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[1]王斌,鐘浩博,楊劍鋒.3種內(nèi)固定治療PauwelsⅢ型股骨頸骨折的生物力學研究[J].中醫(yī)正骨,2018,30(07):6-9,13.
　WANG Bin,ZHONG Haobo,YANG Jianfeng.A biomechanical study of three kinds of internal fixation for treatment of Pauwels typeⅢfemoral neck fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2018,30(07):6-9,13.
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3種內(nèi)固定治療PauwelsⅢ型股骨頸骨折的生物力學研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第30卷
期數(shù):
2018年07期
頁碼:
6-9,13
欄目:
基礎(chǔ)研究
出版日期:
2018-07-20

文章信息/Info

Title:
A biomechanical study of three kinds of internal fixation for treatment of Pauwels typeⅢfemoral neck fractures
作者:
王斌; 鐘浩博; 楊劍鋒
(廣東省惠州市第一人民醫(yī)院,廣東 惠州 516003)
Author(s):
WANG Bin; ZHONG Haobo; YANG Jianfeng
The First People's Hospital of Huizhou,Huizhou 516003,Guangdong,China
關(guān)鍵詞:
股骨頸骨折;  骨折固定術(shù); 內(nèi);  生物力學
Keywords:
femoral neck fractures;  fracture fixation; internal;  biomechanics
摘要:
目的:比較空心釘、動力髖螺釘及股骨近端鎖定鋼板固定PauwelsⅢ型股骨頸骨折的生物力學特征。方法:通過CT掃描獲取Sawbone人工股骨的數(shù)據(jù),利用Mimics15.0軟件、3Matic7.0軟件及3D打印機制作PauwelsⅢ型股骨頸骨折(Pauwels角=70°)截骨模具及3種內(nèi)固定(空心釘、動力髖螺釘及股骨近端鎖定鋼板)的固定導向模具。利用制作的股骨頸骨折截骨模具將18根Sawbone股骨均制成PauwelsⅢ型股骨頸骨折模型,并將其分為3組,每組6根。空心釘組、動力髖螺釘組和鎖定鋼板組均借助制作的內(nèi)固定導向模具,分別以3枚直徑7.3 mm空心釘、動力髖螺釘、股骨近端鎖定鋼板進行固定。將股骨頸骨折內(nèi)固定模型固定于夾具上,應用生物力學材料測試機進行靜態(tài)加壓測試和循環(huán)載荷測試。結(jié)果:①靜態(tài)加壓測試結(jié)果。測試過程中,空心釘組先發(fā)生成角位移再出現(xiàn)垂直位移; 動力髖螺釘組及鎖定鋼板組先出現(xiàn)一定程度的垂直位移,達到一定程度后才出現(xiàn)成角位移,其中動力髖螺釘組同時發(fā)生了股骨頭旋轉(zhuǎn)。3組的固定剛度比較,差異有統(tǒng)計學意義[(319.00±44.00)N·mm-1,(540.00±102.00)N·mm-1,(441.00±116.00)N·mm-1,F=7.165,P=0.026]。動力髖螺釘組和鎖定鋼板組的固定剛度均大于空心釘組(P=0.010,P=0.050); 動力髖螺釘組和鎖定鋼板組的固定剛度比較,差異無統(tǒng)計學意義(P=0.249)。3組的失效載荷比較,差異有統(tǒng)計學意義[(2.11±0.56)kN,(5.77±0.56)kN,(4.69±0.91)kN,F=21.597,P=0.002]。動力髖螺釘組和鎖定鋼板組的失效載荷均大于空心釘組(P=0.001,P=0.004); 動力髖螺釘組和鎖定鋼板組的失效載荷比較,差異無統(tǒng)計學意義(P=0.108)。②循環(huán)載荷測試結(jié)果。測試過程中,空心釘組1根股骨出現(xiàn)退釘現(xiàn)象。3組的股骨頭軸向位移比較,差異有統(tǒng)計學意義[(4.34±0.50)mm,(2.63±0.41)mm,(2.61±0.43)mm,F=14.734,P=0.005]。動力髖螺釘組和鎖定鋼板組的股骨頭軸向位移均小于空心釘組(P=0.003,P=0.003); 動力髖螺釘組和鎖定鋼板組的股骨頭軸向位移比較,差異無統(tǒng)計學意義(P=0.958)。結(jié)論:動力髖螺釘固定和股骨近端鎖定鋼板固定治療PauwelsⅢ型股骨頸骨折,在固定剛度和后期穩(wěn)定性方面較空心釘固定具有一定優(yōu)勢,但二者之間無明顯差別。
Abstract:
Objective:To compare the biomechanical characteristics of internal fixation between hollow nail,dynamic hip screw and proximal femoral locking plate in treatment of Pauwels typeⅢfemoral neck fractures.Methods:The data of Sawbone artificial femurs was obtained by CT scanning,and the osteotomy mould of Pauwels typeⅢfemoral neck fracture(Pauwels angle of 70 degrees)and the moulds for guiding three kinds of internal fixation(hollow nail,dynamic hip screw and proximal femoral locking plate)were made by using Mimics15.0 software,3Matic7.0 software and 3D printer.Eighteen Sawbone femurs were made into Pauwels typeⅢfemoral neck fracture models by using the ready-made femoral neck fracture osteotomy mould,and the ready-made models were divided into hollow nail group,dynamic hip screw group and locking plate group,6 models in each group.The femoral neck fracture models in the 3 groups were fixed with three 7.3-mm diameter hollow nails,dynamic hip screws and proximal femoral locking plates respectively with the assistance from internal fixation guide moulds.The static pressure test and cyclic loading test were carried out by using biomechanical material tester after the internal fixation models of femoral neck fracture were fixed with the clampers.Results:During the process of testing,angular displacements and subsequent vertical displacements were found in hollow nail group,while vertical displacements were found firstly and angular displacements were not found till the vertical displacements reached a certain degree in dynamic hip screw group and locking plate group,moreover,femoral head rotation was found simultaneously in dynamic hip screw group.There was statistical difference in fixation rigidity between the 3 groups(319.00+/-44.00,540.00+/-102.00,441.00+/-116.00 N/mm,F=7.165,P=0.026).The fixation rigidity was greater in dynamic hip screw group and locking plate group compared to hollow nail group(P=0.010,P=0.050),and there was no statistical difference in fixation rigidity between dynamic hip screw group and locking plate group(P=0.249).There was statistical difference in failure loads between the 3 groups(2.11+/-0.56,5.77+/-0.56,4.69+/-0.91 kN,F=21.597,P=0.002).The failure loads were greater in dynamic hip screw group and locking plate group compared to hollow nail group(P=0.001,P=0.004),and there was no statistical difference in failure loads between dynamic hip screw group and locking plate group(P=0.108).One nail dropped out in hollow nail group during the process of testing.There was statistical difference in axial displacements of femoral head between the 3 groups(4.34+/-0.50,2.63+/-0.41,2.61+/-0.43 mm,F=14.734,P=0.005).The axial displacements of femoral head were smaller in dynamic hip screw group and locking plate group compared to hollow nail group(P=0.003,P=0.003),and there was no statistical difference in axial displacements of femoral head between dynamic hip screw group and locking plate group(P=0.958).Conclusion:Dynamic hip screw internal fixation and proximal femoral locking plate internal fixation show superiorities to hollow nail internal fixation in fixation rigidity and later-stage stability in treatment of Pauwels typeⅢfemoral neck fractures,while there is no significant difference between the two methods.

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備注/Memo

備注/Memo:
基金項目:廣東省惠州市科技計劃項目(2016Y064) 通訊作者:王斌 E-mail:[email protected]
更新日期/Last Update: 2018-11-30