摘要
目的:通过生物力学测试和临床初步应用明确微创动力髋螺钉(MTDHS)治疗股骨转子间骨折的效果。方法:采用成人新鲜尸体10根股骨标本,制成股骨转子间骨折模型,随机分为MTDHS组和动力髋螺钉(DHS)组进行骨折固定。标本在WE-5型万能试验机上加载不同级别载荷,以检测载荷-应变变化、载荷-位移变化、股骨的强度和刚度,试验数据经统计学处理,进行组间对比。临床应用MTDHS治疗股骨转子间骨折15例,按Harris标准评分,确定疗效。结果:MTDHS组股骨张力侧应变变化比DHS组小14%,压力侧应变小11%;下沉位移比DHS组小19%,水平位移小22%;外侧应力强度比DHS组高12%,内侧应力强度高11%;轴向刚度和弯曲刚度比DHS组分别高19%和37%;MTDHS组最大破坏扭矩比DHS组高15%,而扭角变形小18%,最大平均扭转刚度比DHS组高15%;在1800N的作用下,MTDHS组骨折断面张开角为2.28°,而DHS组达到3.60°,相差37%。以上数据经统计学处理,差异都具有统计学意义(P<0.01)。15例股骨转子间骨折经MTDHS固定,平均得分91分,优良率为92.7%,未发生内固定失效、术后感染等并发症。结论:MTDHS结构合理,能实现小切口微创植入固定,有效对抗骨折端旋转、剪切和内翻应力,是治疗股骨转子间骨折理想的内固定器械。
Objective：To recognize the effect of minimal-invasive dynamic hip screw（MIDHS）on the treatment of intertro- chanteric fracture of the hip by biomechanical test and preliminary clinical application. Methods：Ten artifical made intertrochanteric fractures of femoral specimen from five cadavers were divided into two groups randomly. The fractures in first group were fixed by MIDHS and other group were fixed by dynamic hip（DHS）. Biomechanical characteristics of two different devices were compared with the biomechanical character of load-straining, load-displacing, rigidity and strength of femur by statistic analysis. According to the Harris evaluation, healing effect of intertrochanteric fractures was evaluated clinically on the 15 cases. Results：Straining changes of MIDHS were 14% and 11% less than that of DHS on the tensile side and the pressure side respectively ;Sinking and horizontal displacement,were 19% and 22% less than that of DHS respectivly. But external and internal stress intensity ,axial and bending rigidity were all higher than that of DHS,they were 12%, 11%, 19% and 37%. Maximal destroyed twisting moment （15%）and average twisting rigidity （15%）were both higher than that of DHS, but twisting angle was 18% less. Under the force ,of 1 800 N ,the open angle of the fracture on transverse section was 2.28° ,while the DHS＇s was 3.60°. The data above were significant differences statistically （P 〈0.01 ）. The average Harris score of the 15 cases with intertrochanteric fractures treated by MIDHS was 91 ,excellent and good rate was 92.7% ,without complications of internal fixation failure ,postoperative infection and so on. Conclusion：The design of minimal-invasive dynamic hip screw is reasonable and effective against rotating, shearing and varus stress force of the fracture, and it provides possibility of implanting the internal fixation with minimal incision. So it is an ideal internal fixation device for the treatment of intertrochanteric fractures.
出处
《中国骨伤》
CAS
2008年第5期334-336,共3页
China Journal of Orthopaedics and Traumatology
关键词
微创动力髋螺钉
骨折固定术
内
生物力学
Micro-trauma dynamic hip screw
Fracture fixation,internal
Biomechanics
