股骨近端骨折内固定头颈钉不同位置置放的生物力学研究  

Biomechanical study of positions of femoral head-and-neck nail in fixation of proximal femoral fracture

作　　者：刘磊[1] 周建伟[1] 王以进[2] 李文生[3] 许庆利[1] 张传寅[1] 梁钟鸣[1] 蒋毅[1] 张亮[1] 张燕鹏[1] 

机构地区：[1]上海复旦大学附属华山医院宝山分院骨科,上海市长江西路1999号200431 [2]上海大学生物力学研究所 [3]上海复旦大学医学院解剖室,上海200431

出　　处：《中国矫形外科杂志》2010年第4期300-303,共4页Orthopedic Journal of China

基　　金：上海市宝山区科学发展基金(08-E-17)

摘　　要：[目的]通过生物力学实验应力分析,论证头颈钉不同置放位置的生物力学性能,固定牢固,有利于骨折愈合以指导临床手术。[方法]采集24具新鲜股骨标本,分别造成股骨粗隆间稳定和不稳定骨折,用r钉、DHS固定,头颈钉分别置放不同位置,测定股骨抗压、抗弯、抗剪和抗扭等力学性能,分析比较不同位置头颈钉内固定的优劣。[结果]从股骨强度、刚度、稳定性和承载能力测试结果表明,对于稳定型股骨粗隆间骨折,头颈钉应放在股骨头颈中下1/3偏后处,骨质致密,有股骨距支撑,承载能力大为增强,有利于早期下床活动且不易发生切割;对于不稳定型股骨粗隆间骨折,头颈钉应放入股骨头颈中间,有强斜力学效应,有利于骨折早期愈合。[结论]通过生物力学测试,确认股骨近端骨折头颈钉最佳固定位置,是提高现代器械临床固定效果,提高股骨近端骨折手术疗效的关键。[Objective]To analyze the biomechanics of different positions of femoral head-and-neck nail in fixation of proximal femoral fracture.[Method]Stable and unstable fracture models were made from 24 fresh femur specimens,and fixed with r-nail and DHS.Head-and-neck nails were placed in different positions to test their mechanical properties of anti-compression,anti-bending,anti-shearing and anti-torsion,and compared with each other.[Result]Mechanical properties of the femoral strength,stiffness,stability and loading capacity were tested and compared.To the stable fracture group,head-and-neck nail should be placed in middle-lower and posterior 1/3 of femoral neck,which leads to the best loading capacity.To the unstable fracture group,it should be placed between femoral head and neck,which lead to strong obliquity mechanics and valuable for bone union.[Conclusion]Confirm of the best position of femoral head-and-neck nail could improve the effect of fixation and enhance the surgical treatment of proximal femoral fracture.

关 键 词：股骨粗隆间骨折 2种器械内固定 最佳固定位置 生物力学 

分 类 号：R687.3[医药卫生—骨科学] R318.01[医药卫生—外科学]