新型髓内钉治疗股骨不稳定骨折生物力学探究.doc

新型髓内钉治疗股骨不稳定骨折生物力学探究 　 作者：闫宏伟，龙泳，王坤正，刘凯，黄向辉，刘军，张开放，宋金辉 【关键词】 骨钉；骨折固定术,髓内;股骨；骨折；生物力学 【Abstract】 AIM: To discuss the possibility and virtues of a new intramedullary nail for treating unsteady femoral fractures. METHODS: The properties of antiaxial compression, antilateral bending and antitorsion of the new interlocking intramedullary nail were tested and compared with those of imported Orthofix interlocking intramedullary nail and AO dynamic compression plate in treating unsteady femoral fracture. RESULTS: In the cases of unsteady fractures, the imported Orthofix nail presented the best antiaxial compression performance and the new nail the second, and the AO compression plate was the worst; the difference was very significant (Plt;0.01). The AO compression plate showed the best in both antilateral bending and antitorsion, and the new nail performed the second; the differences were also obvious (Plt;0.01). CONCLUSION: In unsteady fracture, the new developed nails have superior biomechanical characters with a reliable fixation; dynamic compression plate is not the best choice for internal fixation, especially in unsteady fracture; the shape of the narrow part of medullary cavity has a great influence on antilateral bending steady. 【Keywords】 bone nail; fracture fixation intramedullary; femur; fracture; biomechanics 【摘要】 目的： 将新型髓内钉用于股骨不稳定骨折模型治疗，探讨新型髓内钉用于不稳定骨折治疗的可行性及力学性能优劣. 方法： 将新型股骨髓内钉与Orthofix进口交锁髓内钉及AO加压钢板等不同方式内固定在股骨不稳定骨折条件下的抗轴向压缩、抗侧弯、抗旋转力学性能进行测试与比较. 结果： 不稳定骨折情况下，钢板对照组的抗轴向压缩能力最差，新型髓内钉的抗短缩能力居于髓内钉对照组和钢板对照组之间，组间差异有统计学意义（Plt;0.01）. 髓内钉实验组的抗侧弯稳定性明显优于髓内钉对照组，三组中钢板对照组抗侧弯性能最优，组间差异有统计学意义（Plt;0.01）. 髓内钉实验组的抗扭转性能次于钢板对照组而优于髓内钉对照组. 结论： 新型髓内钉对股骨不稳定骨折固定的综合力学性能具有明显优越性，固定稳定性好，能够满足临床治疗需要；加压钢板内固定并不是骨折内固定的最佳选择，尤其是在不稳定骨折；骨髓腔狭窄部形态亦是影响侧弯稳定性的重要因素. 【关键词】 骨钉；骨折固定术，髓内;股骨；骨折；生物力学 0引言 髓内钉治疗骨折的优点在于早期稳定的骨折固定，控制了骨折断端旋转，保护了骨折端软组织及血运，骨折愈合时间较短. 但对于不稳定骨折的的治疗尚存在争议［1-2］，尤其在选择静力固定还是动力固定问题上. 我们通过对不同固定方式治疗不稳定骨折的生物力学性能的对比研究，评价新型髓内钉在不稳定骨折治疗中的作用和力学性能优劣. 1材料和方法 1.1材料实验组为新型股骨髓内钉20套，股骨钉直径9 mm，长度310 mm，原材料及加