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。     

两端膨胀自锁髓内钉治疗股骨骨折的生物力学评价

目的 对一种新型无需传统锁钉的两端膨胀自锁髓内钉进行生物力学性能测试和评价. 方法将6对新鲜人股骨尸体标本分为两组,均制备股骨中段横行骨折模型,分别用两端膨胀自锁髓内钉和国产传统交锁髓内钉内固定,并使断端间保留1.5 cm的裂隙.分别对其进行轴向压缩载荷、水平扭转及三点弯曲等生物力学测试,并对相关实验数据进行统计学分析. 结果两端膨胀自锁髓内钉的抗短缩刚度、抗旋转刚度及抗弯曲刚度均略小于传统交锁髓内钉,差异无统计学意义(P>0.05). 结论两端膨胀自锁髓内钉与交锁髓内钉固定效果相当,具有较强抗压、抗弯、抗旋性能,符合生物学固定的要求,有较好的临床推广应用前景.     

两端膨胀自锁髓内钉治疗股骨骨折的生物力学评价

目的 对一种新型无需传统锁钉的两端膨胀自锁髓内钉进行生物力学性能测试和评价. 方法将6对新鲜人股骨尸体标本分为两组,均制备股骨中段横行骨折模型,分别用两端膨胀自锁髓内钉和国产传统交锁髓内钉内固定,并使断端间保留1.5 cm的裂隙.分别对其进行轴向压缩载荷、水平扭转及三点弯曲等生物力学测试,并对相关实验数据进行统计学分析. 结果两端膨胀自锁髓内钉的抗短缩刚度、抗旋转刚度及抗弯曲刚度均略小于传统交锁髓内钉,差异无统计学意义(P>0.05). 结论两端膨胀自锁髓内钉与交锁髓内钉固定效果相当,具有较强抗压、抗弯、抗旋性能,符合生物学固定的要求,有较好的临床推广应用前景.     

三种内固定在股骨干骨折中的应用

目的观察股骨干骨折三种内固定的疗效。方法股骨干骨折,以外侧入路,分别予交锁髓内钉、梅花钉、加压钢板螺钉内固定。结果随访6～144个月,术后畸形愈合、延迟愈合及不愈合率:交锁髓内钉组3.1%、梅花钉组6.0%、加压钢板螺钉组10.6%;内固定失效率:交锁髓内钉组0%、梅花钉组4.5%、加压钢板螺钉组17.0%;术后患肢关节功能优良率:交锁髓内钉组81.3%、梅花钉组70.1%、加压钢板螺钉组59.6%。结论交锁钉治疗股骨干骨折近远期疗效满意,梅花钉次之,加压钢板螺钉最差。     

股骨远端骨折三种内固定方法生物力学比较研究与临床应用

目的　对股骨远端骨折三种内固定方法进行定量生物力学评价 ,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 (AO分类的C1型 ) ,采用股骨髁上交锁髓内钉、L形髁钢板、加压钢板三种内固定方法 ,进行实验应力分析 ,比较不同内固定方法的优劣 ,并以有限元理论分析进一步论证它的结果。结果　发现在受同等载荷条件下 ,髁上交锁髓内钉固定最佳 ,而采用加压钢板固定的股骨髁强刚度较差 (P <0 0 5 )。临床手术 47例 ,按Kolmert功能评定标准 ,优良率分别为 :股骨髁上交锁髓内钉 94 1% ,L形髁钢板 82 4% ,加压钢板 76 9%。结论　采用股骨髁上交锁髓内钉固定方法优于其它内固定方法 ,值得临床推广应用。     

股骨干骨折髓内钉固定疗效分析

目的探讨3种髓内固定方式治疗股骨干骨折的临床效果。方法97例股骨干骨折分别选用梅花钉(31例)、带锁髓内钉(37例)、内锁钉(29例)固定,比较3种固定的手术时间、术中出血量、适用范围、愈合时间及并发症等。结果梅花钉和内锁钉固定在手术时间、术中出血方面差异无统计学意义(P>0.05),带锁髓内钉固定手术时间长,出血量也较多(P<0.05)。骨折固定范围:带锁髓内钉最大,梅花钉最小。患者均获,时间6～24个月,梅花钉组出现感染1例、成角畸形1例、骨不连1例;带锁髓内钉组出现锁钉断钉2例、骨不连3例;内锁钉组未出现感染、断钉及骨不连。结论内锁钉髓内固定股骨干骨折有操作简单、创伤小、愈合快、发生骨不连及延迟愈合率低的优点,适用范围较梅花钉广,但不适用于粉碎性骨折。带锁髓内钉适用范围广,但操作复杂,骨不连发生率较其它髓内钉高,骨折平均愈合时间较内锁钉及梅花钉长。     

自带内锁髓内针治疗长骨骨折的生物力学与临床

目的 研制一种新型的髓内内固定器械－－自带内锁髓内针，对其生物力学性能进行测试，同时小组病例临床应用，为临床安全应用提供依据。方法 采用６副新鲜股骨标本人为造成股骨中下１／３骨折并２ｃｍ的骨缺损，分另用自带内锁髓内针和国产的匀锁髓内针内固定后的标本进行生物力学测试，用ＳＰＳＳ统计软件对实验数据进行结果分析。临床应用该针治疗股骨中下段骨折１６例，用股骨远段骨折功能评定标准（Ｋｏｌｍｅｒｔ １９８２）     

胫骨交锁髓内钉远端不同锁钉方式的生物力学测试

目的对胫骨交锁髓内钉远端不同锁钉方式进行生物力学测试，为临床交锁髓内钉治疗胫骨骨折提供理论指导。方法以成人新鲜胫骨标本为试验对象，每具标本先后模拟骨折愈合、稳定骨折及不稳定骨折3种状态，远端采用1枚或2枚锁钉固定，MTS轴向加载0～1000N，测试锁钉应力应变变化。结果随着骨骼稳定性的变化，各锁钉应力应变均发生显著性变化，在远端2枚锁钉中，靠近侧的锁钉应力应变更大。远端改用1枚锁钉固定后，远端锁钉承受的应力应变进一步显著增加，且以离骨折线较近的1枚锁钉固定应力应变更大。结论骨折线远端的锁钉应力应变大，易发生断裂及退钉，尤其是靠近骨折线者；应尽量以2枚锁钉固定远端并尽量远离骨折线。     

肱骨自锁髓内钉的生物力学测试与临床应用

目的　研制出一种新型肱骨自锁髓内钉 ,并对其生物力学进行测试 ,同时采用鹰嘴窝上方为进针点逆行进针进行小组病例测试 ,为临床治疗肱骨干骨折的安全应用提供方法和依据。方法　取 1 2付新鲜青壮年肱骨干人工造成骨折 ,采用 31 7L不锈钢肱骨自锁髓内钉内固定对其标本进行生物力学测试 ,并对其结果进行分析。临床采用该钉由鹰嘴窝上方逆行进钉内固定治疗肱骨干骨折 ,并对其进行评价。结果　肱骨自锁髓内钉抗弯、抗旋及抗拉伸和抗压缩均符合生物力学需要。临床治疗结果满意。结论　肱骨自锁髓内钉符合人体生物学固定要求 ,采用鹰嘴上方逆行进钉 ,并发症少 ,优良率高 ,该器械具有结构合理、安全、简单、实用等优点。     

股骨远端骨折三种内固定方法生物力学比较研究与临床应用

目的：对股骨远端骨折三种内固定方法定量生物力学评价,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（AO分类的C1型）,采用股骨髁上交锁髓内钉,L形髁钢板,加压钢板三种内固定方法,进行实验应力分析,比较不同内固定方法的优劣,并以有限元理论分析进一步论证它的结果。结果：发现在受同等载荷条件下,髁上交锁髓内钉固定最佳,而采用加压钢板固定的股骨髁强刚度较差（P＜0．05）,临床手术47例,按Kolmert功能评定标准,优良率分别为：股骨髁上交锁髓内钉94．1％,L形髁钢板82．4％,加压钢板76．9％。结论：采和股骨髁上交锁骨内钉固定方法优于其它内固定方法,值得临床推广应用。     

Treatment of infected pseudarthrosis of the femur and tibia with an interlocking nail

Between 1970 and 1977, 64 patients with infected pseudarthrosis of the femur and tibia were treated with an interlocking nail. The type of primary treatment prior to the development of the infected pseudarthrosis was plate fixation in 21 femurs and seven tibias and conventional intramedullary nails in 16 femurs and 20 tibias. Fracture union was obtained in 34 of the 38 femoral infected pseudarthrosis (89.5%) and 19 of 27 tibial infected nonunions (62.5%) following interlocking nailing. Seven of the eight failures (87.5%) in the tibial group were the result of reoperation with interlocking nails following infected plate fixation. Following removal of the interlocking nail and treatment of residual infection, osteomyelitis was considered quiescent in 59 patients (35 femurs and 24 tibias) and active in five patients (two femurs and three tibias). Today, external fixation in combination with gentamicin-PMMA chains for local antibiotic treatment is used in the majority of such cases, because fracture instability and the chronic osteomyelitis can be treated simultaneously.     

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。     

弹性髓内钉治疗儿童股骨干骨折

目的探讨弹性髓内钉治疗儿童股骨干骨折的方法和疗效。方法采用弹性髓内钉内固定治疗儿童股骨干骨折32例。结果 32例均获随访,时间5～12个月,骨折全部愈合。按Flynn评分标准:优26例,良6例。无骨不愈合、畸形愈合和骨骺损伤等。结论弹性髓内钉内固定具有微创、不累及骨骺、并发症少等特点,是治疗儿童股骨干骨折的有效方法。     

Biomechanical comparison of flexible stainless steel and titanium nails with external fixation using a femur fracture model

There are several options available for surgical stabilization of pediatric femoral shaft fractures. The purpose of this study was to compare the stability afforded by Ender stainless steel nails, titanium elastic nails, and one-plane unilateral external fixators for the fixation using a synthetic adolescent midshaft femur fracture model. The anterior-posterior (sagittal plane) bending, lateral (coronal plane) bending, torsional, and axial stiffness values were calculated using 6 different fixation configurations. These included pairs of 3.5-mm-diameter Ender nails with and without distal locking, 3.5- and 4.0-mm-diameter titanium elastic nails as well as single- and double-stacked monolateral external fixators. Eight synthetic femur models, 4 each with simulated transverse and comminuted fracture patterns, were sequentially tested for stability afforded by the various fracture fixation configurations. External fixation exhibited significantly greater control of anterior-posterior angulation compared with all flexible-nailing systems. Although Ender nails were slightly superior to titanium nails in control of sagittal plane angulation, this was not statistically significant. Compared with the external fixation constructs, all 4 flexible nail constructs demonstrated higher torsional stability. For prevention of axial shortening, all fixation methods were similar for the transverse fracture pattern, whereas external fixation was superior to flexible nails in the comminuted fracture model. No significant benefit was demonstrated with double stacking of external fixators. These findings may help guide clinicians choose the optimal fixation method for treatment of pediatric femoral shaft fractures.     

可膨胀自锁式髓内钉固定胫骨干骨折的力学测试

目的了解Fixion IM可膨胀自锁式髓内钉在胫骨干骨折中的力学特性。方法对Fixion IM可膨胀自锁式髓内钉行抗轴向压缩、抗弯曲、抗扭转强度及应力遮挡力学测评,并与其他用于胫骨干骨折不同方式内固定器械相对比。结果 Fixion IM可膨胀自锁式髓内钉在轴向压缩、抗弯曲强度、抗扭转强度及应力遮挡方面,所测出的实验性材料力学结果表明,其性能优于目前普遍应用于临床的国产交锁髓内钉及标准加压钢板。结论 Fixion IM可膨胀自锁式髓内钉的材料是一种力学性能比较优秀的植入性材料,能较好地适应国人胫骨干髓腔,是一种理想的新型内固定器械。     

Differences in biomechanical stability of femur fracture fixation when using titanium nails of increasing diameter

Purpose The purpose of this study was to compare the biomechanical stability generated when utilizing increasing sizes of titanium (Ti) flexible nails for fixation of simulated comminuted femur fractures. Methods Five synthetic adolescent-sized femur models were reamed to create a 9-mm canal. A 2-cm section was removed in the mid-diaphysis to simulate comminution. Each femur was first stabilized with bilateral, retrograde 3.0-mm titanium elastic nails. Femurs were tested in axial rotation and axial compression. The constructs were removed, and femurs were re-nailed with 3.5-mm nails. Identical testing was conducted. These nails were then removed, and femurs were re-nailed with 4.0-mm nails. This provided data on “canal fill” representing 67, 78 and 89% of the reamed canal diameter. Data for axial rotation (degrees) and failure load (N) required to produce 5 mm of fracture shortening were analyzed with a one-way ANOVA (P < 0.05) and a Tukey’s post-hoc test for multiple comparisons. Results For axial rotation, there were statistically significant improvements in rotational control for each increase in nail size. For axial stability, each increase in nail size resulted in increased axial failure loads to 5 mm, although these data were not statistically different. A specific comparison between 3.0- and 3.5-mm nails for compressive stability found significantly greater stability afforded by using 3.5-mm nails. Conclusions Data from this study demonstrate that increasing the amount of canal fill provides significant improvements in rotational control. The largest improvement was seen when increasing from 3.0- to 3.5-mm nails. While increasing the nail size from 3.5 to 4.0 mm again provided greater stability, larger nails may be more difficult to insert. Thus, increasing the nail size for femoral fracture fixation should be considered after measuring the diameter of the canal and evaluating the potential difficulty of insertion as well as specific demands of the fracture pattern.     

The effects of reaming and intramedullary nailing on fracture healing

Most closed fractures of the shaft of the femur and tibia can be treated successfully with internal fixation with medullary or interlocking nails. Unlike plate fixation, intramedullary nailing does not provide absolutely rigid fixation, so that some motion at the fracture site exists. The process of reaming causes circulatory disturbances in the inner two-thirds of the diaphyseal cortex. However, this does not impede the formation of external callus. The parts of bone that have sustained vascular damage by trauma or surgery are revascularized. Delay in the healing process due to disruption of the blood supply to fracture fragments is not known. The majority of patients are able to weight-bear a few days after surgery.     

夹板对股骨闭合复位内固定术后碎骨片的复位作用

目的:评估外用夹板对股骨粉碎骨折术后碎骨片的复位作用。方法:自2004年7月-2005年5月收治12例13侧股骨干粉碎骨折,男7例,女5例;平均年龄46.8岁。外伤后1周内施行闭合复位髓内钉内固定术,术中未对骨折处进行剥离固定,术后即刻摄片发现有大块的骨折片明显移位,股骨整体力线和长度恢复良好。予以夹板外固定2~4周,移位的骨折片处适当加压,每周摄片观察调整。结果:所有病例移位明显的骨折片在夹板固定1周后即有满意的复位,碎骨片向中心轴靠拢0.5~3cm,无夹板造成的软组织挤压伤,创口I期甲级愈合,骨折愈合时间平均16.2周,患侧髋、膝关节功能良好。结论:外用夹板对股骨碎骨片的复位疗效确切、方法简便,与微创内固定相互结合,明显提高疗效。