两段式拉力螺钉的滑丝率和加压力研究  

The thread stripping rate and pressurization force of a two-segmental lag screw:a biomechanical study

作　　者：刘超 仇成华[2] 徐达强 LIU Chao;QIU Chenghua;XU Daqiang(Luoyang Orthopedic-Traumatological Hospital,Luoyang 471002,Henan,China;Yancheng Third People’s Hospital,Yancheng 224008,Jiangsu,China)

机构地区：[1]河南省洛阳正骨医院/河南省骨科医院,河南洛阳471002 [2]盐城市第三人民医院,江苏盐城224008

出　　处：《中医正骨》2025年第2期28-33,共6页The Journal of Traditional Chinese Orthopedics and Traumatology

基　　金：国家骨科与运动康复临床医学研究中心创新基金资助项目(2021-NCRC-CXJJ-ZH-19)。

摘　　要：目的:观察两段式拉力螺钉的滑丝率和加压力。方法:招募10位骨科医生和1位独立研究员,在密度为0.08 g·cm^(-3)、0.16 g·cm^(-3)、0.32 g·cm^(-3)的合成松质骨块上进行实验。在相同密度的合成松质骨块上,每位医生分别使用两段式拉力螺钉和AO拉力螺钉各拧紧10次。10位医生在3种密度的合成松质骨块上共操作600次。在医生操作完成后,研究员继续拧紧螺钉,直至加压力明显下降,以确保每次测试所得的加压力曲线均包含上升期、峰值和下降期3个阶段。测量并比较医生与研究员拧紧螺钉时的加压力,判断螺钉是否滑丝。同时,记录医生停止拧紧螺钉时的加压力,以比较两段式拉力螺钉与AO拉力螺钉的加压力。结果:两段式拉力螺钉的滑丝率低于AO拉力螺钉(5.33%,75.67%,χ^(2)=307.923,P=0.000)。不同医生之间,两段式拉力螺钉和AO拉力螺钉的滑丝率均存在差异(χ^(2)=109.366,P=0.000;χ^(2)=17.430,P=0.042)。在密度为0.08 g·cm^(-3)、0.16 g·cm^(-3)、0.32 g·cm^(-3)的合成松质骨块上,两段式拉力螺钉的滑丝率均低于AO拉力螺钉(χ^(2)=126.750,P=0.000;χ^(2)=101.282,P=0.000;χ^(2)=82.353,P=0.000)。不同密度合成松质骨块之间,两段式拉力螺钉的滑丝率存在差异(χ^(2)=6.470,P=0.039),AO拉力螺钉滑丝率的差异无统计学意义(χ^(2)=1.340,P=0.512)。两段式拉力螺钉的整体加压力高于AO拉力螺钉(t=-5.800,P=0.000)。两段式拉力螺钉和AO拉力螺钉的加压力均随合成松质骨块密度的增加而增加(F=2812.63,P=0.000;F=755.193,P=0.000)。结论:相同规格的两段式拉力螺钉的加压力高于AO拉力螺钉,且滑丝率低于AO拉力螺钉。Objective:To observe the thread stripping rate and pressurization force of a two-segmental lag screw(TSLS).Methods:Ten orthopedic surgeons and an independent investigator were recruited to conduct the experiments on synthetic cancellous bone blocks with densities of 0.08,0.16,and 0.32 g/cm^(3),respectively.On the synthetic cancellous bone block with the same density,the TSLS and AO lag screw(AOLS)were tightened 10 times,respectively,by each surgeon.In total,the 10 surgeons operated on the synthetic cancellous bone blocks with three different densities for 600 times.After each surgeon finished the operation,the independent investigator advanced the screw until a remarkable decrease of pressurization force was observed,thereby ensuring the pressurization force curve obtained from each test included the ascending phase,the peak value phase,and the descending phase.The pressurization force applied by each surgeon and the investigator when tightened the screw were measured and compared to determine whether the thread was stripped.Meanwhile,the pressurization forces when the surgeons stopped tightening the screw were recorded to analyze the difference of the pressurization force between TSLS and AOLS.Results:The thread stripping rate of TSLS was lower than that of AOLS(5.33%,75.67%,χ^(2)=307.923,P=0.000).There was difference in the thread stripping rate of TSLS and AOLS among different surgeons(χ^(2)=109.366,P=0.000;χ^(2)=17.430,P=0.042).The thread stripping rate of TSLS was lower than that of AOLS on the synthetic cancellous bone blocks with densities of 0.08,0.16,and 0.32 g/cm(3),respectively(χ^(2)=126.750,P=0.000;χ^(2)=101.282,P=0.000;χ^(2)=82.353,P=0.000).Further comparison revealed that there was difference in the thread stripping rate of TSLS,while,no statistical difference in the thread stripping rate of AOLS among the synthetic cancellous bone blocks with different densities(χ^(2)=6.470,P=0.039;χ^(2)=1.340,P=0.512).The overall pressurization force of TSLS was higher than that of AOLS(t=-5.800,P=0.000).T

关 键 词：骨螺丝 骨质疏松性骨折 松质骨 滑丝 加压力 

分 类 号：R687.3[医药卫生—骨科学]