改良空心钉系统治疗Pauwels Ⅲ型儿童股骨颈骨折的生物力学分析  

Biomechanical analysis of modified cannulated screw system for treatment of Pauwels type Ⅲ femoral neck fracture in children

作　　者：高连云 陈少坚 陈雁华 吴涛华 阮康明 刘清平 GAO Lianyun;CHEN Shaojian;CHEN Yanhua;WU Taohua;RUAN Kangming;LIU Qingping(Orthopedics Division 5(Department of Trauma,Pediatric Orthopedics),Mindong Hospital Affiliated to Fujian Medical University,Fujian,Fu'an 355000,China)

机构地区：[1]福建医科大学附属闽东医院骨科五区(创伤、小儿骨科),福建福安355000

出　　处：《中国现代医生》2021年第22期77-81,共5页China Modern Doctor

基　　金：福建省宁德市2018年医技提升科研项目(宁卫医〔2018〕137号)。

摘　　要：目的探讨改良配套可锁定实心栓的空心钉系统治疗PauwelsⅢ型儿童股骨颈骨折的生物力学性能。方法采用人工合成的生物骨标本40个,进行编号后随机分成A组、B组、C组、D组(n=10),制成PauwelsⅢ型儿童股骨颈骨折模型(Pauwels 70°),解剖复位骨折标本。A组采用2枚传统空心钉固定、B组采用2枚改良配套可锁定实心栓的空心钉系统固定、C组采用3枚传统空心钉固定、D组采用3枚改良配套可锁定实心栓的空心钉系统固定,固定后进行生物力学测试,比较四组的轴向压缩刚度、循环载荷位移变化、极限压缩载荷、极限测试刚度。结果四组骨折内固定模型之间轴向压缩刚度、循环载荷位移变化、极限压缩载荷、极限测试刚度比较,差异有统计学意义(P<0.05)。其中轴向压缩刚度:A组(706.30±20.86)N/mm<B组(821.00±24.01)N/mm<C组(1197.90±79.38)N/mm<D组(1381.80±99.88)N/mm;循环载荷位移:A组(0.93±0.09)mm>B组(0.74±0.05)mm>C组(0.45±0.04)mm>D组(0.35±0.03)mm;极限压缩载荷:A组(1517.80±39.30)N<B组(1840.90±47.64)N<C组(3252.10±71.02)N<D组(3859.90±83.20)N;极限测试刚度:A组(912.50±30.35)N/mm<B组(1010.80±45.56)N/mm<C组(1421.20±72.94)N/mm<D组(1525.50±127.61)N/mm。结论改良配套可锁定实心栓的空心钉系统治疗PauwelsⅢ型儿童股骨颈骨折比传统空心钉具有更好的静态稳定和动态稳定,生物力学性能更好,值得临床推广使用。Objective To investigate the biomechanical properties of modified cannulated screw system with locking solid bolt in the treatment of Pauwels III type femoral neck fracture in children.Methods Forty artificial bone specimens were numbered and randomly divided into group A,group B,group C and group D(n=10).Pauwels Ⅲ model of femoral neck fracture in children(Pauwels 70°)was made for anatomic reduction of fracture specimens.Group A was fixed with 2 traditional cannulated screws;group B was fixed with 2 cannulated screws with improved matching and locking solid bolts;group C was fixed with 3 traditional cannulated screws;group D was fixed with 3 cannulated screws with improved matching and locking solid bolts.After the fixation,biomechanical tests were conducted.The axial compression stiffness,cyclic load displacement,ultimate compression load and ultimate test stiffness of the four groups were compared.Results Statistically significant differences were observed in axial compression stiffness,cyclic load displacement,ultimate compression load and ultimate test stiffness among the four groups of fracture internal fixation models(P<0.05).Axial compression stiffness:group A(706.30±20.86)N/mm<group B(821.00±24.01)N/mm<group C(1197.90±79.38)N/mm<group D(1381.80±99.88)N/mm;cyclic load displacement:group A(0.93±0.09)mm>group B(0.74±0.05)mm>group C(0.45±0.04)mm>group D(0.35±0.03)mm;ultimate compression load:group A(1517.80±39.30)N<group B(1840.90±47.64)N<group C(3252.10±71.02)N<group D(3859.90±83.20)N;ultimate test stiffness:group A(912.50±30.35)N/mm<group B(1010.80±45.56)N/mm<group C(1421.20±72.94)N/mm<group D(1525.50±127.61)N/mm.Conclusion The modified cannulated screw system with locking solid bolt in the treatment of Pauwels III type of femoral neck fracture in children has better static and dynamic stability and better biomechanical properties than the traditional cannulated screw system,which is worthy of clinical promotion and use.

关 键 词：儿童股骨颈骨折 空心钉 锁定实心栓 生物力学 骨折内固定 

分 类 号：R687.3[医药卫生—骨科学]