股骨头坏死范围与人工全髋表面置换术后股骨颈骨折的相关性研究.DOCVIP

临床医学论文-股骨头坏死范围与人工全髋表面置换术后股骨颈骨折的相关性研究 【摘要】? 目的：通过生物力学实验观察并探讨股骨头坏死的范围大小与人工全髋表面置换术后发生股骨颈骨折的相关性。方法：选取成年人股骨上段防腐标本15对，共30具，要求生前无髋关节疾患，骨质较好。将其随机分组，模拟股骨头内不同范围的囊性变（即坏死区域），将标本分为正常组、股骨头坏死10%、20%、30%、40%、50%，6组。在股骨头表面覆盖相匹配的金属假体，模拟单足站立时肢体负重力线的方向,加载一定的压力，直至股骨颈发生骨折为止。记录测试结果并分析股骨头不同坏死范围与股骨颈骨折发生的生物力学相关性。结果：（1）随着股骨头坏死范围的增加,股骨颈的承载能力呈不断下降的趋势, 股骨颈骨折越容易发生，差异具有显著统计学意义（P＜0.01）；（2）随着股骨头坏死范围的增加，股骨颈的强度呈不断下降趋势，即坏死范围越大，股骨颈的强度下降越厉害，以至人体不能负重，其差异具有显著统计学意义（P＜0.01）。结论：股骨头坏死范围达25%~40% 的年轻患者(≤55岁)是人工全髋表面置换术(MMSA)的最佳适应证。股骨头坏死范围超过50%的患者是MMSA术的相对禁忌证，术后股骨颈骨折发生的风险较大。 【关键词】? 股骨头坏死；股骨颈骨折；生物力学；人工全髋表面置换术　 ??? [Abstract]?? Objective:To observe and approach the relation between the range of femoral head necrosis and femoral neck fracture after the total hip resurfacing by biomechanics.? Methods :Thirty normal proximal femur of human were harvested . We divided them into six groups at random and simulated the different range? of femoral head necrosis : normal 、10%、20% 、30%、 40% 、50% . both of them were tested in vitro by simulating single-leg stance phase. Rigidity of the whole proximal femur and the strain value at the juncture of femoral head and neck under 0、500N、1000N load … were evaluated , until the femoral neck fracture. Results : （1）The bearing capacity of femoral neck assumed the tendency which unceasingly drops with the increasing of the range of femoral head necrosis. In the other word , the bigger the necrosis range is ,the easier femoral neck fracture to occur, there are remarkable statistical differences(P0.001). （2）The intensity of femoral neck assumed the tendency which unceasingly drops with the increasing of the range of femoral head necrosis, there are remarkable statistical differences (P0.01).?Conclusions : When the range of femoral head necrosis is up to 25%~40% , we should first choose the hip resurfacing , which has many advantages compared to total hip arthroplasty. If the range of femoral head necrosis is up to 50%, we should choose the hip resurfacing?cautiously, because the femoral n