不同内固定方式治疗股骨颈骨折的生物力学比较-骨外科专业论文.docxVIP

PAGE PAGE 4 不同内固定方式治疗股骨颈骨折的生物力学比较 摘 要 目的：闭合复位内固定术是治疗股骨颈骨折的主要方式之一。目前 临床使用比较多的内固定方式有空心拉力螺钉（Cannulated Screws， CS） 和髋动力螺钉（Dynamic Hip Screw，DHS）。 本次研究通过生物力学实 验，比较不同空间构象的空心拉力螺钉（正三角置钉、倒三角置钉）以 及DHS＋CS在固定股骨颈骨折中的生物力学特点，为临床上治疗股骨颈 骨折选择内固定提供理论依据。方法：取18只成人尸体骨股骨上段标本， 制成内收型股骨颈骨折（ Pauwels角为70度）。随机分成3组， A组用3 根空心拉力螺钉正三角形构型固定，B组用3根空心拉力螺钉倒三角形构 型固定，C组用DHS＋CS固定。分别先后进行轴向载荷试验及水平扭转 试验。结果：在轴向载荷实验中，各组载荷—位移曲线呈线性变化。A 组的r 值平均值为1.888±0.232 mm/kN，B组为2.095±0.157 mm/kN，C组 为0.908±0.116 mm/kN。在抗轴向载荷能力上DHS＋CS优于两种空间构 型（正三角置钉与倒三角置钉）的CS，其差异具有统计学意义(P0.01)。 CS正三角形置钉与CS倒三角形置钉在抗轴向载荷能力上的差异没有统 计学意义(P0.05)。在抗扭转实验中，A组的平均最大扭距为38.87±3.81 N﹒m，B组为37.21±4.65 N﹒m，C组为38.23±4.05 N﹒m。三组之间在 抗扭转能力上的差异没有统计学意义(P0.05)。 结论：DHS＋CS固定股 骨颈骨折在抗轴向载荷能力上优于两种空间构型的CS，而在抗扭转能力 上三者没有明显区别。 关键词： 股骨颈骨折，生物力学，内固定 The Biomechanical Comparison of Different Internal Fixation in the Treatment of Femoral Neck Fracture ABSTRACT Objective: Close reduction and internal fixation is one of the mainstreams in treating femoral neck fracture. The internal fixation instruments that we used most are the Cannulated Screws (CS) and the Dynamic Hip Screw (DHS). In this biomechanical experiment, we want to provide theoretic basis rational choice of internal fixation in clinical by comparing two kinds of CS(triangle and inverted triangle) and DHS with a CS in fixing femoral neck fracture. Methods: Eighteen cases of femoral neck fracture which were produced from adult femoral samples were divided into three groups at random. Three diferent kinds of internal fixation, DHS with a CS, CS with triangle pattern and inverted triangle pattern, were performed to the three groups of samples separately. After that, we took axial loading test and rotation test on the three groups in order. Results: In the axial loading test, the compress-displacement curve of the three groups shows they are linear correlation. The average value of the correlation coefficient r in the group A is 1.888±0.232 mm/kN, in the group B is 2.095±0.157 mm/kN, and in the group C is 0.908±