内固定物置入治疗股骨远端骨折的生物力学变化与临床效果  

Biomechanical changes and clinical effect of internal fixator placement for the treatment of distal femoral fractures

作　　者：关继奎[1] 关雨[2] 赵丽[1] 王慧[1] 孔丽[1] 李静[1] 刘建国[3] 

机构地区：[1]大庆油田总医院骨科,黑龙江省大庆市163001 [2]北京朝阳医院口腔科,北京市100020 [3]吉林大学第一医院骨科,吉林省长春市130021

出　　处：《中国组织工程研究》2013年第13期2439-2446,共8页Chinese Journal of Tissue Engineering Research

摘　　要：背景:以置入内固定物治疗是股骨远端骨折研究的首选方法之一。目的:因股骨远端骨折的解剖结构复杂,故评价股骨远端骨折后不同内固定物治疗后生物力学变化可引导临床应用。方法:分别测定微创内固定系统钢板、动力髁螺钉以及逆行交锁髓内钉内固定治疗股骨远端骨折时的抗压刚度和抗弯强度,同时比较3种内固定之间的生物力学变化。对应用微创内固定系统钢板、动力髁螺钉以及逆行交锁髓内钉内固定治疗股骨远端骨折的患者进行随访观察,明确3组内固定物临床治疗效果,并进行比较分析。结果与结论:生物力学测试结果显示,内固定物置入治疗股骨远端骨折时,动力髁螺钉的应力遮挡过大,而逆行交锁髓内钉的刚度过低。微创内固定系统钢板既具有一定的变形性,使应力能够通过骨传导,又具有较强的刚度,能够为骨折的内固定提供较好的稳定性。对股骨远端骨折内固定治疗的患者进行随访观察发现,应用微创内固定系统钢板内固定骨折愈合时间更短,并发症发生率更低,膝关节功能优良率更高,是股骨远端骨折首选的治疗方法之一。BACKGROUND： Placement of internal fixators is one of the preferred methods for the treatment of distal femoral fractures.OBJECTIVE： To evaluate the biomechanical changes of different internal fixators after distal femoral fracture due to the complexity of the anatomical structure of distal femoral fractures, in order to guide the clinical application.METHODS： Compressive stiffness and bending strength of less invasive stabilization system steel plate, dynamic condylar screw and retrograde interlocking intramedullary nail internal fixation for the treatment of distal femoral fractures were detected, and the biomechanical changes of the three internal fixations were compared. Patients with distal femoral fractures who were treated with less invasive stabilization system steel plate, dynamic condylar screw and retrograde interlocking intramedullary nail internal fixations were followed-up to identify the clinical effect of three internal fixators and the clinical effects were compared.RESULTS AND CONCLUSION： Biomechanical testing showed that during the treatment of distal femoral fractures with internal fixators, dynamic condylar screw had higher stress shielding, while the retrograde interlocking intramedullary nail had lower stiffness. Less invasive stabilization system steel plate had a certain degree of deformability which can conduct the stress through bone, and it also had strong rigidity, which can provide better stability for the internal fixation of fracture. The follow-up of the patients with distal femoral fractures showed that less invasive stabilization system steel plate had shorter fracture healing time, lower incidence of complications and higher excellent and good rate of knee joint, which is considered as the best method for the treatment of distal femoral fractures.

关 键 词：骨关节植入物 骨关节植入物学术探讨 股骨远端骨折 内固定 生物力学 微创内固定系统钢板 动力髁螺钉 逆行交锁髓内钉 膝关节 膝内翻 并发症 

分 类 号：R318[医药卫生—生物医学工程]