股骨近端防旋髓内钉治疗伴股骨颈缺损的转子间骨折体外力学研究  

In Vitro Biomechanical Study of Proximal Femoral Nail Anti-rotation Fixation for Femoral Intertrochanteric Fracture with Femoral Neck Base Defect

作　　者：刘乐 王松 张向 杨红胜[1] Liu Le;Wang Song;Zhang Xiang;Yang Hongsheng(Department of Orthopaedics,The First Affiliated Hospital of Chengdu Medical College,Chengdu 610500,China)

机构地区：[1]成都医学院第一附属医院骨科,成都610500

出　　处：《成都医学院学报》2025年第1期78-82,共5页Journal of Chengdu Medical College

基　　金：四川省卫生健康委员会科技项目(No:23LCYJ032);四川省中医药管理局基金项目(No:2023MS095);成都市科技项目(No:2024-YF05-00874-SN);成都市卫生健康委员会医学科研基金项目(No:2023295);成都医学院第一附属医院科研基金(No:CYFY-2020YB03)。

摘　　要：目的评估股骨近端防旋髓内钉(PFNA)内固定术治疗伴有股骨颈基底部不同部位缺损的股骨转子间骨折(IFF)的生物力学情况。方法于2024年5-7月制备伴有股骨颈基底部骨缺损的IFF模型12具,根据骨缺损的具体部位进行实验分组:股骨颈基底部无缺损(A组)、伴股骨颈基底部前内侧缺损(B组)、伴股骨颈基底部中内侧缺损(C组)、伴股骨颈基底部后内侧缺损(D组),每组3具模型。4组模型制备成功后,均按标准方式采用PFNA内固定。力学测试方案:在万能试验机上模拟正常人站立姿势,施加适当力进行轴向压缩实验。比较不同载荷下4组固定模型的轴向压缩刚度和失效载荷;记录不同载荷强度下4组模型的轴向位移情况,并绘制载荷-位移曲线图。结果A组轴向压缩刚度(48.05±0.83)N/m高于其他3组(P<0.05);B组轴向压缩刚度(35.67±1.03)N/m低于C组和D组(P<0.05)。A组失效载荷(720.67±12.51)N高于其他3组(P<0.05),B组失效载荷(535.00±12.50)N低于C组和D组(P<0.05)。当载荷在500 N时,B组轴向位移14.52 mm高于其余3组(P<0.05);当载荷达到600 N时,B组轴向位移>15 mm判定为内固定失效,而其余3组均在内固定有效范围内。结论股骨颈区骨质缺损对行PFNA内固定术治疗IFF体外生物力学强度有明显影响,且伴有股骨颈基底部前内侧缺损对力学强度影响最大。在临床处理伴有股骨颈基底部缺损尤其是前内侧骨缺损的IFF时,采用PFNA内固定需同时重视骨缺损区域的重建和固定。Objective To evaluate the biomechanics of proximal femoral nail anti-rotation(PFNA)internal fixation in the treatment of intertrochanteric fracture of femur(IFF)with defects in different parts of the femoral neck base.Methods From May to July 2024,12 IFF models with bone defects in different parts of the femoral neck base were prepared.Experimental grouping scheme:Group A had no defect at the base of femoral neck;Group B had anteromedial defect at the base of femoral neck;Group C had medial defect at the base of femoral neck;Group D had posterior medial defect at the base of femoral neck,with 3 models in each group.All models were fixed by PFNA in standard way after successful preparation.Mechanical test scheme:Apply appropriate force to simulate the standing posture of normal people on the universal test machine for axial compression,record the axial displacement and axial stiffness of the femoral head under different loads,and the failure load of the fixed model.And the load-displacement curves of the 4 groups of models were plotted.Results Comparison of the axial stiffness among the models revealed that group A exhibited the highest axial compression stiffness at(48.05±0.83)N/m,with a statistically significant difference when compared to the other three groups(P<0.05).Conversely,group B demonstrated the lowest axial compression stiffness at(35.67±1.03)N/m,which was also statistically significantly different from the remaining groups(P<0.05).In terms of model failure load,group A recorded the highest failure load of(720.67±12.51)N,showing a statistically significant difference relative to all other groups(P<0.05),while group B had the lowest failure load at(535.00±12.50)N,which was similarly statistically significant in comparison to the other three groups(P<0.05).Regarding axial displacement under varying loads:for loads below 500 N,group B(the anteromedial defect group)exhibited significantly greater axial displacement than all other groups,with this difference being statistically significant as well(P<0.

关 键 词：股骨转子间骨折 股骨颈基底部缺损 股骨近端防旋髓内钉 生物力学 

分 类 号：R683.42[医药卫生—骨科学] R67.33[医药卫生—外科学] R318.01[医药卫生—临床医学]