不同手术方法治疗老年股骨粗隆间骨折效果及其生物力学研究  

Effects of Different Surgical Methods for Treating Femoral Intertrochanteric Fracture in the Elderly and Biomechanical Study

作　　者：张全 曾勇 舒鑫 ZHANG Quan;ZENG Yong;SHU Xin(Department of Orthopedic Trauma,Qian Xi Nan People's Hospital,Xingyi 562400,Guizhou,China)

机构地区：[1]贵州省黔西南州人民医院创伤骨科,贵州兴义562400

出　　处：《医用生物力学》2020年第5期470-475,共6页Journal of Medical Biomechanics

摘　　要：目的分析股骨近端锁定钢板(locking proximal femoral plate,LPFP)和股骨近端抗旋髓内钉(proximal femoral nail anti-rotation,PFNA)内固定术治疗老年股骨粗隆间骨折的疗效及生物力学性能。方法 106例老年股骨粗隆间骨折患者随机分为LPFP治疗组53例和PFNA治疗组53例,于治疗干预后分别统计两组患者的手术时间、术中出血量、负重时间、骨折愈合时间及术后9个月Harris髋关节功能评分,统计两组患者术后并发症的发生率。取新鲜老年股骨标本10具制备老年股骨粗隆间骨折模型,并将其随机分为PFNA组和LPFP组各5具,于治疗干预后采用力学试验机进行轴向压缩实验、破坏载荷实验和扭转刚度实验,记录生物力学性能指标。结果 PFNA组平均手术时间、负重时间及骨折愈合时间均短于LPFP组(P <0.05),平均术中出血量少于LPFP组(P <0.05),平均Harris评分高于LPFP组(P <0.05)。PFNA组、LPFP组术后并发症总发生率分别为7.56%、18.87%,差异有统计学意义(P <0.05)。骨折模型治疗干预后,PFNA组平均轴向压缩、破坏载荷、扭转刚度均高于LPFP组(P <0.05)。结论 PFNA治疗老年股骨粗隆间骨折创伤小,其良好的生物力学性能可有效促进骨折愈合和髋关节功能的恢复,并显著减少髋内翻和螺钉松动与切割并发症的发生率。Objective To analyze the efficacy and biomechanical properties of locking proximal femoral plate( LPFP) and proximal femoral nail anti-rotation( PFNA) for treating intertrochanteric fracture in elderly patients.Methods One hundred and six elderly patients with intertrochanteric fracture of femur were randomly divided into LPFP group( 53 cases) and PFNA group( 53 cases).After treatment intervention,the operation time,intraoperative bleeding volume,weight-bearing time,fracture healing time and Harris hip function score of9 months after operation in two groups were recorded.The complications after operation in two groups were analyzed.Ten elderly fresh femoral specimens were selected to prepare the model of intertrochanteric femoral fracture in the elderly.They were randomly divided into PFNA group and LPFP group with 5 models in each group.After treatment and intervention,axial compression test,destructive load test and torsional stiffness test were conducted by mechanical testing machine,and biomechanical properties were recorded.Results The average operation time,weight-bearing time and fracture healing time in PFNA group were shorter than those in LPFP group( P < 0.05),and the average intraoperative bleeding volume in PFNA group was less than that in LPFP group( P < 0.05),and the average Harris score was higher than that in LPFP group( P < 0.05).The total incidence of postoperative complications in PFNA group and LPFP group was 7.56% and 18.87%,respectively,indicating a significant difference between the two groups( P < 0.05).After intervention treatment,the average axial compression,damage load and torsional stiffness in PFNA group were higher than those in LPFP group( P < 0.05).Conclusions PFNA caused minimal trauma for treating intertrochanteric femoral fractures in the elderly.With its good biomechanical properties,PFNA could effectively promote fracture healing and hip function recovery,and significantly reduce the incidence of hip varus,screw loosening and cutting complications.

关 键 词：股骨粗隆间骨折 股骨近端锁定钢板 股骨近端抗旋髓内钉 生物力学 

分 类 号：R318.01[医药卫生—生物医学工程]