髋关节置换术后假体周围骨折三种内固定方式的生物 力学研究-外科学专业论文.docxVIP

万方数据 万方数据 目 录 中文摘要·······································································1 英文摘要········································································3 英文缩写········································································6 研究论文 髋关节置换术后假体周围骨折三种内固定方式的生物力学 研究 前言········································································7 材料与方法·································································13 结果········································································16 附图································································18 附表·········································································27 讨论·········································································29 结论·········································································31 参考文献·································································32 综述 髋关节置换术后假体周围骨折治疗进展·······························37 致谢···············································································46 个人简历·········································································48 中 中 文 摘 要 PAGE 1万方数据 PAGE 1 万方数据 髋关节置换术后假体周围骨折三种内 固定方式的生物力学研究 摘 要 目的：通过分析有假体的股骨和股骨假体置换术后股骨假体周围骨折 行不同内固定物固定后的生物力学分析当前固定模式存在的缺陷，探讨 如何提高老年骨质疏松患者假体周围骨折的固定强度，使患者尽早的下 地活动，恢复其骨折前的生活状态，减少术后并发症，有效降低死亡率。 方法：选取9对新鲜完整股骨尸体标本（河北医科大学解剖教研室提 供），并将选取标本分为3组（每组6根）。所有被选取标本均常规行放射 学检查，以排除风湿、结核、肿瘤等溶骨性疾病和骨折的存在。将所有 被选标本近端行股骨假体置换，所有股骨置换假体型号保持一致。所有 标本均制作成Vancouver B1型股骨近端假体骨折模型。对于所有已制股 骨假体周围骨折标本模型，均选取8孔锁定接骨板置于股骨干外侧并对称 放置于骨折的两侧，骨折端两侧各4孔。对每个已制成的Vancouver B1型 股骨近端假体骨折标本模型，骨折依次严格按如下方法进行固定，并标 记为结构A(钢丝-钢板系统)、结构B（螺钉-钢板系统）和结构C（钢丝-螺 钉-钢板系统）。Vancouver B1型股骨近端假体周围骨折标本模型制成后分 别行轴向压载实验、扭转实验、内外四点弯曲实验、前后四点弯曲实验 及轴向压载单次破坏实验。 结果：本研究纳入新鲜尸体9例，男性尸体6例，女性尸体3例；平均 年龄为70±5岁。轴向压载实验：结构A，即钢丝-钢板系统抗短缩刚度为 1796.8±90.6N/mm ； 结构 B ，即 螺钉 - 钢板 系 统 抗 短 缩 刚 度 为 2239.1±213.0N/mm ； 结构 C ，即 钢丝 - 螺钉 - 钢板 系 统 抗 短 缩 刚 度 为 2926.0±56.6N/mm。结构C，即钢丝-螺钉-钢板系统抗短缩刚度明显高于结 构A，即钢丝-钢板系统及结构B，即螺钉-钢板系统。三种固定结构之间的 抗短缩刚度存在显著性差异（P＜0.01）。扭转实验:结构A，即钢丝-钢板 系统抗扭转刚度为0.169±0.018N