加长生物股骨柄联合股骨近端外侧壁重建用于人工关节置换的生物力学研究  

Biomechanical Study of Extended Biotype Stem Combined with Reconstruction of the Lateral Wall of the Proximal Femur for Artificial Joint Replacement

作　　者：缪建云[1] 黄连水[1] 何明长[1] 诸灵祺 周亮[1] 翟文亮[1] MIAO Jianyun;HUANG Lianshui;HE Mingchang;ZHU Lingqi;ZHOU Liang;ZHAI Wenliang(The 909th Hospital(Southeast Hospital Affiliated to Xiamen University),Zhangzhou 363000,Fujian China)

机构地区：[1]第九〇九医院(厦门大学附属东南医院),福建漳州363000

出　　处：《中国中医骨伤科杂志》2025年第2期50-54,共5页Chinese Journal of Traditional Medical Traumatology & Orthopedics

基　　金：国家骨科与运动康复临床医学研究中心课题(15ZD027);厦门大学附属东南医院重点计划项目(22ZD003)。

摘　　要：目的:探讨股骨近端外侧壁骨折使用加长生物股骨柄进行人工关节置换的生物力学特征,为临床应用提供生物力学依据。方法:取标准的人工股骨模型24根,随机分为4组,每组6根。模拟临床手术操作切除股骨颈,以股骨颈冠状面宽度为1倍外侧壁作为基准设定。对照组使用同一型号加长生物股骨柄置入股骨近端并稳定。观察组用摆锯纵向切断大转子下1倍的外侧壁,使用同一型号加长生物股骨柄置入固定并稳定(A组);用摆锯纵向切断大转子下2倍的外侧壁,使用同一型号加长生物股骨柄置入固定并稳定(B组);用直径0.6 mm钢丝2道重建捆扎2倍外侧壁骨折,并使用同一型号加长生物股骨柄置入固定并稳定(C组)。对4组模型进行轴向压缩刚度和扭转力学刚度生物力学测试并进行数据分析,比较各组的轴向稳定性和扭转稳定性。结果:在轴向压缩刚度方面,各组在1750 N的压力下可以保持小于2 mm的位移,有良好的轴向稳定性,差异有统计学意义(P<0.05);而在扭转刚度方面,A组扭转刚度最佳,C组次之,B组最差,差异有统计学意义(P<0.05)。结论:股骨近端外侧壁骨折行人工关节置换选用加长生物股骨柄,有优越的轴向稳定性,但在外侧壁缺损较大情况下,要尽可能重建外侧壁恢复其完整性,以获得满意的抗扭转稳定性;而对于无法重建外侧壁的人工关节置换或翻修,因缺少股骨假体柄初始抗扭转稳定性,需避免过早下地接受扭转应力活动。Objective:To investigate the biomechanical characteristics of artificial joint replacement with long biological femoral stem for proximal femoral lateral wall fractures,and to provide biomechanical basis for clinical application.Methods:24 standard artificial femoral models were randomly divided into 4 groups,6 in each group.The coronal width of the femoral neck was 1 times the lateral wall as a benchmark.In the control group,the same model of extended biological femoral stem was used to insert into the proximal femur and stabilize.In the observation group,the lateral wall of the greater trochanter was longitudinally cut off by a pendulum saw and fixed and stabilized by the same model of extended biological femoral stem(group A).The lateral wall 2 times below the greater trochanter was longitudinally cut with a pendulum saw and fixed with the same model of extended biological femoral stem(group B).In group C,2 times lateral wall fractures were reconstructed and bound with 2 pieces of 0.6 mm diameter steel wire and fixed with the same type of long biological femoral stem.The axial compression stiffness and torsional mechanical stiffness of the 4 groups of models were tested and the data were analyzed to compare the axial and torsional stability of each group.Results:In terms of axial compression stiffness,each group can maintain a displacement of less than 2 mm under the pressure of 1750 N,with good axial stability,and the difference was statistically significant.In terms of torsional stiffness,group A had the best torsional stiffness,followed by group C,and group B had the worst,showing significant differences(P<0.05).Conclusion:In the treatment of proximal femoral lateral wall fractures,the extended biological femoral stem has superior axial stability.However,when the lateral wall defect is large,it is necessary to reconstruct the integrity of the lateral wall as much as possible to obtain satisfactory anti-torsion stability.However,for prosthetic joint replacement or revision without reconstruction of the later

关 键 词：股骨近端外侧壁 骨折 生物长柄 人工关节翻修 生物力学 

分 类 号：R687.4[医药卫生—骨科学]