.10.
FAN Zhen- huan, YU Zhen- hai, ZHAO Tingbao, et al. Biomechanical test of NICE knot fixation for mid- shaft clavicle fracture[J]. Orthopedic Journal of China , 2023, 31 (10): 912-916. DOI:10.3977/j. issn.1005-8478.2023.10.10.

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  • 收稿日期:2022-12-01
  • 最后修改日期:2023-03-28
  • 在线发布日期: 2023-05-24