成人的遠端肱骨骨折為肘部疾患中，不容易處理且極富挑戰的外傷之一。目前對於遠端肱骨骨折的治療主流以骨折復位固定手術為主，手術治療目前認為比起非手術治療能帶來更好的臨床結果。手術治療的目標為提供一個穩定的骨折復位固定，使病患於手術後可以盡早進行手肘活動度的復健運動，以及在復健的同時降低術後併發症的發生。目前手術固定的方式，大部分建議需要以骨板固定，治療原則需要同時固定遠端肱骨的外柱及內柱。目前較常使用的遠端肱骨骨折固定方式為利用平行雙骨板或是垂直雙骨板系統固定；這兩種固定方式已經廣泛的研究在不同的臨床實驗以及生物力學實驗之中。然而，目前針對哪一種骨板系統對於遠端肱骨骨折為較好的固定方式仍然沒有定論。即便平行雙骨板系統在生物力學測試上的表現良好，但是其臨床上的應用仍對平行系統有其他疑慮，其最大的考量在於使用平行雙板固定系統相對於其他固定系統而言，需要較大的遠端肱骨骨折之周圍軟組織剝離，傷害性可能較大，對解剖構造的破壞較高。臨床上，後側固定系統為另一種替代性的遠端肱骨取代傳統雙骨板系統來治療遠端肱骨骨折；後側固定系統亦可以同時進行遠端肱骨雙柱的固定，其固定系統主要包括單一後側Y型骨板固定系統或是後側雙骨板固定系統。目前臨床研究成果顯示，利用後側雙骨板固定系統來治療遠端肱骨粉碎性骨折能達到良好的臨床上成效。然而，此系統比起在生物力學上與較常使用的平行或垂直雙骨固定板系統，後側固定系統的生物力學表現及研究仍然不明確。此外，臨床上目前也有新型的單一後側Y型骨板互鎖式系統可以用來治療遠端肱骨踝間骨折，然此一骨板的生力力學研究亦缺乏。因此，本研究兩個目標為，第一，透過生物力學文獻的實證搜尋分析，來比較平行雙板固定系統與垂直雙板固定系統之間的力學指標差異性，並且進行統合研究。第二，透過生物力學實驗來比較後側固定系統與平行固定系統之間的生物力學特性，並且進一步比較後側單一骨板與後側雙骨板固定之間的差異性。在本研究中，統合分析部分納入了18篇生物力學文獻，結果顯示，平行骨板在軸向及旋轉剛性、軸向及矢狀最大負載的生物力學表現優於垂直雙骨板。敏感性測試的方法透過組間再分析則顯示，對於踝間遠端肱骨骨折模型而言，平行雙骨板在向後的矢狀剛性較強於垂直雙骨板；而在踝上骨折模型中，則是平行雙骨板旋轉剛性較強於垂直雙骨板。至於本研究中，生物力學實驗則發現，對於雙骨板結構來說，不管是使用平行雙骨板或後側雙骨板，其剛性及最大負載均無統計學上得差異。然而單骨板（Y型單板）相較於雙骨板（含平行及後側雙版）而言，其剛性及最大負載均較雙骨板來得差。兩種系統經過疲勞測試後，均無固定失敗的情形。此外，本研究發現骨質密度與平行骨板的最大負荷有顯著的正相關性。總結來說，根據統合研究的整合生物力學證據顯示，平行結構相對於垂直結構可以提供較優異的生力力學強度。至於利用生物力學實驗分析後側固定系統與平行固定系統則顯示，若是兩種系統均以雙骨板固定的生物力學強度是相近的。然而，單骨板固定（單Y型骨板）較雙骨板固定強度來得差。對於踝間的穩定性來說，平行系統及後側系統在疲勞測試中，均提供相仿的踝間固定穩定度。

Distal humerus fracture (DHF) is complicated injury to treat among elbow injuries. Surgical fixation for DHFs has been the mainstay of treatment with superior outcomes to non-operative management. The purpose for fixation surgery is to provide a rigid construct to for elbow rehabilitation exercise. The principle for surgical fixation is to provide rigid medial and lateral column stabilization, mostly with strong plates. Not only parallel but orthogonal configuration using double plating has been adopted for many orthopedic surgeons based on many established evidence of clinical researches and biomechanical studies. Nevertheless, there are still controversies in which system should be used in DHF fixation. Some authors suggested the use of dorsal plate construct as alternatives for fixation of fracture of distal humerus, including a dorsal Y plate and a posterior-two plate constructs that have less soft tissue injury during surgeries. Using the posterior constructs for fixation was reported to produce good results for comminuted DHFs. However, the mechanical characteristics of posterior fixation system are still unclear as compared with those of the parallel and orthogonal systems currently. There is also new generation of posterior Y plate for treatment of DHFs, for which the biomechanical properties are still widely unknown. Thus, the present study aims are to compare the mechanical parameters between orthogonal and parallel configuration by meta-analytic methods and to compare the differences between parallel configuration and those of the posterior constructs. The results of present biomechanical meta-analytic study, including eighteen researches, demonstrated higher axial/torsional stiffness, axial/sagittal (dorsal) failure strength in parallel constructs than in orthogonal ones. Using sensitivity analysis with subgroup comparison, the result showed that parallel system is stronger in dorsal bending direction for the intercondylar model and stiffer in torsional aspects for the supracondylar model. For the results of the present biomechanical study, there were no differences for any biomechanical parameters for both parallel and posterior systems when two plates were used axially and sagittally. In contrast, two-plate constructs (both parallel and posterior ones) demonstrated greater stiffness and failure strength than one-plate construct (the single Y-plate one). Implant failure was not noted for both systems after fatigue testing. Additionally, bone marrow density was positively correlated with failure strength for parallel constructs. In conclusion, from the evidence of pooled biomechanical meta-analysis, parallel constructs demonstrated higher axial failure strength and stiffness, torsional stiffness, and posterior bending strength than orthogonal plate for DHF fixation. Regarding posterior versus parallel configuration in the treatment of DHFs, both constructs provided comparative strength if dual plates were applied. However, the one-plate construct (the single Y-plate) strength is inferior to other dual-plate constructs. All parallel and posterior constructs provided comparable fixation stability to the intercondylar segments during fatigue tests.

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