叉型股骨自锁髓内钉治疗股骨骨折的生物力学研究

目的 对叉型股骨自锁髓内钉(Tridentate self-locking intramedullary femoral.nail,TSIFN)力学性能进行实验研究,为临床应用提供依据。方法 采用8具成人新鲜尸体股骨标本进行应力分析实验。比较用TSIFN、梅花钉、Orthofix公司生产的第三代交锁髓内钉固定的股骨骨折在抗压、抗弯、抗扭强度、刚度及其系统承载能力等方面的差异性。结果 实验结果表明:TSIFN在抗压、抗弯、抗扭强度和刚度及其系统承载能力均优于梅花钉内固定(P<0.05)。与Orthofix交锁髓内钉两者无显著性差异(P>0.05)。结论 TSIFN不但生物力学性能优越,强刚度符合生物力学要求,而且应力遮挡小,远端毋需交锁,弹性固定,固定牢靠,能加速骨折愈合,且手术操作简单,便于推广应用。     

股骨远端骨折3种内固定方法的生物力学研究比较

目的:对股骨远端骨折三种内固定方法进行定量生物力学比较,为临床选择有效的内固定方法提供理论依据。方法:取12具新鲜尸体股骨标本,制成股骨髁间骨折模型(AO分类的C1型),采用股骨交锁髓内钉(A)、"L"形髁钢板(B)、加压钢板(C)3种内固定方法,观察股骨髁上应变、位移、刚度、强度,对股骨远端3种内固定方法进行生物力学分析,并以有限元理论分析论证它的结果。结果:试验发现在受同等载荷条件下,髁上交锁髓内钉固定强度、刚度最佳,而采用"L"形髁钢板和加压钢板固定股骨髁强度、刚度较差。3组应力和髁间位移均有显著差异性(P0.05)。结论:采用股骨髁上交锁髓内钉固定方法优于其他内固定方法,具有操作简单、锁钉定位准确、固定牢靠等优点,是治疗股骨远端骨折较好的内固定方法。     

交锁髓内钉治疗股骨干骨折36例的疗效观察

股骨于大致是管状结构．是进行髓内钉固定的理想部位,股骨干骨折髓内钉固定以闭合穿钉为主。交锁髓内钉因其强度高、抗旋转力强、应力遮挡作用小、适用范围广而成为治疗股骨干骨折的常用术式。本院自2003年7月至2006年6月．采用闭合复位顺行带锁髓内钉同定治疗36例股骨干骨折,     

磁力导航下交锁髓内钉内固定治疗股骨干骨折

目的评价在磁力导航技术下交锁髓内钉固定治疗股骨干骨折的临床疗效。方法对92例行股骨干骨折交锁髓内钉治疗,锁定远端锁孔时在磁力导航下进行。结果 84例获随访,78例骨性愈合取出髓内钉,6例尚在随访中。其中8例发生迟延愈合、膝关节僵硬等并发症经对症处理后均得到很好的治疗效果。结论交锁髓内钉固定治疗股骨干骨折在磁力导航下操作可以解决远端锁定孔锁定困难的问题,操作简单,准确率可达100%。     

股骨内锁髓内钉的设计及临床应用

近十几年来 ,交锁髓内钉的应用大大扩大了以往髓内钉治疗的适应证 ,但远端锁孔技术普遍感到是个棘手难题 ,因此作者设计了股骨内锁髓内钉 (以下简称内锁钉 )及其配套手术器械。自 2 0 0 0年 6月以来 ,应用内锁钉治疗股骨干骨折3 6例 ,疗效满意。1　股骨内锁钉及配套器械1.1　股     

股骨交锁髓钉瞄准器术中变形移位原因及对策

股骨交锁髓内钉固定于股骨干骨折具有抗压应力及旋转应力强、可早期活动、应力遮挡小、适用范围广等优点，已广泛应用于临床，取得了良好的临床治疗效果。但手术操作中常常因瞄准器变形移位，导致压杆不能准确压在髓内钉上或远端锁钉交锁失败而影响手术。本研究通过分析我院2001年10月至2007年8月使用股骨交锁髓内钉治疗股骨干骨折共146例手术，探讨术中瞄准器变形的原因及对策。     

单钉和双钉远端交锁髓内钉固定治疗股骨干骨折的比较——临床及生物力学分析

通过8具尸体16个股骨行单钉和双钉远端交锁髓内钉固定生物力学对比分析,两者扭转及轴向最大负荷无显著差异,临床采用远端单钉交锁髓内钉固定股骨干骨折27例,取得较好效果。     

交锁髓内钉治疗股骨干骨折36例的疗效观察

股骨干骨折是常见的、高能量损伤骨折。股骨干大致是管状结构,是进行髓内钉固定的理想部位,股骨干骨折髓内钉固定以闭合穿钉为主。交锁髓内钉因其强度高、抗旋转力强、应力遮挡作用小、适用范围广而成为治疗股骨干骨折的常用术式。本院自2003年7月至2006年6月,采用闭合复位顺行带锁髓内钉固定治疗36例股骨干骨折．取得良好效果,优良率达100％。现将结果报告如下。     

单钉和双钉远端交锁髓内钉固定治疗股骨干骨折的比…

通过８具尸体１６个股骨行单钉和双钉远端交锁髓内钉固定生物力学对比分析，两者扭转轴向量大负荷无显著差异，临床采用远端单钉交锁髓内钉固定股骨干骨折２７例，取得较好效果。     

带远端锁钉定位装置的交锁髓内钉在股骨干骨折中的应用

目的评价带远端瞄准器的交锁髓内钉在股骨干骨折治疗中的应用特点。方法对采用带远端瞄准器的交锁髓内钉通过闭合复位穿钉技术治疗的26例股骨干骨折患者进行手术过程分析。结果远端锁钉放置顺利21例，放置困难经查找原因并改正后放置成功4例，失败1例。结论使用带远端锁钉定位装置的交锁髓内钉治疗股骨干骨折，可减少术者及患者暴露于X线下的次数及时间。只要操作中正确使用定位装置，减少髓内钉插入过程中产生的应力，减少钉的变形，即可顺利放置远端锁钉。     

An intramedullary nail with multifunctional interlocking for all types of fracture in both femurs

Objective: A femoral compound interlocking intramedullary nail (FCIIN) was designed to treat all types of fractures between the trochanter and epicondyle of both femurs. It could substitute for femoral interlocking intramedullary nails (FIIN) at five points. Methods: According to the morphological characteristics of the femoral medullary canal, the nail is designed to accommodate a 1250 mm radius of radian and a 135° neck‐shaft angle. Three interlocking holes of 6.5 mm diameter are located at the proximal end of the FCIIN, making crossing of the screws possible. The hole is designed to be vertical (90°) or oblique (45° upper or lower). At the tip of the proximal interlocking screws, whose root diameter gradually increases from 3.5 mm to 6.5 mm, a self‐tapping cancellous screw is placed. There are two types of distal interlocking screws. One is a fine thread and the other a bolt screw. Two interlocking holes and a recess 4.5 mm in diameter are located at the distal end of the FCIIN. Under biomechanical destructive testing, the proximal interlocking screw device has satisfactory strength and reasonable structure. A total of 47 patients (31 males and 16 females, with an average age of 39.83 years) with femoral fractures were assessed in this study. Fourteen cases were diagnosed as intertrochanteric, 7 as subtrochanteric, 18 as femoral shaft, and 8 as supracondylar fractures. All 47 patients were treated with the FCIIN. Results: Of the 47 patients, anatomic reduction was achieved in 34, good reduction in 11, and forced line reduction in 2 cases. Reduction was excellent or good in 95.87% of the fractures. The removal time of the FCIIN was 12 to 21 months (average, 16.9 months). One patient with an intertrochanteric fracture who had a fixation failure combined with non‐union achieved healing with an external fixator at 18 months. Failure to insert the distal interlocking screws occurred in 5 patients but did not affect bone healing. Conclusion: The FCIIN is a useful device in the treatment of a variety of femoral fractures.     

国产带瞄准器交锁髓内钉远端锁钉准确性研究

目的 分析瞄准器引导下交锁髓内钉远端锁钉困难的原因,以提高远端锁钉成功率.方法 自2000年2月至2006年6月拆除有瞄准器的国产股骨交锁髓内钉56根,胫骨交锁髓内钉80根;均采取静力型固定,远近端各2枚锁钉.观察其远端髓内钉钻痕的情况,以分析瞄准器的远端锁钉准确性.结果 本组研究发现瞄准器第一次锁钉的成功率不高,股骨髓内钉瞄准器第一次锁钉的成功率为36%,胫骨髓内钉瞄准器第一次锁钉的成功率为65%.结论 交锁髓内钉远端锁钉困难的原因是多方面的.要提高远端锁钉一次成功率,必须重视瞄准器定位孔偏移问题.     

髓内扩张自锁钉治疗胫骨骨折的生物力学研究

目的对髓内扩张自锁钉(IESN)的生物力学性能进行实验研究,为临床应用提供理论依据。方法采用新鲜成人胫骨标本18根,制成中段斜行骨折模型;梅花针、交锁钉、IESN固定胫骨后进行抗屈伸、抗侧弯、抗短缩、抗扭转、抗疲劳方面的生物力学测试,评价IESN的内固定稳定性;同时比较三种内固定稳定程度的差异。结果IESN在抗侧弯、抗短缩、抗扭转、抗疲劳刚度方面明显强于梅花针(P<0.01),在抗屈伸方面与梅花针、交锁钉相当(P>0.05);在抗侧弯方面强于交锁钉(P>0.05);在抗扭转方面稍差于交锁钉(P>0.05);在抗短缩方面明显弱于交锁钉(P<0.01)。结论髓内扩张自锁钉具有良好的生物力学性能,有较强的固定作用和稳定性。     

远端锁钉数目对加锁髓内钉力学性能影响的研究

目的　测试远端锁钉数目对加锁髓内钉整体力学性能的影响。　方法　实验共选用国产 TAMZ钛合金制造 9mm胫骨加锁髓内钉 2 0根 ,将所有髓内钉随机分成单钉组 ,远端仅安装 1根锁钉 ;双钉组 ,远端安装 2根锁钉。各组再平均分成两小组 ,将髓内钉安装在自行设计的不锈钢模型中 ,利用万能力学实验机测试各组髓内钉的抗压缩和抗扭转力学特性。　结果　在压缩实验中单钉组平均最大压缩载荷为 1880 N,双钉组的平均最大载荷为 2 16 0 N,两组比较有统计学意义 (P<0 .0 5 ) ;在扭转实验中平均最大扭矩、扭角单钉组分别为 5 5 .5 Nm和 5 8.0°,双钉组分别为 5 5 .8Nm和 5 8.3°,两组无差异 (P>0 .0 5 )。　结论　单根锁钉的力学性质可满足临床要求。临床上安装髓内钉时 ,长管状骨近端或中 1/ 3较稳定的骨折 ,可在远端选择安装 1根锁钉 ;而远端 1/ 3骨折或者粉碎性、伴骨缺损的严重骨折 ,应在远端尽量安装 2根锁钉。     

阻钉技术对交锁髓内钉断钉的影响

目的探讨阻钉技术对交锁髓内钉断钉的预防作用。方法2003年1月~2005年8月,采用交锁髓内钉固定长骨干骨折56例,男32例,女24例。年龄21~65岁,平均34岁。其中股骨骨折26例,胫骨骨折30例,均为新鲜、闭合性骨折。骨折类型:中部横断骨折10例,中部短斜形骨折11例,中部长斜形或螺旋形骨折20例,远、近1/3骨干骨折15例。前期32例患者采用常规的交锁髓内钉固定骨折(组),后期24例中部长斜形或螺旋形骨折及远、近1/3骨折患者采用交锁髓内钉配合阻钉固定骨折(组)。结果获随访12~21个月,平均16个月。组3例患者骨折未愈合,其中1例股骨中部长斜形骨折主钉在骨折线附近断裂,另2例胫骨远1/3骨折主钉在靠近骨折端的第1个锁钉孔处断裂;其余患者术后6~12个月获骨性愈合,但骨折处出现较多骨痂。组患者于术后3~8个月获骨性愈合,骨折对位、对线良好,无断钉发生。结论阻钉技术配合交锁髓内钉应用可明显增强骨折断端稳定性,减少断钉发生。     

Deformation of femoral nails with intramedullary insertion

Current methods of distal interlocking of intramedullary femoral nails are dependent on image intensification. However, radiation exposure to the patient, the operating room staff, and the surgeon remains a concern. Proximally mounted, radiation-free aiming systems for distal interlocking of femoral nails have reportedly failed because of nail deformation with insertion. To better understand this deformation, a threedimensional magnetic motion tracking system was used to determine the position of the distal interlocking hole following nail insertion. The amount and direction of deformation of commercially available smalldiameter implants (unslotted 9-mm nails inserted without reaming) and large-diameter implants (slotted 13-mm nails inserted with reaming) from a single manufacturer were analyzed. Measurements of deformation (three translations and three angles), based on the center of the distal transverse locking hole, were performed on 10 paired intact human cadaveric femora before and after insertion. The technique produced the following results for the small and large-diameter nails, respectively: lateral translations of 18.1 ± 10.0 mm (mean ± SD, range: 47.8 mm) and 21.5 ± 7.9 mm (range: 26.4 mm), dorsal translations of -3.1 ± 4.3 mm (range: 15.2 mm) and 0.4 ± 9.8 mm (range: 30.1 mm), and rotation about the longitudinal axes of ?0.1 ± 0.2° (range: 0.7°) and 10.0 ±3.1° (range: 7.8°). This technique is useful for measuring insertion-related femoral nail deformation. The data for the nails tested suggest that a simple aiming arm, mounted on the proximal end of the femoral nail alone, will not sufficiently provide accurate distal aiming.     

Treatment of femoral supracondylar unstable comminuted fractures

Summary A prospective study was done of 66 consecutive unstable comminuted supracondylar femoral fractures in adults, fixed with either plates (28 cases) or Grosse-Kempf interlocking nails (38 cases). Patients were followed up for at least 1 year (average 44 months). Interlocking nails led to a higher union rate and more satisfactory functional results. Nevertheless, the first distal transverse screw hole took a potential risk of breakage due to stress concentration. The authors conclude that for a cooperative patient, a closed static interlocking nail with strict non-weight-bearing should be the treatment of choice, and for an uncooperative patient, a closed static interlocking nail should be supplemented with a cast brace to reduce the complication rate.     

股骨复合型带锁髓内钉的设计及临床应用

目的 阐述股骨复合型带锁髓内钉(femoral compound interloeking intramedullary nail,FCIIN)的设计原理,探讨其临床疗效.方法 根据股骨髓腔形态学特点,没计FCIIN的主钉弧度半径为1250 mm,近端斜形交锁角度(钉的颈干角)为135°.主钉近端有三个直径6.5 mm的锁钉孔,使锁钉可以横穿,也可以向左上或下、右上或下45°斜穿.主钉远端有两个直径4.5 mm的锁钉孔和一个相同直径的凹槽.近端锁钉尖部有长30～40 mm自攻松质骨螺纹,螺纹直径由3.5 mm逐渐增大至6.5 mm.远端锁钉有两种:一种是螺纹锁钉,另一种是螺栓锁钉.2000年1月至2004年12月,用FCIIN治疗股骨骨折患者47例,男31例,女16例;年龄18～74岁,平均39.83岁;转子间骨折14例,转子下骨折7例,股骨干骨折18例,髁上骨折8例.其中不扩髓顺行打钉30例.结果 所有患者均获得随访,随访时问21～36个月,平均25.9个月.骨愈合时间6～18个月,平均8.4个月.解剖复位34例,良好复位11例,力线复位2例,复位优良率95.74%.取钉时问12～21个月,平均16.9个月.1例转子间骨折固定失败并骨不愈合患者,采用辅助外固定支架治疗,18个月后骨折愈合.远端锁钉安装失败5例,未做任何处理骨折均愈合.结论 FCIIN 临床应用效果理想,可用于治疗各类股骨骨折.     

Intramedullary nailing of femoral shaft fractures. Part III: Long-term effects of static interlocking fixation.

The results of treatment of fractures of the femoral shaft with static interlocking nailing were reviewed retrospectively to determine the clinical importance of any stress-riser or stress-shielding properties of the nail. These properties, if relevant, would have been manifested by refracture of the femur, either through a hole used for a locking screw or through the original site of fracture after extraction of the device. Two hundred and fourteen fractures that had been treated with static interlocking nailing and that had healed without conversion to dynamic intramedullary fixation were divided into two groups. In Group I, which comprised 111 fractures, the static interlocking-fixation device was retained and in Group II, which comprised 103 fractures, the static interlocking-fixation device was removed during one operative procedure at an average of fourteen months after the injury. The average duration of follow-up was thirty months from the time of the original fixation in both groups. All patients in Group II were followed for a minimum of six months after removal of the nail. No femur in Group I, in which the static interlocked nail remained in situ, refractured. No femur in either group fractured through the proximal or the distal holes used for the locking screws. No locking screws or nails broke. One patient (1 per cent) in Group II had a refracture of the femoral shaft through the site of the original fracture six weeks after removal of the nail.(ABSTRACT TRUNCATED AT 250 WORDS)     

Biomechanical analysis of the mechanism of interlocking nail failure

Summary From December 1986 to May 1989, 412 patients with 274 femoral and 144 tibial fractures were treated with Grosse-Kempf interlocking nails at our hospital. 324 cases (78.6%) were followed-up for at least 1 year (average 23 months). There were 13 breakages in the locking nails in femora and none in tibiae. The recorded incidence of breakage in the femur is therefore 4.7% (13/274). The mechanisms of locking nail failure are stress concentration around screw hole and nail slot, nicking of the nail during drilling of the screw holes, too close proximity of the screw hole to the fracture, and larger loading over the proximal femur. The incidence of failure is 4.9% in the upper third, 1.9% in the mid-third, and 8.2% in the distal third (P > 0.05, ² test). The site most at risk is the first screw hole of the distal third, especially if it is near the fracture site. Prevention of failure involves using a nail of larger diameter and sufficient length, improving the surgical drilling technique, and allowing only protected weight bearing. Management of nail breakage by insertion of a new implant and supplementary cancellous bone grafting can gain satisfactory results.