中国组织匸程研究»2013,Vol.17»Issue⑷:728-735DOI:10.3969/j.issn.2095・4344.2013.04.025骨科学术探讨锁定加压钢板置入内固定治疗胫骨骨折的力学分析Mechanicalanalysisoflockingcompressionplatefixationforthetreatmentoftibialfracture全文：PDF摘要背景：锁定加压钢板结合了传统钢板和支架原理，即头部有锁定螺纹的螺钉和钢板锁钉孔构成的内固定支架锁定单元，乂育传统螺钉和动力加压孔构成的内固定支架加压单元，在骨折的内固立治疗方面具有很多优势。目的：分析锁定加压钢板置入内同定治疗胫骨骨折的生物力学特点，以及在胫骨骨折治疗中的疗效。方法：锁定加压钢板是依靠钢板与螺钉的成角稳定性和螺钉与骨Z间的把持力來实现骨折内固立的。骨髓腔细小时应避免螺钉尖端损伤近端皮质的骨螺纹，应更换为双皮质口攻螺钉至少在对侧骨皮质获得把持力。骨质疏松植入螺钉，由于单皮质骨螺钉产生的工作长度减少，在所冇骨折块均使用双皮质自攻螺钉，以提高螺钉工作长度。当长骨轴线与钢板对线不良时，要么打入长自攻螺钉，要么改变角度打入标准螺钉。锁定加压钢板应选择适宜的长度，钢板的长度取决钢板跨越比和钢板螺钉密度，钢板与螺钉间的应力还受螺钉数暈和位置的影响。结果与结论：锁定加压钢板置入内固定可应用于骨干或干断端的简单骨折、粉碎性骨折、关节内及关节周围骨折、骨折延迟愈合、闭合或开放截骨术和不适合髓内钉固定的骨干骨折，对于骨质疏松骨折和假体周围骨折的内固定有很好的成角稳定性和把持力。锁定加压钢板置入内固立治疗胫F#折均取得满意的疗效，符合牛物力学固定原理。需要术者熟练掌握锁定加压钢板的内固定技术，避免由于失误导致内固定的失败。关键词：骨关节植入物;骨关节植入物学术探讨;锁定加压钢板;胫骨骨折;心物力学;内I占I也解剖复位;加丿诃占淀;解剖钢板;粉碎性骨折;拉出力;弯曲应力;成角稳定性;抗疲劳测试;感染;骨折延迟愈合;Abstract:BACKGROUND:Lockingcompressionplatecombineswithtraditionalsteelplateandbracketprinciple,whichhaslockingthreadedscrewsonheadandmountingbracketlockunitcomposedwithsteellockingnailholes,aswellastheinternalfixationbracketpressurizedunitcomposedwithtraditionalscrewsanddynamiccompressionholes.Sothelockingcompressionplatehasmanyadvantagesinthetreatmentoffracturefixation.OBJECTIVE:Toanalyzethebiomechanicalcharacteristicsandeffectoflockingcompressionplateinthetreatmentoftibialfracture.METHODS:Lockingcompressionplatecouldachievethefracturefixationdependedontheangularstabilityofsteelplateandscrewsandthepulloutstrengthbetweencrewsandbone.Whenthemarrowcavitsywassmall,thetopofthescrewshouldbeavoidedtodamagetheproximalcorticalbonethreaded,andthenthescrewsshouldbechangedintothebicorticalself-tappingscrewsatleastinordertoobtainthepulloutstrengthfromthecontralateralcorticalbone.Screwimplantationforthetreatmentofosteoporosis,duetothereducedworkinglengthofunicorticalscrewfixation,thebicorticalself・tappingscrewswereusedinallthefracturefragmentstoimprovetheworkinglengthofthescrews・Whenthealignmentbetweenthelongboneaxisandsteelplatewasnotinorder,implantingthelongself-tappingscrewsorchangingtheangletoimplantthestandardscrewswerepreferred・Thelockingcompressionplateshouldselectaappropriatelength・Thelengthofthelockingcompressionplatedependedonthelengthandthedensityoftheplateandscrew・ThestressbetweenplateandscrewwasalsoaffectedbythenumberandthepositionofthescreRESULTSANDCONCLUSION:Lockingcompressionplatefixationcanbeusedforthetreatmentofbackboneormetaphysealsimplefracture,comminutedfracture,intra-articularandperiarticularfractures,delayedfracturehealing,closedoropenosteotomyandtheshaftfracturewhichisnotsuitableforintramedullarynailing.Andforthefixationofosteoporoticfract...