共查询到20条相似文献,搜索用时 0 毫秒
1.
《Foot and Ankle Surgery》2021,27(8):911-919
BackgroundThere have been no biomechanical evaluations of naviculocuneiform (NC) joint fixation. This study compared biomechanically 3 different fixation constructs for NC-1–3 joint fixation.MethodsThe present study compared the three fixation constructs lag screw with locking plate for each NC joint, two crossed lag screws for each NC joint and a separate lag screw for each NC joint with bridging locking plates. NC-1-3 fixation was performed stepwise, and rotation of each joint was evaluated after the application of each lag screw or locking plate and their removal.ResultsAll examined fixation techniques led to a significant reduced rotation of the NC joints. For NC-1 rotation decreased from 2.8° (Range 1.2–6.6°) to 0.6° (0.2–3.0°) for lag screw and locking plate (p = 0.002) and from 5.0° (1.7–9.8°) to 1.0° (0.1–3.6°) for crossed lag screws (p = 0.002). For NC-2, locking plate constructs were better with 0.2° (0.1–0.5°) compared to crossed lag screw osteosynthesis with 0.9° (0.2–1.6°) (p = 0.011).ConclusionEach evaluated fixation technique led to a reduced NC joint rotation. The fixation of any NC joint had no relevant effect on the adjacent NC joints. The results might support surgeons treating NC joint disorders. 相似文献
2.
Biomechanical analysis of the dynamic hip screw in the treatment of intertrochanteric fractures 总被引:2,自引:1,他引:1
Summary A prospective study was performed in 148 elderly patients (over 60 years old) whose intertrochanteric fractures were caused by moderate trauma. The patients were treated with dynamic hip screws and followed up for at least 2 years (average 34 months). The lag screw was placed as the biomechanical analysis favored. Follow-up showed that the majority achieved good union and were without mechanical failure. The authors conclude that a lag screw should ideally be placed inferiorly toward the medial margin in the frontal plane and centrally in the sagittal plane. The length of the lag screw should be such as to extend from 1.0 cm beneath the subchondral bone to the lateral femoral cortex. At least four cortical screws (piercing the cortex at eight points) should be inserted on the distal femoral fragment. 相似文献
3.
Biomechanical evaluation of a new type of hip compression screw with retractable talons 总被引:2,自引:0,他引:2
OBJECTIVES: We investigated the biomechanical performance of a compression hip screw with four reversibly deployable talons. We hypothesized that the talons would increase purchase strength of the lag screw and prevent rotation of the femoral head by resisting torsional forces between the lag screw and the femoral head. DESIGN: Reproducible, stable two-part intertrochanteric fractures were created on matched pairs of embalmed human femurs. Fractures were fixed using the compression hip screw with either the talons deployed (talon) or not deployed (screw) configuration. Pre- and postimplantation radiographs and dual energy x-ray absorptiometry scans were used to ensure geometric and balanced equivalency between contralateral limbs. Torsional tests were performed on femoral pairs at 1 Hz for 5000 cycles prior to torque failure. Compression tests were performed on femoral pairs with the screw in the inferior or central position. RESULTS: Peak torque and torque at 15 degrees of rotation were significantly greater for the talon versus screw device (6.5 +/- 1.7 Nm vs. 1.9 +/- 1.7 Nm for peak torque, P = 0.0002; and 4.2 +/- 2.0 Nm vs. 1.2 +/- 1.2 Nm for torque at 15 degrees rotation, P = 0.003). The peak compressive forces generated by the talon device were significantly greater than for the screw device in the inferior position (P = 0.005), with compression values of 1398 +/- 467 N and 713 +/- 323 N, respectively. Peak compression forces did not differ significantly between talon and screw devices in the central position. CONCLUSIONS: Talon deployment significantly improved interfragment compression and torsional strength. Engagement or penetration into or through the cortical bone at the base of the femoral head-neck junction in the inferior lag screw position is the critical technical step to maximize the talon purchase. 相似文献
4.
锁定钢板与动力髋螺钉治疗股骨粗隆间骨折的临床对照试验 总被引:3,自引:2,他引:3
目的:探讨锁定钢板治疗股骨粗隆间骨折的临床疗效。方法:回顾性分析2006年2月至2008年12月收治的108例股骨粗隆间骨折患者的临床资料。采用股骨近端锁定钢板治疗股骨粗隆间骨折51例,男23例,女28例;年龄45~86岁,平均66.0岁;采用DHS治疗股骨粗隆间骨折57例,男26例,女31例,年龄43~81岁,平均64.1岁。观察手术时间、术中出血量、术后引流量、骨折临床愈合时间、术后并发症及术后髋关节功能恢复情况。术后髋关节功能按Harris评分评定。结果:108例均获随访,时间8~24个月,平均12.5个月。锁定钢板组手术时间平均(87±14)min,术中出血量平均(367±213)ml,术后引流量平均(63±14)ml,骨折临床愈合时间平均(11.9±3.4)周,术后并发症7例,Har-ris评分平均(85±6)分;DHS组手术时间(115±23)min,术中出血量平均(582±243)ml,术后引流量平均(98±16)ml,骨折临床愈合时间平均(12.4±2.5)周,术后并发症9例,Harris评分平均(84±8)分。两组骨折愈合时间、术后并发症及髋关节功能恢复情况差异无统计学意义(P〉0.05),手术时间、术中出血量及术后引流量差异有统计学意义(P〈0.05)。与DHS组相比,股骨近端锁定钢板组手术时间短、术中出血量及术后引流量少。结论:股骨近端锁定钢板操作简单、创伤小、固定牢靠、并发症少,是治疗股骨粗隆间骨折的有效方法。 相似文献
5.
Biomechanical evaluation of the Ender's pins, the Harris nail, and the dynamic hip screw for the unstable intertrochanteric fracture 总被引:3,自引:0,他引:3
While intramedullary fixation may have less operative morbidity than sliding plate systems, there also may be a loss of stability and strength of the fixation. In a biomechanical study with simulated unstable intertrochanteric fractures in cadaver femurs, multiple Ender's pins were 18% stronger than the single Harris nail. Compression hip screws were three times stronger than the Harris nail and two and one-half times stronger than Ender's pins. The compression hip screw was five times more rigid than either condylocephalic system. 相似文献
6.
目的通过生物力学实验测试并评价有限动力髋螺钉(Limited dynamic hip screw,LDHS)内固定治疗股骨粗隆间骨折的生物力学性能。方法采集6具新鲜尸体中12根股骨中上段标本,造成EvansⅠ、Ⅱ型股骨粗隆间骨折模型(各6根),分别采用LDHS、DHS固定,要求将主钉安放在股骨头颈中心,且保持前倾10°-15°。LDHS组和DHS组分别进行股骨固定强度测试、刚度测试、头颈部剪断测试、扭转强度测试和极限载荷测试。结果 LDHS组与DHS组中EvansⅠ、Ⅱ型骨折模型在1200N载荷作用下,LDHS组股骨内、外侧固定强度更高,股骨头颈的轴向刚度、水平剪切刚度更高,剪切应变较小,差异均有统计学意义(P〈0.05)。在EvansⅠ、Ⅱ型骨折模型中,LDHS组最大扭矩较DHS组大,抗扭转刚度更高,但差异无统计学意义(P〉0.05);LDHS组能承受的极限载荷较DHS组大,差异有统计学意义(P〈0.05)。结论生物力学试验表明LDHS不仅在结构设计、整体生物力学性能上优于DHS,而且置入后未发生退钉现象。LDHS可能是治疗股骨粗隆间骨折更加理想的内固定器械。 相似文献
7.
Percutaneous dynamic hip screw 总被引:2,自引:0,他引:2
We present the results of a technique of dynamic hip screw insertion through a very small incision, typically 2-2.5 cm. The technique is performed using a standard dynamic hip screw set and requires no additional equipment. We compared the results to those of an age and sex-matched group who had undergone the operation through a traditional approach. We compared the time spent in theatre, the pre- and post-operative haemoglobin concentration, haematocrit and prevalence of wound infection. Thirteen consecutive cases were performed by one surgeon using the percutaneous technique. There were nine females and four males with a mean age of 84 years (range 62-96 years). Each had a 135 degrees four-hole plate. The mean post-operative drop in haemoglobin concentration in the percutaneous group was 2.2 g/dl (range 0-4.4 g/dl) compared to 3.5 g/dl (range 1.2-5.4 g/dl) in the control group (p = 0.014). The mean haematocrit drop was 0.07 (range 0-0.12) in the percutaneous group compared to 0.10 (range 0.03-0.17) in the control group (p = 0.017). The mean theatre time with the percutaneous technique was 57 min (range 40-75 min) and in the control group, 60 min (range 30-95 min). There were no wound problems. It is likely that this minimally invasive technique offers a better clinical outcome at no extra expense and warrants further evaluation in a larger study. 相似文献
8.
9.
动力加压髋螺钉取出后钉道内植骨的生物力学意义 总被引:5,自引:0,他引:5
目的:探讨动力加压髋螺钉(DHS)内固定治疗股骨上段骨折愈合后,取出DHS以后不处理的股骨上段、钉道植骨的股骨上段和完整的股骨上段的生物力学特性,为临床DHS取出术后进一步治疗提供理论依据。方法:收集16具新鲜尸体股骨标本进行实验应力分析,分别测定完整股骨上段,DHS取出后不处理的股骨上段和DHS取出后钉道内植骨股骨的股骨上段的力学特性,结果:DHS取出术后,不处理的股骨上段与完整股骨上段、DHS取出术后钉道植骨的股骨上段的力学特性相比,差异有显著性(P<0.01)。结论:股骨颈骨折DHS治疗骨折愈合取出固定后,应在股骨上段螺钉道内植骨补强,这有利于提高股骨上段的生物学性能,便于患者早期全负荷功能锻炼,防止再骨折和髋畸形等并发症的发生。 相似文献
10.
Marcus J K Bankes Jon M H Simmons Anthony Catterall 《Journal of pediatric orthopedics》2002,22(1):101-104
The authors report a series of 10 patients (4 male, 6 female) with end-stage hip degeneration who underwent unilateral hip arthrodesis at an average age of 19 years (range 14-35). Surgery was performed with the patient in the supine position through a Watson-Jones approach and fixation was stabilized with the AO Dynamic Hip Screw (DHS). After surgery, patients were mobilized in a short hip spica. Stable fixation with the DHS could not be achieved at surgery in one patient. Bony union was achieved in seven of the nine patients (78%) with a DHS after an average of 17 weeks (range 9-34). In one patient a painful nonunion developed; it was converted to a total hip arthroplasty 23 months later. Another patient obtained a painless pseudarthrosis, for which no further surgery is planned. The DHS provides a satisfactory means of stabilizing a hip arthrodesis when combined with a hip spica. This method of arthrodesis does not violate the origin or insertion of the abductor mechanism, thereby facilitating future conversion to total hip arthroplasty. 相似文献
11.
R H Lange R Vanderby W D Engber R W Glad M L Purnell 《Journal of orthopaedic trauma》1990,4(3):275-282
The Herbert screw has been demonstrated to have widespread clinical applicability. A biomechanical and histological evaluation of the Herbert screw was conducted to better define its applications. When subjected to pull-out, toggle, and compression testing, in a cancellous bone calf model, it was demonstrated to be biomechanically inferior to the 4.0 mm ASIF cancellous screw. The use of two Herbert screws minimized but did not eliminate this difference. Articular cartilage healing in a rabbit model was consistently demonstrated if the Herbert screw was buried deep to the osteochondral junction. However, toluidine blue histochemical staining showed that the hyaline-like repair cartilage differed qualitatively from normal cartilage. Utilization of the Herbert screw should include an understanding of the limitations of its fixation potential and a recognition of the repair response after intraarticular applications. 相似文献
12.
动力髋螺钉手术治疗转子间骨折 总被引:1,自引:0,他引:1
目的 探讨西藏高原转子间骨折动力髋螺钉(DHS)内固定手术的疗效.方法 对18例股骨转子间骨折行手术切开复位DHS内固定术,重建内侧支持结构,恢复髋关节功能.结果 18例经过4~36个月随访.17例伤口一期愈合;1例发生深部感染,经治疗1周后愈合.按黄公怡疗效评定标准:优12例,良4例,差2例.结论 DHS手术治疗转子间骨折,内固定可靠,并发症相对少,可有效预防髋内翻的发生. 相似文献
13.
14.
动力髋螺钉治疗股骨转子间骨折 总被引:8,自引:4,他引:8
我院 1995~ 1999年采用动力髋螺钉 (dynamichipscrew ,DHS)治疗股骨转子间骨折 5 2例 ,其中 45例随访 6个月~ 4年 ,疗效满意。1 病例资料本组 5 2例 ,男 2 8例 ,女 2 4例 ,年龄 2 3~ 82岁。致伤原因 :车祸伤 2 1例 ,高处坠落伤 12例 ,跌伤 19例。骨折类型〔1〕:顺转子间骨折 5 0例 ,按Evans分型 ,Ⅰ型 4例 ,Ⅱ型 7例 ,Ⅲ型2 1例 ,Ⅳ型 18例 ;逆转子间骨折 2例。2 治疗方法患者仰卧位 ,取股骨上端外侧切口 ,打入螺钉时 ,可在C形臂X线机透视下进行。按AO〔2〕推荐的方法使用动力髋螺钉。术后常规给予抗生素预… 相似文献
15.
16.
The authors report on 140 cases of fractures near the hip joint, which had been treated by applying a dynamic hip compression screw (DHS). DHS is an ideal method for stabilising pertrochanteral stable and lateral fractures. In unstable pertrochanteral fractures it is recommended to use a 130 degrees or 150 degrees DHS, depending on the age and the patient's preoperative ability to walk. In medial fractures of the neck of the femur the use of DHS offers no advantage compared with screwing or total endoprosthesis. The article reports on the postoperative results. In respect of these results DHS appears to be superior to fracture nailing according to Ender. 相似文献
17.
目的比较股骨近端锁定钢板(LCP)和动力髋螺钉(DHS)治疗老年股骨转子间骨折的临床疗效。方法手术治疗老年股骨转子间骨折112例,其中股骨近端LCP固定60例,DHS固定52例。患者术后4~6周逐渐负重下地行走。比较两组手术时间、术中出血量和术后恢复及并发症情况。结果 112例均获随访,时间6~18个月。骨折愈合时间3~9个月。LCP组有2例因负重过早出现轻度髋内翻;Harris评分:优48例,良10例,可2例,优良率为96.7%。DHS组亦有2例因负重过早出现轻度髋内翻,4例Ⅳ型骨折大转子粉碎者出现内固定松动移位;Harris评分:优33例,良9例,可6例,差4例,优良率为80.8%;两组优良率比较差异有统计学意义(P<0.05)。结论根据骨折类型合理选择内固定,股骨近端LCP和DHS治疗EvansⅠ~Ⅲ型老年股骨转子间骨折均可获得良好的临床效果,EvansⅣ型骨折和骨质疏松性骨折更宜采用股骨近端LCP固定。 相似文献
18.
Between 1983 and 1987 419 patients with femoral neck fractures were operated on at the University Clinics of Graz. In 120 patients we could preserve the head of the femur doing an internal fixation with cancellous bone screws or DHS. 68 of them we personally could control with a mean follow up of 45.2 months. The most important complications were the necrosis of the head which were observed in 19.1% of our patients and the non union which occurred in 5.8% but not all these patients required reoperation. 相似文献
19.
Internal fixation of intracapsular hip fractures results in a high failure rate with non-union and avascular necrosis being the two most important complications. In order to prevent these possible complications treatment should consist of an anatomical reduction and stable fixation by insertion of a low volume, dynamic implant, providing angular and rotational stability to the femoral head. According to these principles a new implant, the dynamic locking blade plate (DLBP) was designed for the fixation of intracapsular hip fractures. We performed a biomechanical analysis in synthetic bone to compare the rotational stability and cut out resistance of the DLBP with a conventional sliding hip screw (SHS) and the more recently developed Twin Hook. The rotational stability of the DLBP proved to be three times higher than the rotational stability of a SHS and two times higher than the Twin Hook. There was no major difference in cut out resistance between the different implants. The design of the DLBP and possible advantages with regard to the healing of an intracapsular hip fracture are discussed. 相似文献