胫骨平台后侧骨折损伤机制与后侧固定的生物力学研究及有限元分析

Tibial plateau fracture which common in clinic is an intra-articular fracture with complex fracture morphology and high rate in loss of reduction. Especially the posterior tibial plateau fracture, accurate radiological examinations are eclipsed by the lack of standard solution of internal fixation and reasonable classification system. According to our clinical experience,the CT based Three-Column classification can offer a new concept for the treatment of complex tibial plateau fracture, not only for its higher reproducibility, but also for its reasonable and acceptable clinical results. We hypothesized that the three-dimensional (3D) morphological features of posterior tibial plateau fractures were related to the mechanism of injury, and the internal fixations reversing mechanism of injury were the best solution. In our experiment,we will firstly explore the relationship between the morphology of fracture and the related injury mechanism through radiological measurement and biomechanical test of injury mechanism simulation. Secondly, to test the biomechanical advantage of the fixation based on the injury mechanism over the conventional fixation of posterior tibial plateau fractures, a biomechanical experiment and finite element analysis will be done. It is our destination to establish a new classification which based on the 3D CT and the injury mechanism, moreover, to suggest a new philosophy of reasonable, individual and precise fixation for the posterior tibial plateau fractures.

胫骨平台骨折是临床上常见的关节内骨折，骨折形态复杂，术后内固定失效及骨折复位丢失等并发症较多。特别是胫骨平台后侧骨折，尽管目前的影像学诊断技术精确，但缺乏标准化的内固定方案及合理的骨折分型系统。我们根据临床经验，提出了基于三维形态学的胫骨平台骨折三柱分型，为骨折治疗提供了新的理念，也取得了良好的临床效果。我们假设，胫骨平台后侧骨折的三维形态学特征与损伤机制相关，逆损伤机制进行的内固定是最佳的固定方案。我们拟利用暴力冲击的力学实验建立不同损伤机制的胫骨平台后侧骨折模型，结合已积累的临床形态学资料，来探索损伤机制与骨折形态学之间的联系；在此基础上，建立骨折的内固定模型，利用生物力学实验及有限元分析技术，证明逆损伤机制进行内固定的方案更具优势。本研究对揭示胫骨平台后侧骨折的形态学特征与损伤机制之间的关系具有重要意义，可为胫骨平台骨折分型系统和手术内固定方案提供理论基础。

胫骨平台骨折是临床上常见的下肢关节内骨折，骨折形态复杂，术后内固定失效及骨折复位丢失等并发症较多。尤其是位于胫骨平台后侧的骨折，本研究实施以前，仅有精确的影像学检查技术，而缺乏标准化的内固定方案及合理的骨折分型系统。.通过本研究，我们明确胫骨平台后侧骨折的损伤机制与骨折形态之间的关系——胫骨平台后侧的骨折多来源于屈膝损伤；验证了针对胫骨平台后侧骨折每一种损伤机制的最佳内固定策略，证明逆损伤机制进行内固定的优势，对于屈膝内翻型损伤，应该伸膝外翻位复位，并将主力钢板放置于后内侧；建立了基于骨折的三维形态特征、可推导骨折的发生机制又能指导治疗方案的的胫骨平台骨折分类系统——胫骨平台骨折的新三柱分型。