[1]王斌,钟浩博,杨剑锋.3种内固定治疗PauwelsⅢ型股骨颈骨折的生物力学研究[J].中医正骨,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种内固定治疗PauwelsⅢ型股骨颈骨折的生物力学研究()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第30卷
期数:
2018年07期
页码:
6-9,13
栏目:
基础研究
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; 钟浩博; 杨剑锋
(广东省惠州市第一人民医院,广东 惠州 516003)
Author(s):
WANG Bin; ZHONG Haobo; YANG Jianfeng
The First People's Hospital of Huizhou,Huizhou 516003,Guangdong,China
关键词:
股骨颈骨折;  骨折固定术; 内;  生物力学
Keywords:
femoral neck fractures;  fracture fixation; internal;  biomechanics
摘要:
目的:比较空心钉、动力髋螺钉及股骨近端锁定钢板固定PauwelsⅢ型股骨颈骨折的生物力学特征。方法:通过CT扫描获取Sawbone人工股骨的数据,利用Mimics15.0软件、3Matic7.0软件及3D打印机制作PauwelsⅢ型股骨颈骨折(Pauwels角=70°)截骨模具及3种内固定(空心钉、动力髋螺钉及股骨近端锁定钢板)的固定导向模具。利用制作的股骨颈骨折截骨模具将18根Sawbone股骨均制成PauwelsⅢ型股骨颈骨折模型,并将其分为3组,每组6根。空心钉组、动力髋螺钉组和锁定钢板组均借助制作的内固定导向模具,分别以3枚直径7.3 mm空心钉、动力髋螺钉、股骨近端锁定钢板进行固定。将股骨颈骨折内固定模型固定于夹具上,应用生物力学材料测试机进行静态加压测试和循环载荷测试。结果:①静态加压测试结果。测试过程中,空心钉组先发生成角位移再出现垂直位移; 动力髋螺钉组及锁定钢板组先出现一定程度的垂直位移,达到一定程度后才出现成角位移,其中动力髋螺钉组同时发生了股骨头旋转。3组的固定刚度比较,差异有统计学意义[(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]。动力髋螺钉组和锁定钢板组的固定刚度均大于空心钉组(P=0.010,P=0.050); 动力髋螺钉组和锁定钢板组的固定刚度比较,差异无统计学意义(P=0.249)。3组的失效载荷比较,差异有统计学意义[(2.11±0.56)kN,(5.77±0.56)kN,(4.69±0.91)kN,F=21.597,P=0.002]。动力髋螺钉组和锁定钢板组的失效载荷均大于空心钉组(P=0.001,P=0.004); 动力髋螺钉组和锁定钢板组的失效载荷比较,差异无统计学意义(P=0.108)。②循环载荷测试结果。测试过程中,空心钉组1根股骨出现退钉现象。3组的股骨头轴向位移比较,差异有统计学意义[(4.34±0.50)mm,(2.63±0.41)mm,(2.61±0.43)mm,F=14.734,P=0.005]。动力髋螺钉组和锁定钢板组的股骨头轴向位移均小于空心钉组(P=0.003,P=0.003); 动力髋螺钉组和锁定钢板组的股骨头轴向位移比较,差异无统计学意义(P=0.958)。结论:动力髋螺钉固定和股骨近端锁定钢板固定治疗PauwelsⅢ型股骨颈骨折,在固定刚度和后期稳定性方面较空心钉固定具有一定优势,但二者之间无明显差别。
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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备注/Memo

备注/Memo:
基金项目:广东省惠州市科技计划项目(2016Y064) 通讯作者:王斌 E-mail:wangbin12120123@sina.com
更新日期/Last Update: 2018-11-30