復合型可注射磷酸鈣骨水泥在脛骨平臺塌陷骨折中的生物力學研究_《中國修復重建外科雜志》

作者：

鄒華章 ¹ , 馬曉春 ² , 唐程 ¹ , 李創 ¹ , 陳建偉 ³ , 葉建東 ⁴

1廣州醫學院第四附屬醫院骨科（廣州，511447）;;
2廣州番禺區大石人民醫院骨科;;
3中山大學骨科研究所;;
4華南理工大學生物材料研究所;

關鍵詞：

脛骨平臺骨折磷酸鈣骨水泥生物力學

DOI：

10.7507/1002-1892.20130187

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目的探討復合聚乳酸-羥基乙酸共聚物[poly（lactic-co-glycolic acid），PLGA]的可注射磷酸鈣骨水泥（calcium phosphate cement，CPC）結合雙螺釘固定在脛骨平臺Schatzker Ⅱ型骨折模型中的生物力學性能，為臨床微創治療提供生物力學依據。方法取10對老年尸體脛骨近端標本制備脛骨平臺Schatzker Ⅱ型骨折模型后，左右側隨機配對分為2組，分別為復合型可注射CPC組（實驗組，n=10）和自體松質骨組（對照組，n=10）。實驗組和對照組分別采用CPC加壓注入和自體松質骨充填植骨，結合雙螺釘橫排固定方法固定脛骨平臺骨折。兩組標本分別在MTS 858材料試驗機上進行軸向垂直壓縮，記錄載荷-位移數據，測量兩組標本的最大載荷和抗壓剛度。結果復合型可注射CPC室溫下具有良好的可注射性，在脛骨平臺塌陷下方骨缺損區不僅充填充分，且材料在骨缺損區周圍松質骨中進一步滲透、擴散。實驗組和對照組脛骨干骺端骨密度分別為（0.639 ± 0.081）、（0.668 ± 0.083）g/cm2，差異無統計學意義（t=1.012，P=0.331）。實驗組最大載荷為（4 101 ± 813）N，顯著高于對照組的（692 ± 138）N，差異有統計學意義（t=3.932，P=0.001）。實驗組抗壓剛度為（1 363 ± 362） N/mm，顯著高于對照組的（223 ± 54） N/mm，比較差異有統計學意義（t=3.023，P=0.013）。結論在脛骨平臺Schatzker Ⅱ型骨折中采用復合型可注射CPC加壓充填植骨結合雙螺釘固定技術能有效恢復脛骨平臺的抗塌陷力學性能，是一種理想的植骨填充材料。

引用本文： 鄒華章,馬曉春,唐程,李創,陳建偉,葉建東. 復合型可注射磷酸鈣骨水泥在脛骨平臺塌陷骨折中的生物力學研究. 中國修復重建外科雜志, 2013, 27(7): 855-859. doi: 10.7507/1002-1892.20130187 復制

1.	梁承偉, 朱炯, 沈海敏. 內固定治療脛骨平臺骨折64例分析. 中國矯形外科雜志, 2006, 14(18): 1393-1396.
2.	Lim TH, Brebach GT, Renner SM, et al. Biomechanical evaluation of an injectable calcium phosphate cement for vertebroplasty. Spine (Phila Pa 1976), 2002, 27(12): 1297-1302.
3.	Heini PF, Berlemann U. Bone substitutes in vertebroplasty. Eur Spine J, 2001, 10(2): S205-213.
4.	Kruyt MC, Persson C, Johansson G, et al. Towards injectable cell-based tissue-engineered bone: the effect of different calcium phosphate microparticles and pre-culturing. Tissue Eng, 2006, 12(2): 309-317.
5.	van Lieshout EM, van Kralingen GH, El-Massoudi Y, et al. Microstructure and biomechanical characteristics of bone substitutes for trauma and orthopaedic surgery. BMC Musculoskelet Disord, 2011, 12: 34.
6.	Wang X, Ye J, Wang Y. Hydration mechanism of a novel PCCP + DCPA cement system. J Mater Sci Mater Med, 2008, 19(2): 813-816.
7.	Trenholm A, Landry S, McLaughlin K, et al. Comparative fixation of tibial plateau fractures using alpha-BSM, a calcium phosphate cement, versus cancellous bone graft. J Orthop Trauma, 2005, 19(10): 698-702.
8.	Stuart MJ, Beachy AM, Grabowski JJ, et al. Biomechanical evaluation of a proximal tibial opening-wedge osteotomy plate. Am J Knee Surg, 1999, 12(3): 148-154.
9.	Wu CC, Tai CL. Plating treatment for tibial plateau fractures: a biomechanical comparison of buttress and tension band positions. Arch Orthop Trauma Surg, 2007, 127(1): 19-24.
10.	Ali AM, Saleh M, Bolongaro S, et al. The strength of different fixation techniques for bicondylar tibial plateau fractures: a biomechanical study. Clin biomech (Bristol, Avon), 2003, 18(9): 864-870.
11.	Yetkinler DN, McClellan RT, Reindel ES, et al. Biomechanical comparison of conventional open reduction and internal fixation versus calcium phosphate cement fixation of a central depressed tibial plateau fracture. J Orthop Trauma, 2001, 15(3): 197-206.
12.	Frankenburg EP, Goldstein SA, Bauer TW, et al. Biomeetumieal and histological evaluation of a calcium phosphate cement. J Bone Joint Surg (Am), 1998, 80(8): 1112-1124.
13.	葉建東, 王秀鵬, 白波, 等. 一種可注射可降解磷酸鈣骨水泥的結構與性能. 功能材料, 2008, 39(2): 271-274, 278.
14.	鄒華章, 廖威明, 段昕, 等. 新型可注射磷酸鈣骨水泥在椎體后凸成形術中的生物力學評價. 中華生物醫學工程雜志, 2011, 17(2): 151-155.
15.	Fernández E, Vlad MD, Gel MM, et al. Modulation of porosity in apatitic cements by the use of alpha-tricalcium phosphate-calcium sulphate dihydrate mixtures. Biomaterials, 2005, 26(17): 3395-3404.
16.	Fernández E, Sarda S, Hamcerencu M, et al. High-strength apatitic cement by modification with superplasticizers. Biomaterials, 2005, 26(15): 2289-2296.
17.	廖紅興, 段昕, 鄒華章, 等. 含聚乳酸-羥基乙酸共聚物的新型磷酸鈣骨水泥體內降解性能研究. 中國修復重建外科雜志, 2012, 26(8): 934-938.
18.	Schipplein OD, Andreiacchi TP. Interaction between active and passive knee stabilizers during level walking. J Orthop Res, 1991, 9(1): 113-119.
19.	Mueller KL, Karunakar MA, Frankenburg EP, et al. Bicondylar tibial plateau fractures: a biomechanical study. Clin Orthop Relat Res, 2003, (412): 189-195.

1. 梁承偉, 朱炯, 沈海敏. 內固定治療脛骨平臺骨折64例分析. 中國矯形外科雜志, 2006, 14(18): 1393-1396.
2. Lim TH, Brebach GT, Renner SM, et al. Biomechanical evaluation of an injectable calcium phosphate cement for vertebroplasty. Spine (Phila Pa 1976), 2002, 27(12): 1297-1302.
3. Heini PF, Berlemann U. Bone substitutes in vertebroplasty. Eur Spine J, 2001, 10(2): S205-213.
4. Kruyt MC, Persson C, Johansson G, et al. Towards injectable cell-based tissue-engineered bone: the effect of different calcium phosphate microparticles and pre-culturing. Tissue Eng, 2006, 12(2): 309-317.
5. van Lieshout EM, van Kralingen GH, El-Massoudi Y, et al. Microstructure and biomechanical characteristics of bone substitutes for trauma and orthopaedic surgery. BMC Musculoskelet Disord, 2011, 12: 34.
6. Wang X, Ye J, Wang Y. Hydration mechanism of a novel PCCP + DCPA cement system. J Mater Sci Mater Med, 2008, 19(2): 813-816.
7. Trenholm A, Landry S, McLaughlin K, et al. Comparative fixation of tibial plateau fractures using alpha-BSM, a calcium phosphate cement, versus cancellous bone graft. J Orthop Trauma, 2005, 19(10): 698-702.
8. Stuart MJ, Beachy AM, Grabowski JJ, et al. Biomechanical evaluation of a proximal tibial opening-wedge osteotomy plate. Am J Knee Surg, 1999, 12(3): 148-154.
9. Wu CC, Tai CL. Plating treatment for tibial plateau fractures: a biomechanical comparison of buttress and tension band positions. Arch Orthop Trauma Surg, 2007, 127(1): 19-24.
10. Ali AM, Saleh M, Bolongaro S, et al. The strength of different fixation techniques for bicondylar tibial plateau fractures: a biomechanical study. Clin biomech (Bristol, Avon), 2003, 18(9): 864-870.
11. Yetkinler DN, McClellan RT, Reindel ES, et al. Biomechanical comparison of conventional open reduction and internal fixation versus calcium phosphate cement fixation of a central depressed tibial plateau fracture. J Orthop Trauma, 2001, 15(3): 197-206.
12. Frankenburg EP, Goldstein SA, Bauer TW, et al. Biomeetumieal and histological evaluation of a calcium phosphate cement. J Bone Joint Surg (Am), 1998, 80(8): 1112-1124.
13. 葉建東, 王秀鵬, 白波, 等. 一種可注射可降解磷酸鈣骨水泥的結構與性能. 功能材料, 2008, 39(2): 271-274, 278.
14. 鄒華章, 廖威明, 段昕, 等. 新型可注射磷酸鈣骨水泥在椎體后凸成形術中的生物力學評價. 中華生物醫學工程雜志, 2011, 17(2): 151-155.
15. Fernández E, Vlad MD, Gel MM, et al. Modulation of porosity in apatitic cements by the use of alpha-tricalcium phosphate-calcium sulphate dihydrate mixtures. Biomaterials, 2005, 26(17): 3395-3404.
16. Fernández E, Sarda S, Hamcerencu M, et al. High-strength apatitic cement by modification with superplasticizers. Biomaterials, 2005, 26(15): 2289-2296.
17. 廖紅興, 段昕, 鄒華章, 等. 含聚乳酸-羥基乙酸共聚物的新型磷酸鈣骨水泥體內降解性能研究. 中國修復重建外科雜志, 2012, 26(8): 934-938.
18. Schipplein OD, Andreiacchi TP. Interaction between active and passive knee stabilizers during level walking. J Orthop Res, 1991, 9(1): 113-119.
19. Mueller KL, Karunakar MA, Frankenburg EP, et al. Bicondylar tibial plateau fractures: a biomechanical study. Clin Orthop Relat Res, 2003, (412): 189-195.

《中國修復重建外科雜志》

復合型可注射磷酸鈣骨水泥在脛骨平臺塌陷骨折中的生物力學研究

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《中國修復重建外科雜志》

復合型可注射磷酸鈣骨水泥在脛骨平臺塌陷骨折中的生物力學研究

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