复合型可注射磷酸钙骨水泥在胫骨平台塌陷骨折中的生物力学研究_《中国修复重建外科杂志》

作者：

邹华章 ¹ , 马晓春 ² , 唐程 ¹ , 李创 ¹ , 陈建伟 ³ , 叶建东 ⁴

1广州医学院第四附属医院骨科（广州，511447）;;
2广州番禺区大石人民医院骨科;;
3中山大学骨科研究所;;
4华南理工大学生物材料研究所;

关键词：

胫骨平台骨折磷酸钙骨水泥生物力学

DOI：

10.7507/1002-1892.20130187

视频：

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摘要 全文 图表 视频 参考文献 施引文献 补充材料

目的探讨复合聚乳酸-羟基乙酸共聚物[poly（lactic-co-glycolic acid），PLGA]的可注射磷酸钙骨水泥（calcium phosphate cement，CPC）结合双螺钉固定在胫骨平台Schatzker Ⅱ型骨折模型中的生物力学性能，为临床微创治疗提供生物力学依据。方法取10对老年尸体胫骨近端标本制备胫骨平台Schatzker Ⅱ型骨折模型后，左右侧随机配对分为2组，分别为复合型可注射CPC组（实验组，n=10）和自体松质骨组（对照组，n=10）。实验组和对照组分别采用CPC加压注入和自体松质骨充填植骨，结合双螺钉横排固定方法固定胫骨平台骨折。两组标本分别在MTS 858材料试验机上进行轴向垂直压缩，记录载荷-位移数据，测量两组标本的最大载荷和抗压刚度。结果复合型可注射CPC室温下具有良好的可注射性，在胫骨平台塌陷下方骨缺损区不仅充填充分，且材料在骨缺损区周围松质骨中进一步渗透、扩散。实验组和对照组胫骨干骺端骨密度分别为（0.639 ± 0.081）、（0.668 ± 0.083）g/cm2，差异无统计学意义（t=1.012，P=0.331）。实验组最大载荷为（4 101 ± 813）N，显著高于对照组的（692 ± 138）N，差异有统计学意义（t=3.932，P=0.001）。实验组抗压刚度为（1 363 ± 362） N/mm，显著高于对照组的（223 ± 54） N/mm，比较差异有统计学意义（t=3.023，P=0.013）。结论在胫骨平台Schatzker Ⅱ型骨折中采用复合型可注射CPC加压充填植骨结合双螺钉固定技术能有效恢复胫骨平台的抗塌陷力学性能，是一种理想的植骨填充材料。

引用本文： 邹华章,马晓春,唐程,李创,陈建伟,叶建东. 复合型可注射磷酸钙骨水泥在胫骨平台塌陷骨折中的生物力学研究. 中国修复重建外科杂志, 2013, 27(7): 855-859. doi: 10.7507/1002-1892.20130187 复制

1.	梁承伟, 朱炯, 沈海敏. 内固定治疗胫骨平台骨折64例分析. 中国矫形外科杂志, 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.	叶建东, 王秀鹏, 白波, 等. 一种可注射可降解磷酸钙骨水泥的结构与性能. 功能材料, 2008, 39(2): 271-274, 278.
14.	邹华章, 廖威明, 段昕, 等. 新型可注射磷酸钙骨水泥在椎体后凸成形术中的生物力学评价. 中华生物医学工程杂志, 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.	廖红兴, 段昕, 邹华章, 等. 含聚乳酸-羟基乙酸共聚物的新型磷酸钙骨水泥体内降解性能研究. 中国修复重建外科杂志, 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. 梁承伟, 朱炯, 沈海敏. 内固定治疗胫骨平台骨折64例分析. 中国矫形外科杂志, 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. 叶建东, 王秀鹏, 白波, 等. 一种可注射可降解磷酸钙骨水泥的结构与性能. 功能材料, 2008, 39(2): 271-274, 278.
14. 邹华章, 廖威明, 段昕, 等. 新型可注射磷酸钙骨水泥在椎体后凸成形术中的生物力学评价. 中华生物医学工程杂志, 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. 廖红兴, 段昕, 邹华章, 等. 含聚乳酸-羟基乙酸共聚物的新型磷酸钙骨水泥体内降解性能研究. 中国修复重建外科杂志, 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.

《中国修复重建外科杂志》

复合型可注射磷酸钙骨水泥在胫骨平台塌陷骨折中的生物力学研究

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《中国修复重建外科杂志》

复合型可注射磷酸钙骨水泥在胫骨平台塌陷骨折中的生物力学研究

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