课题背景：髋臼后壁骨折的常规内固定手段有钢丝、螺钉和重建钢板，生物力学研究表明重建钢板的强度最大，分叉钢板方法是在重建钢板基础上加用一块短钢板，并与重建钢板经螺钉连接成“+”字或“T”形，扩大了内固定对髋臼后壁的固定范围，固定强度应优于单纯使用重建钢板。国外已有分叉钢板用于同心圆型粉碎性骨折的报道。

应用要点：本组生物力学实验证实了分叉钢板可增加髋臼后壁骨折的内固定强度。可促进关节内软骨的愈合，有效减少关节僵硬和深静脉栓塞的发生。本科临床运用分叉钢板材料置入治疗髋臼后壁骨折19例，近期结果满意。

偏倚或不足：由于实验标本数较少，降低了统计结果的准确性。

摘要
目的：国外已有分叉钢板的力学性能研究，但其运用的骨折模型为同心圆型粉碎骨折模型。本组实验运用生物力学方法观察分叉钢板治疗髋臼后壁骨折的力学特征。
方法：实验于2005-11/12在上海大学上海生物力学工程研究所完成。①材料：选取9具经防腐保湿处理成人骨盆，由苏州大学医学院解剖教研室提供，死者生前自愿捐献遗体，家属均知情同意。内固定钢板由常州市康辉医疗器械有限公司提供。②分组：髋臼后壁范围为从髋臼顶点至髋臼后壁与坐骨枝相交处，将其等分为两部分，上部为A区，下部为B区。将骨盆从中锯开分成两个髋关节，共18个髋关节，随机分为A区截骨组，B区截骨组，A，B区截骨组，每组6个。其中3个髋关节采用6孔髋臼重建钢板固定，另外3个髋关节采用重建钢板+分叉钢板固定。截骨厚度为髋臼后缘至坐骨切迹之间厚度的1/2。③测试方法及评估指标：采用WE-5型万能材料试验机，从150 N开始等级加载至600 N，加载速率为1.4 mm/min，髋臼和股骨头按常规布置高精度小标距应变片，骨块移位由高精度精显光栅位移计测定，应变由YJ-14数显应变仪记录。
结果：①600 N载荷下，各组重建钢板+分叉钢板固定后，分离位移和应变均低于重建钢板固定 (P < 0.05)。②600 N载荷下，采用分叉钢板固定的平均强度和平均轴向刚度较重建钢板组分别高出13%和10%，差异有显著性意义 (P < 0.05)。③B区骨折模型的平均强度和平均轴向刚度也较A区和AB区骨折模型大。
结论：通过生物力学实验证实了分叉钢板的使用可增加髋臼后壁骨折的内固定强度，尤其适合后壁粉碎骨折的固定。
关键词：髋臼骨折；骨科植入体；分叉钢板；骨折内固定；生物力学

严军，郑祖根，董启榕，王以进.分叉钢板置入治疗髋臼后壁骨折的生物力学分析[J].中国组织工程研究与临床康复，2008，12(17):3229-3232 [www.zglckf.com/zglckf/ejournal/upfiles/08-17/17k-3229(ps).pdf]

Spike plate implantation in the treatment of posterior wall fracture of the acetabulum: Biomechanical analysis

Abstract

AIM:Many studies have been conducted to explore the mechanical performance of spike plate, in which the models of fracture are concentric comminution. In this study, we observed the biomechanical characteristics of this technique in treating fracture of posterior wall of the acetabulum.
METHODS: The experiment was performed in Shanghai Institute of Biomechanical Engineering of Shanghai University from November to December 2005. ①Nine pretreated adult cadaveric pelvises (voluntary donors) were supplied by Department of Anatomy of Soochow University. The informed consent was obtained from their families. Plates of internal fixation were supplied by Changzhou Kanghui Medical Instrument Company. ②Acetabular posterior wall was started from top of acetabulum to the junction of acetabular posterior wall and ischium. This area was equally divided into two parts: part A-superior, part B-inferior. The pelvises were saw and 18 hip joints were randomly divided into A zone osteotomy group, B zone osteotomy group, and A+B zone osteotomy group with 6 hip joints in each group. Three joints were fixed by six-hole reconstruction plate, and the other three were fixed by technique of reconstruction plate and spike plate. Depth of osteotomy was defined as half of the distance between acetabulum and sciatic notch. ③Universal testing machine (WE-5) was used to load the specimen from 150 N to 600 N, 1.4 mm/min. Displacement and strain of fracture fragment was recorded by displacement gauge and strain gauge (YJ-14).
RESULTS: ①Average displacement and strain under 600 N load of spike plate and reconstruction group were smaller than those of reconstruction group (P < 0.05). ②Average strength and axial rigidity of spike plate and reconstruction group were 13% and 10% greater than those of reconstruction group (P < 0.05). ③Average strength and axial rigidity of B zone osteotomy group were also greater than those of A and A+B groups.
CONCLUSION: The biomechanical results show that spike plate can improve the internal fixation rigidity of posterior wall fracture of the acetabulum, in particular to the fixation of communited posterior wall fracture.

Yan J, Zheng ZG, Dong QR, Wang YJ.Spike plate implantation in the treatment of posterior wall fracture of the acetabulum: Biomechanical analysis. Zhongguo Zuzhi Gongcheng Yanjiu yu Linchuang Kangfu 2008;12(17):3229-3232(China) [www.zglckf.com/zglckf/ejournal/upfiles/08-17/17k-3229(ps).pdf]