股骨头内撑器的研制及其治疗股骨头缺血性坏死的生物力学研究  

The development and biomechanical study of interior maintaining system for treatment of avascular necrosis in femoral head

作　　者：李康华[1] 肖东民[2] 高曙光[1] 李雄[3] 雷光华[1] 

机构地区：[1]中南大学湘雅医院骨科,长沙410008 [2]永州市人民医院骨科,425000 [3]中南大学湘雅医院运动医学科,长沙410008

出　　处：《中华关节外科杂志（电子版）》2011年第4期46-49,共4页Chinese Journal of Joint Surgery(Electronic Edition)

基　　金：国家科技部863项目(2011AA030101)

摘　　要：目的探讨一种新型股骨头内撑器对股骨头颈生物力学的影响,为股骨头缺血性坏死提供一种新的治疗方法。方法根据股骨头、颈的解剖特点和生物力学原理,设计制造股骨头内撑器。取正常成人股骨上段标本15具,随机分为3组,正常对照组(A组);减压植骨组(B组),于股骨外侧粗隆下沿股骨中心至股骨头软骨下0·5cm钻一直径1cm隧道,用刮匙将股骨头软骨下刮出一直径约2cm空间,然后进行植骨;内撑器植骨组(C组),按照B组先制造股骨头颈隧道及扩大股骨头软骨下空间,然后安装内撑器、植骨。采用力学实验机在股骨头顶部逐级加载至股骨毁损,分别记录并比较股骨转子窝部、股骨距、股骨大转子下的应变,股骨头塌陷和股骨头颈损毁时的最大载荷。结果 300N载荷时,股骨转子窝部及股骨矩应变:A组和C组均大于B组,A组和C组之间无统计学差异。股骨转子下应变:A组小于B、C组,C组小于B组。应变组间比较:A组股骨转子窝部与股骨矩无统计学差异,均大于股骨转子下;B组股骨转子窝部与股骨矩无统计学差异,均小于股骨转子下;C组股骨转子窝部与股骨矩无统计学差异,均小于股骨转子下。各组股骨头塌陷和股骨头颈损毁的最大载荷:B组小于A、C组,A组和C组无统计学差异。以上结果显示,正常情况下应力集中于股骨转子窝部和股骨距,减压植骨后应力则集中于股骨转子下,承载负荷明显低于正常,置入内撑器并植骨后其应力分布及承载负荷均接近正常。结论股骨头内撑器加植骨能有效地维持股骨头颈的生物力学性能,为该方法的临床应用提供了生物力学依据。Objective To develope a new type of femoral head interior supporting system for the treatment of femoral head osteonecrosis and evaluate its biomechanical efficacy. Methods The new type of femoral head interior supporting system was designed according to biomechanical principles and the characteristics of femoral head and neck . Fifteen normal adult femoral specimens were randomly divided into three groups： Group A, normal control; Group B, the femoral heads were dealt with decompression and bone graft; Group C, the femoral heads were dealt with interior supporting system and bone graft. Femoral heads were subjected to axial torque. Strain of fossa trochanterica, femoral calcar and subtrochantarer was calculated and the maximum load of femoral sink and damage was measured. Results No significant difference of the strain of fossa trochanterica and femoral calcar was noted between Group A and Group C under 300N loading condition. Compared to Group A or Group C, Group B had lower strain of fossa trochanterica and femoral calcar under 300N loading condition （P 〈 0. 05）. Group A had lower strain of subtrochantarer than Group B and Group C, while Group C had lower strain of subtrochantarer than Group B under 300 N loading condition （ P 〈 0. 05 ）. No significant difference of the strain in Group A was noted between fossa trochanterica and, femoral calcar and their strain values were higher than subtrochantarer. Neither was it in Group B and Group C, and their strain values were also lower than subtrochantarer. No significant difference of the maximum load of femoral collapse and damage was noted between Group A and Group C. Compared to Group A or Group C, Group B had lower maximum load of femoral collapse and damage （ P 〈 0. 05 ）. These results showed that under normal circumstances, the stress concentrated on fossa trochanterica and femoral calcar, while after decompression and bone graft, the stress concentrated on subtrochantarer and the bearing load was obviously lower than normal condition. The

关 键 词：股骨头 骨坏死 生物力学 

分 类 号：R687.3[医药卫生—骨科学]