经髋动力螺钉侧孔注入Ⅲ型丙烯酸树脂骨水泥强化固定轴向稳定性的测试  

Axial stability of lateral-hole dynamic hip screw fixation using type Ⅲ polymethylmethacrylate bone cement argumentation

作　　者：王红兵 徐瑞生[2] 王雪松[2] 吴洁石[2] 薛骏[2] 袁凤来[2] 

机构地区：[1]江阴市文林卫生院,江苏省江阴市214100 [2]无锡市第三人民医院,江苏省无锡市214041

出　　处：《中国组织工程研究与临床康复》2010年第42期7943-7946,共4页Journal of Clinical Rehabilitative Tissue Engineering Research

基　　金：国家自然科学基金(青年)课题(30901526)~~

摘　　要：背景:髋动力螺钉系统仍旧是治疗高龄患者骨质疏松性转子间骨折最常用的器械,但是高龄患者往往由于股骨上端骨质疏松髋动力螺钉固定失败增高。目的:通过生物力学实验测试经髋动力螺钉侧孔注入骨水泥强化螺钉固定的效果。方法:在髋动力螺钉头端制作了4个侧孔,使骨水泥能够通过髋动力螺钉"中央孔→侧孔"注入股骨头的松质骨。成对的骨质疏松性股骨标本12根,复制股骨转子间不稳定型骨折模型后随机分入带侧孔髋动力螺钉固定加骨水泥强化组和标准髋动力螺钉固定组(标准髋动力螺钉固定组)。分别进行轴向"加载-应变"和"载荷-位移"测试、抗扭转力学性能测试、拔出强度测试。结果与结论:带侧孔髋动力螺钉与标准髋动力螺钉的生物力学强度差异无显著性意义;轴向加载试验的"载荷-应变"的测试表明:骨水泥强化组张力侧的应变明显小于标准髋动力螺钉固定组(t=2.795,P<0.05),压力侧骨水泥强化组明显低于标准髋动力螺钉固定组(t=2.621,P<0.05)。加载到600N时,骨水泥强化组的下沉位移较标准髋动力螺钉固定组减少31%,横向位移减少29%,差异均有显著性意义(P<0.05)。结果提示,通过髋动力螺钉中央孔和侧孔注入骨水泥的强化技术能够显著提高髋动力螺钉对股骨转子间骨折固定的生物力学强度。BACKGROUND： Dynamic hip screw （DHS） is the commonest instrument for treatment of osteoporosis intertrochanteric fracture in aged patients, but the fixation is strongly impacted by osteoporosis, leading to a higher failure. OBJECTIVE： To study the fixation effect of a lateral-hole DHS together with bone cement argumentation by biomechanical test. METHODS： Lateral-hole DHS were designed by drilling four lateral holes in the thread part of the screw. Bone cement was injected into femoral cancellous bone via DHS ＂central hole-lateral hole＂. Biomechanical study with axial loading was performed in six matched pairs of fresh frozen human cadaver femurs, unstable intertrochanteric fracture models were produced, then each paired model was randomly distributed to lateral-hole DHS fixation together with bone cement argumentation and standard DHS fixation group. Biomechanical study of ＂load-strain＂ and ＂load-displacement＂ test, anti-torsion and pull-out strength were performed. RESULTS AND CONCLUSION： There was no statistical difference of biomechanical strength between lateral-hole DHS fixation together with bone cement argumentation group and standard DHS fixation group; axial loading ＂load-strain＂ test showed the strain at the tension side in the bone cement argumentation group was significantly less than that in standard DHS fixation group （t=2.795, P0.05）. The same result was seen in the pressure side （t=2.621, P0.05）. When axial loading increased to 600 N, vertical displacement decreased by 31% and horizontal displacement decreased by 29% in bone cement argumentation group as compared with standard DHS fixation group, with significant difference （P0.05）. The augmentation technique of injecting bone cement to femoral head through central channel and lateral holes of DHS can significantly increase biomechanical strength of DHS fixation for intertrochanteric fracture.

关 键 词：髋动力螺钉 骨水泥 转子间骨折 老年 生物力学 

分 类 号：R318[医药卫生—生物医学工程]