内侧支撑髓内钉和股骨近端抗旋髓内钉治疗股骨转子间骨折A3.3型的生物力学研究  

Biomechanical study on the treatment of intertrochanteric fracture of A3.3 type with medial sustainable nail and proximal femoral anti-rotation nail

作　　者：聂少波 李建涛 赵燕鹏 赵喆 朱保璋 闫云超 张里程 唐佩福 NIE Shao-bo;LI Jian-tao;ZHAO Yan-peng;ZHAO Zhe;ZHU Bao-zhang;YAN Yun-chao;ZHANG Li-cheng;TANG Pei-fu(不详;Department of Orthopaedics,the First Medical Center,Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]中国人民解放军总医院第一医学中心骨科,北京100853 [2]国家骨科与运动康复临床医学研究中心,北京100853 [3]清华长庚医院,北京102218 [4]北京纳通医学科技研究院有限公司,北京100094 [5]中国人民解放军总医院第一医学中心放射科,北京100853

出　　处：《中国骨伤》2020年第12期1161-1165,共5页China Journal of Orthopaedics and Traumatology

基　　金：首都卫生发展科研专项项目(编号:2016-1-5012)。

摘　　要：目的:A3型股骨转子间骨折是极其不稳定的骨折,临床上常常采用髓内治疗,但是髓内固定失败率高,股骨后内侧结构不能重建是主要原因。介绍一种可以早期重建股骨内侧支撑的新型内侧支撑髓内钉,通过生物力学试验验证力学效果。方法:利用人工股骨模型(Sawbones)制作内侧失支撑的A3.3型转子间骨折模型,分别用新型内侧支撑髓内钉(medial sustainable nail-Ⅱ,MSN-Ⅱ)和股骨近端抗旋髓内钉(proximal femoral nail anti-rotation,PFNA-Ⅱ)固定后,行轴向加载和轴向破坏试验,测定两种内固定物的轴向刚度、屈服载荷、头颈骨块的位移和断端扭转角度,比较两种内固定的生物力学差异,明确重建内侧支撑的髓内钉早期重建股骨内侧支撑的效果。结果:MSN-Ⅱ的轴向刚度、屈服载荷、当轴向载荷为1800 N时头颈骨块的位移、破坏试验后的骨折断端扭转角度分别为(222.76±62.46)N/mm,(4241.71±847.42)N,(11.51±0.62)mm,(1.71±0.10)°;PFNA-Ⅱ分别为(184.58±40.59)N/mm,(3058.76±379.63)N,(16.15±1.36)mm,(2.52±0.26)°,两组差异均有统计学意义。结论:MSN-Ⅱ轴向刚度优于PFNA-Ⅱ,在固定A3.3型骨折时能耐受更大的载荷,具有更大的轴向和旋转稳定性,是重建A3型股骨转子间骨折内侧支撑有效的手段。Objective:A3 intertrochanteric fracture is an extremely unstable fracture,which is often treated with intramedullary nail,but the implant failure is common due to the posterior medial fragment cannot be reconstructed.A new medial sustainable nail(MSN-Ⅱ)which can reconstruct the femoral medial support by sustainable screw was introduced in this study.The mechanical effect was verified by biomechanical experiment.Methods:The loss medial support model of intertrochanteric fracture(A3)was made by artificial Sawbones model,fixed with MSN-Ⅱand PFNA-Ⅱ,underwent axial loading and axial failure tests.The axial stiffness,yield load,displacement of head-neck fragment and torsional angle of fracture site of these nails were recorded and compared for biomechanical differences.The effect of early reconstruction of medial support with MSN-Ⅱwas determined.Results:The axial stiffness,yield load,the displacement of head and neck fragment when the axial load was 1800 N and torsional angle of the fracture site after the axial failure test of MSN-Ⅱwere(222.76±62.46)N/mm,(4241.71±847.42)N,(11.51±0.62)mm,(1.71±0.10)°respectively,while the PFNA-Ⅱwas(184.58±40.59)N/mm,(3058.76±379.63)N,(16.15±1.36)mm,(2.52±0.26)°respectively.The difference between the two groups was statistically significant.Conclusion:The axial stiffness of MSN-Ⅱis better than that of PFNA-Ⅱ.The MSN-Ⅱcan bear more loads when fixed A3.3 intertrochanteric fracture and has greater axial and rotational stability.It is an effective means to reconstruct the medial support of A3 intertrochanteric fracture.

关 键 词：股骨转子间骨折 内侧支撑 髓内钉 生物力学 

分 类 号：R683.4[医药卫生—骨科学]