| Objective: Fracture of tibial plateau fracture is more common in the joint,occupy a certain proportion of in the elderly fracture and other fractures~[1],the goal of treatment is to restore a smooth articular surface,stable fixation,functional recovery.On the basis of Schatzker type~[4] tibial plateau fractures were divided into six types,Schatzker? type and Schatzker? type is more common articular surface the collapse of fractures,if not the anatomical reduction of the articular surface and fixed with different degrees of subsidence and fracture displacement,it will lead to articular surface pressure,cartilage wear,which lead to the occurrence of traumatic osteoarthritis~[2-3],will seriously affect the quality of life of patients.So the tibial plateau fractures treatment in order to achieve anatomical reduction,through bone grafting or support metaphyseal reconstruction,collapse prevention,recovery of articular surface and lower extremity as well as minimally invasive surgery,soft tissue protection,joint function The degree of recovery.For the purpose of optimal tibial plateau fracture after subchondral bone has lost support function,even if the anatomical reduction of the articular surface,but also can be compressed cancellous bone of a bone defect resulting in metaphysis,thus affecting the joint stability,so the bone graft or support metaphyseal reconstruction and maintenance of reduction the state of fracture block,prevent articular surface fracture collapse has important significance effect on the treatment of fractures of tibial plateau.Now more fixed and method of treatment of tibial plateau fracture,also achieved good results,but the anatomy of tibial plateau in itself,which strengthen the joint support,again collapse operation method prevent articular surface fracture and anatomy of metal plate is still rare.Through the study and comparison of biomechanics,anatomic plate model designed by Professor Feng Wenling And new surgical method in the treatment of tibial platform fracture,especially for Schatzker type ? and schatker type ? under arthroscope fractures provide experimental basis.The model anatomical type plate application convenient,with less trauma,articular surface and other plate compared more to strengthen the joint surface of the support,after bone grafting to prevent articular surface again collapse may be.Methods: Select 24 samples of fresh adult tibial plateau after formalin fixed,including 1/2 proximal tibia and fibula,gross observation and X-ray to exclude congenital malformations,osteoporosis,bone diseases,etc.stored in sealed-20? refrigerator with double bag,before the test day out at room temperature after thawing.Take the tibial plateau and the distal 15 cm complete,stripped of all soft tissue around the tibial plateau,and the joint surface of 1 5cm truncation,the serial number of a specimen reserve.According to the test method of Yetkinler and miaojun with tibial intercondylar eminence is bounded on both sides of the midpoint,divided the metaphysis into internal and external side,hollow drill about 5 m m with 16 m m in the outside diameter of the lateral tibial plateau articular surface and parallel to the articular surface from outside to inside the drilling depth is 15 mm,remove the cancellous bone,the columnar bone defect diameter of 16 m m 15 mm deep,underlying the lateral tibia Platform with 15 mm in diameter stainless steel cylindrical pressure head is placed in a cylindrical bone defect impact and collapse around about 7-9mm,made of tibial plateau fracture of schatker type ? under arthroscope reserve model,four groups;group A: after the reduction of bone graft model anatomic plate fixation,group B: ordinary plate osteosynthesis fixation after reduction and bone grafting,group C: 2 cannulated screw fixation after reduction and bone grafting,group D: bone graft reduction and internal fixation.Biomechanical tests were performed,including vertical compression force(N)and compression fracture displacement(mm)curve,internal fixation failure(compressive displacement of 5mm)maximum compression force.Compared the stability.Results: 1 Under the same load 50N(Chi-Square=21.638 P=0.000<0.05)and 100N(Chi-Square=21.628,P=0.000<0.05),four groups of fracture displacement there a statistically significant difference.Group A <Group B <Group C <Group D,indicating the stability of each Group A >Group B > Group C >Group D(see Table 1 and Table 2).2 Under the same compression displacement,four groups of specimens under load value is greater,said fracture end stability is better,so the four groups of specimens in the same vertical compressive displacement under pressure is used to evaluate the fracture criterion of stability of the tip,the four groups of specimens in the same compression displacement under the bearing pressure is: Group A >Group B > Group C >Group D.1mm(Chi-Square=21.600,P=0.000<0.05).2mm(Chi-Square=21.619,P=0.000<0.05).3mm(Chi-Square=21.647,P=0.000<0.05).4mm(Chi-Square=21.647,P=0.000<0.05).5mm(Chi-Square=21.638,P=0.000<0.05).The differences were statistically gauge.(see Table 3).3 Failure groups of maximum compression force for each group : A(355.08N)B(272.50N)C(240.52N)D(109.62N).Group A >Group B >Group C>Group D(Chi-Square=21.638 P=0.000<0.05)have statistical significance,due to internal fixation failure when the maximum compressive stress is large,internal resistance deformation force is stronger the fixation is stable and reliable,tibia platform is more stable,so further illustrate the stability of Group A >Group B>Group C >Group D(see Table 4).Conclusions: The type Schatzker? tibial plateau fracture model,reset grafting respectively to model anatomic plate fixation,the ordinary type of metal plate,two cannulated screw fixation and bone graft after reduction without internal fixation,the biomechanical test,comparative analysis of the bone graft after reduction by new anatomic plate fixation,common type the metal plate,two cannulated screw fixation and bone graft,the stability of internal fixation for the treatment of tibial plateau fracture type Schatzker ?,further analysis the new anatomical tibial platform plate with the advantages and the treatment of tibial plateau fractures(especially for Schatzker ? type and Schatzker ? type fractures)the meaning of stability,and draw a conclusion: the anatomical model the tibial plateau plate can be the treatment of tibial plateau fractures(especially for Schatzker ? type and Schatzker? type fracture),and the effect of Better. |
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