股骨颈骨折三种内固定构型的稳定性比较研究
作者：余昱 董福慧
单位：中国中医研究院骨伤科研究所，北京 100700
关键词：骨折；股骨颈；骨折固定术，内；生物力学
中国骨伤000605 摘 要：目的通过力学疲劳实验对30个成人股骨标本进行股骨颈骨折三种内固定构型稳定性比较研究，为临床选择固定构型及能否术后立即承重提供依据。方法采用力学疲劳试验来模拟人体行走中的循环加载方式，对股骨颈骨折三针内固定构型进行稳定性的比较研究。结果股骨颈头下型骨折三针内固定组刚度明显大于头颈型骨折组(P<0.05)；股骨颈头颈型骨折三种三针内固定构型有显著性差异(P<0<0.05)。其中倒三角形固定构型组刚度明显大于直角三角形组；疲劳加载至3倍体重(2.1kN)时，93%骨一三针内固定构件被损坏；疲劳加载达5倍体重(3.5kN)时，所有构件都被损坏。结论对于无后侧皮质缺损的股骨颈头颈型骨折，在三种三针内固定构型中以倒三角形固定构型为佳。实验结果不支持股骨颈骨折多针内固定后早期负重行走。
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A comparative study of the stability of three configurations of the three pin fixation for the trealment of femoral neck fracture
YU Yu ,DONG Fu-hui
(Institute of Orthopaedic and Traumatology,China Academe of Traditional Chinese Medicine(Beijing,100700))
Abstract：Objective Thirty human femur specimens were used as mechanical fatigue models to compare the stability of the three configurations for internal fixation in the treatment of femoral neck fracture,in order to provide a foundation for clincal choice and to delineate whether it is feasible to allow immediate full weight beating following pins/screws fixation of femoral neck fractures.Methods Mechanical fatigue test was used to simulate the circulating loading mode during ambulation.The fixation stability of the three pin configurations was compared.Results The stiffness of three pin configurations in the group of subcapital femoralneck fracture(n=15)was much greater than that in the group of transcervcical femoral neck fracture(n=15)(P<0.05);In the group of transceravical femoral neck fracture the fixation was stronger(P<0.05)in the inverse triangle configuration compared with the right triangle type.93 % of the bone fixation components were damaged when the fatiguing load was three times the normal weight(2.1 kN);none of the components were intact under the load of five times of the normal weight(3.5 kN).Conclusion For the transcervical femoral neck fracture without posterior co mminution,the inverse triangle configuration should be the best for clinical selection.Results of the biomechanical study did not support immediate early ambulation with full weight beating.
, 百拇医药
Keywords：Fracture,femoral neck Fracture fixation,internal Biomechanies
参考文献：
[1]Rarnser J R,Mihalko W M,Carr JB,et al.A comparison of femoralneck fixation with the reconstruction nail versus cancellous screws in anatomic specimens.Clin.Orthop,1993,290:189-196.
[2]Timothy JB.Femoral neck fracture fixation.Clinical Decision Making.Clin Orthop,1997,339:20-31.
[3]Husby T,Alho A,Ronningen H.Stability of femoral neck osteosyn thesis Comparison of fixation methods in cadavers.Acta Orthop.Seand,1989,60(3):299-302.
, http://www.100md.com
[4]Clark D I,Crofts C E,Saleh M.Femoral neck fracture fixation.Comparison of a sliding screw with lag screws.J Bone Joint Surg(Br),1990,72-B:797-800.
[5]Husby T,Alho A,Hoiseth A,et al.Strength of femoral neck fracture fixation.Comparison of six techniques in cadavers.Acta Orthop Scand,1987,Dec,58(6):634-637.
[6]Larsson S,Elloy M,Hansson L I.Fixation of unstable trochanterichip fracture.A cadaver study comparing three different devices.Acta Orthop Scand 1988;59(6):658-663.
, 百拇医药
[7]Neustadt J B,Tronzo R,Hozack W J,et al.Femoral neck fractures.A biomechanical study of a new form of internal fixation using multiple telescoping length comparison screw.Clin Orthop,1989 Nov,(248):181-188.
[8]Sjostedt A,Zetterberg C,Hansson T,et al.Bone mineral content and fixation strength of femoral neck fractures.A cadaver study.Acta Orthop Scand,1994,65(2):161-165.
[9]Arnold W.The effect of early weight-bearing on the stability of femoral neck fractures treated with nowles pins.J Bone Joint Surg [Am],1984 Jul,66(6):847-852.
[10]Shih CH,Wang KC.Femoral neck fractures.121 cases treated by Knowles pinning.Clin Orthop,1991 Oct,(271):195-200.
[11]Paul JP.Forces at the human hip Joint,University of Chicago,1976.
收稿日期：2000-01-10, 百拇医药
单位：中国中医研究院骨伤科研究所，北京 100700
关键词：骨折；股骨颈；骨折固定术，内；生物力学
中国骨伤000605 摘 要：目的通过力学疲劳实验对30个成人股骨标本进行股骨颈骨折三种内固定构型稳定性比较研究，为临床选择固定构型及能否术后立即承重提供依据。方法采用力学疲劳试验来模拟人体行走中的循环加载方式，对股骨颈骨折三针内固定构型进行稳定性的比较研究。结果股骨颈头下型骨折三针内固定组刚度明显大于头颈型骨折组(P<0.05)；股骨颈头颈型骨折三种三针内固定构型有显著性差异(P<0<0.05)。其中倒三角形固定构型组刚度明显大于直角三角形组；疲劳加载至3倍体重(2.1kN)时，93%骨一三针内固定构件被损坏；疲劳加载达5倍体重(3.5kN)时，所有构件都被损坏。结论对于无后侧皮质缺损的股骨颈头颈型骨折，在三种三针内固定构型中以倒三角形固定构型为佳。实验结果不支持股骨颈骨折多针内固定后早期负重行走。
, http://www.100md.com
A comparative study of the stability of three configurations of the three pin fixation for the trealment of femoral neck fracture
YU Yu ,DONG Fu-hui
(Institute of Orthopaedic and Traumatology,China Academe of Traditional Chinese Medicine(Beijing,100700))
Abstract：Objective Thirty human femur specimens were used as mechanical fatigue models to compare the stability of the three configurations for internal fixation in the treatment of femoral neck fracture,in order to provide a foundation for clincal choice and to delineate whether it is feasible to allow immediate full weight beating following pins/screws fixation of femoral neck fractures.Methods Mechanical fatigue test was used to simulate the circulating loading mode during ambulation.The fixation stability of the three pin configurations was compared.Results The stiffness of three pin configurations in the group of subcapital femoralneck fracture(n=15)was much greater than that in the group of transcervcical femoral neck fracture(n=15)(P<0.05);In the group of transceravical femoral neck fracture the fixation was stronger(P<0.05)in the inverse triangle configuration compared with the right triangle type.93 % of the bone fixation components were damaged when the fatiguing load was three times the normal weight(2.1 kN);none of the components were intact under the load of five times of the normal weight(3.5 kN).Conclusion For the transcervical femoral neck fracture without posterior co mminution,the inverse triangle configuration should be the best for clinical selection.Results of the biomechanical study did not support immediate early ambulation with full weight beating.
, 百拇医药
Keywords：Fracture,femoral neck Fracture fixation,internal Biomechanies
参考文献：
[1]Rarnser J R,Mihalko W M,Carr JB,et al.A comparison of femoralneck fixation with the reconstruction nail versus cancellous screws in anatomic specimens.Clin.Orthop,1993,290:189-196.
[2]Timothy JB.Femoral neck fracture fixation.Clinical Decision Making.Clin Orthop,1997,339:20-31.
[3]Husby T,Alho A,Ronningen H.Stability of femoral neck osteosyn thesis Comparison of fixation methods in cadavers.Acta Orthop.Seand,1989,60(3):299-302.
, http://www.100md.com
[4]Clark D I,Crofts C E,Saleh M.Femoral neck fracture fixation.Comparison of a sliding screw with lag screws.J Bone Joint Surg(Br),1990,72-B:797-800.
[5]Husby T,Alho A,Hoiseth A,et al.Strength of femoral neck fracture fixation.Comparison of six techniques in cadavers.Acta Orthop Scand,1987,Dec,58(6):634-637.
[6]Larsson S,Elloy M,Hansson L I.Fixation of unstable trochanterichip fracture.A cadaver study comparing three different devices.Acta Orthop Scand 1988;59(6):658-663.
, 百拇医药
[7]Neustadt J B,Tronzo R,Hozack W J,et al.Femoral neck fractures.A biomechanical study of a new form of internal fixation using multiple telescoping length comparison screw.Clin Orthop,1989 Nov,(248):181-188.
[8]Sjostedt A,Zetterberg C,Hansson T,et al.Bone mineral content and fixation strength of femoral neck fractures.A cadaver study.Acta Orthop Scand,1994,65(2):161-165.
[9]Arnold W.The effect of early weight-bearing on the stability of femoral neck fractures treated with nowles pins.J Bone Joint Surg [Am],1984 Jul,66(6):847-852.
[10]Shih CH,Wang KC.Femoral neck fractures.121 cases treated by Knowles pinning.Clin Orthop,1991 Oct,(271):195-200.
[11]Paul JP.Forces at the human hip Joint,University of Chicago,1976.
收稿日期：2000-01-10, 百拇医药