股骨颈合并同侧粗隆下骨折3种内固定方式的生物力学分析  

Biomechanical analysis of three different fixations for ipsilateral femoral subtrochanteric and femoral neck fractures

作　　者：李仁斌[1] 林焱斌[1] 庄研[1] 熊国胜[1] 熊圣仁[1] 张怡元[1] 

机构地区：[1]厦门大学附属福州第二医院骨科,福建福州350007

出　　处：《中国骨与关节损伤杂志》2015年第2期133-135,共3页Chinese Journal of Bone and Joint Injury

基　　金：福建省医学创新课题(2011-CXB-24)

摘　　要：目的比较股骨近端锁定板(PFLP)、加长型股骨近端防旋髓内钉(PFNA)、加长型股骨近端髓内钉(PFN)内固定股骨颈合并同侧粗隆下骨折的生物力学性能。方法将18根成年防腐人尸体股骨标本编号后通过随机数字表法随机分为3组,每组6根。制作成股骨颈完全无移位骨折,合并同侧股骨粗隆下内侧皮质缺损5 cm的骨折模型。依据标准技术分别予以PFLP、加长型PFNA、加长型PFN固定。在生物力学试验机上先后进行轴向压缩试验、扭转试验和轴向压缩破坏试验。结果加长型PFNA组轴向抗压刚度最高,为(130.61±5.51)N/mm;加长型PFN组其次,为(56.25±4.07)N/mm;PFLP组最低,为(3.59±2.52)N/mm;3组差异有统计学意义(F=2 337.77,P<0.001)。PFLP组扭转刚度最高,为(1.30±0.23)Nm/°;加长型PFNA组其次,为(0.86±0.28)Nm/°;加长型PFN组最低,为(0.38±0.07)Nm/°;3组差异有统计学意义(F=106.05,P<0.001)。加长型PFNA组破坏载荷最大,为(3 072.72±216.81)N;加长型PFN组其次,为(2 726.94±182.78)N;PFLP组最小,为(1 877.61±284.87)N;3组差异有统计学意义(F=138.31,P<0.001)。结论内固定手术治疗股骨颈合并同侧粗隆下骨折时,加长型PFNA较PFLP、PFN具有生物力学优势。Objective To compare the biomechanical properties of three kinds of internal fixations（long-PFN, long-PFNA,PFLP） for ipsilateral femoral subtrochanteric and femoral neck fractures. Methods First of all, eighteen antiseptic femurs were numbered, and then, by the method of random digits table, were averagely divided into three groups（6 each group）, which used to make model of femoral neck fractures without displacement and ipsilateral femoral subtrochanteric fractures with the medial cortical defect 5 cm below the femoral subtrochanter; Secondly, according to technical standard, three groups were fixed respectively by long-PFN, long-PFNA, PFLP. All the fixations model was evaluated by biomechanical test. Experimental tests included vertical load, torsional load and vertical damage load. The compression stiffness and torsional stiffness of boneimplant composite were calculated, and the loads of failure were recorded. Results The compression stiffness of long-PFNA was（130.61±5.51）N/mm, the highest among the three groups, the group of the long-PFNA was（56.25 ±4.07）N/mm, the group of the PFLP was（3.59±2.52）N/mm. There was statistical significance among the three groups（F =2 337.77, P 0.001）. The torsional stiffness was superior to the group of PFLP（1.30±0.23）Nm/°, secondary to the group of long-PFNA（0.86±0.28）Nm/°,and inferior to the group of long-PFN（0.38±0.07）Nm/°. There was statistical significance among the three groups（F =106.05,P 0.001）. The loads of failure of the group of long-PFNA were the highest among the three groups（3 072.72±216.81）N,and the group of long-PFN（2 726.94±182.78）N was higher the group of PFLP（1 877.61 ±284.87）N. There was statistical significance among the three groups（F =138.31,P 0.001）. Conclusion The biological mechanic property of long-PFNA is superior to the other fixed devices.

关 键 词：股骨颈合并同侧粗隆下骨折 股骨近端锁定板 加长型股骨近端防旋髓内钉 加长型股骨近端髓内钉 内固定 生物力学 

分 类 号：R-33[医药卫生]