老年国人股骨近端生物力学特点与股骨粗隆间骨折内固定选择的试验研究  

Biomechanical stress research of proximal femur of old Chinese people and a guide to choose fixation for femoral intertrochanteric fractures

作　　者：闵重函 周瑛 张洪美[2] 严世贵[3] 叶先才[4] 应祖光[5] MIN Zhong-han;ZHOU Ying;ZHANG Hong-mei;YAN Shi-gui;YE Xian-cai;YING Zu-guang(Department of Orthopedic,Jiaxing Hospital of TCM Affiliated to Zhejiang Chinese Medical University,Jiaxing,Zhejiang 314001,China)

机构地区：[1]浙江中医药大学附属嘉兴中医院骨科12病区,浙江嘉兴314001 [2]中国中医科学院望京医院骨关节一科 [3]浙江大学附属医学院附属第二医院骨科 [4]浙江嘉兴学院医学院 [5]浙江大学航空航天学院工程力学系

出　　处：《中国骨与关节损伤杂志》2018年第8期789-793,共5页Chinese Journal of Bone and Joint Injury

基　　金：浙江省科技计划项目(2011C33050);嘉兴市科技计划项目(2015AY23044)

摘　　要：目的探讨老年国人股骨近端生物力学特点以及股骨粗隆间骨折内固定方式的选择。方法选取老年国人尸体股骨标本64根,在环股骨颈基底部、环股骨粗隆间、环股骨小粗隆基底部表面选取力学测量标志点,测量0.5、1.0、1.5、2.0、2.5 k N压应力下的应力值。制作股骨粗隆间骨折(Evans-Jensen分型)PFNA和LCP内固定模型,PFNA组在螺旋刀片前段上方定位M点,在螺旋刀片和主钉连接位置上方定位P点;LCP组在股骨头内最上方螺钉前段上方定位M点,在螺钉和钢板结合部定位P点;测量0.5、1.0、1.5、2.0 k N压应力下的M点及P点的应力值。结果老年国人环股骨颈基底部、环股骨粗隆间、环股骨小粗隆基底部表面的应力值随着压应力增加而增加,M点与P点的应力值均随着压应力的增加而增加,差异有统计学意义(P<0.05)。相同压应力下,PFNA组Ⅱ型与Ⅲ型骨折M点应力值差异无统计学意义(P>0.05),而Ⅳ型骨折应力值大于Ⅲ型骨折,Ⅴ型骨折大于Ⅳ型骨折。在0.5、1.0 k N压应力下,PFNA组Ⅱ型与Ⅲ型骨折P点应力值差异无统计学意义(P>0.05);在1.5、2.0 k N压应力下,PFNA组Ⅲ型骨折P点应力值大于Ⅱ型骨折(P<0.05)。相同压应力下,PFNA组Ⅳ型骨折P点应力值大于Ⅲ型骨折,Ⅴ型骨折大于Ⅳ型骨折。相同压应力下,LCP组Ⅲ型骨折M点、P点应力值大于Ⅱ型骨折,Ⅳ型骨折大于Ⅲ型骨折,Ⅴ型骨折大于Ⅳ型骨折。结论老年股骨粗隆间骨折可根据Evans-Jensen分型选择合理的内固方式,而术中恢复内、外侧骨皮质的连续性对维持良好应力传导、避免内固定失败有重要作用。Objective To investigate biomechanical characteristics of proximal femur and the selection of internal fixation of femoral intertrochanteric fractures of the old Chinese people. Methods Sixty-four old Chinese femurs from fresh cadavers were selected, and the mechanical measurement points were selected on the basal part of the ring of the femur neck, the intertrochanter and the small trochanter. The stress values of those measurements under 0.5, 1.0, 1.5, 2.0, 2.5 kN external compression stress were measured. PFNA and LCP internal fixation models of intertrochanteric fracture were made according to Evans-Jensen classification. PFNA group located point M above the anterior segment of screw blade, positioned point P above the screw blade and the connection position of the main nail; LCP group located the point M above the top of the screw in the upper part of the femoral head, and positioned the point P in the combination of screw and the plate. The stress values of point M and P were measured under compression stress of 0.5, 1.0, 1.5 and 2.0 kN. Results The stress values of the basal part of the ring of the femur neck, the intertrochanter and the small trochanter were increased with the external compressive stress, and the increase of the stress values of point M and P was similar, the difference was statistically significant （P 〈0.05）. Under the same compressive stress, in PFNA group, there was no significant difference in the values on point M between type II and type HI （P 〉0.05）, however, the values of type 1V were greater than type m, and the values of type V were greater than type IV. Under the pressure of 0.5 and 1.0 kN, in PFNA group, there was no significant difference in the values on point P between type I1 and type III （P 〉0.05）. But under the pressure of 1.5 and 2.0 kN, the stress value of type HI was greater than that of type II （P 〈0.05）, at the same stress and the same point, the values of type IV were greater than that of type liT, and the values of type V were greater than

关 键 词：股骨近端 老年国人 股骨粗隆间骨折 生物力学 股骨近端防旋髓内钉 股骨近端锁定钢板 内固定 

分 类 号：R687.3[医药卫生—骨科学]