四种股骨转子间骨折内固定物的力学对比及疗效评价  

MechanicalStudyandClinicalEvaluationofFourKindsofInternalFixationDevicesinTreatmentofIntertrochantericFracturesoftheFemur

作　　者：范卫民[1,2] 陶松年[1,2] 王道新[1,2] 殷国勇[1,2] JJFicat 

机构地区：[1]南京医科大学第一附属医院骨科 [2]法国图卢兹Languedoc医院创伤骨科

出　　处：《中华骨科杂志》1996年第4期229-232,共4页Chinese Journal of Orthopaedics

基　　金：江苏省科学技术委员会和卫生厅基金

摘　　要：作者对Ｒｉｃｈａｒｄｓ钉（滑动加压螺纹钉）、Ｊｅｗｅｔｔ钉、斯氏针和麦氏鹅头钉进行了力学测试，结果经方差分析显示，Ｊｅｗｅｔ钉的强度最大，Ｒｉｃｈａｒｄｓ钉次之，麦氏鹅头钉最弱（Ｐ值＜０．００１）。同时发现Ｒｉｃｈａｒｄｓ钉的抗旋转强度仅３．３ｋｇ·ｍ。临床资料显示，Ｒｉｃｈａｒｄｓ钉疗效最佳，而麦氏鹅头钉，Ｊｅｗｅｔ钉和斯氏针欠理想。作者认为，Ｒｉｃｈａｒｄｓ钉有动力性和静力性加压作用，它结构牢固，固定效果可靠，患者可早期下地活动，是当今治疗股骨转子间骨折比较理想的内固定物。其不足之处是无有效的抗旋转作用。Ｊｅｗｅｔｔ钉和麦氏鹅头钉的结构不够合理，并发症较多。虽然斯氏针的强度不足，但其手术创伤小，故对不能耐受大手术的患者可以考虑使用。TheauthorshadperformedstaticloadtestsofRichardsscrew,Steinmannpins,Jewettnail,andMcLaughlinnail;theanalysisofvariancerevealedthattheJewetnailwasthestrongest,theRichardsscrewsecondandtheMcLaughlinnailwasweakest(P<0.001).Itisalsofoundthatthestrenghofanti-rotationoftheRichardsscrewwas3.3kg·m.ClinicalreviewdemonstratedthattheRichardsscrewwasthebestchoicefortreatmentofintertrochantericfractureofthefemur;theefectsoftheMcLaughlinnail,JewettnailandtheSteinmannpinswerenotsatisfactory.Theauthorsbelievedthat,thereisastaticanddynamiccompressionintheRichardsscrewanditsmechanicstrengthwasgreatenoughforpatienttowalkearly,howevertheinsuficientstrenghofanti-rotationofthisdevicewasitsweakness.ThedesignoftheJewettnailandtheMcLaughlinnailwasunreasonableandthecomplicationswereapttooccur.TheauthorssuggestthatalthoughtheSteinmannpinswerenotstrongenough,itshouldbeusedinthosepatientswhoarenotabletosustainamajorsurgicalprocedure.

关 键 词：股骨 转子 骨折 RICHARDS钉 斯氏针 内固定 

分 类 号：R683.420.5[医药卫生—骨科学]