CAJ | 학술논문

背景:DHS是治疗股骨转子间骨折的标准内固定,对于伴有骨质疏松的骨折,容易发生拉力螺钉切割.国内外文献建议骨水泥强化DHS以达到坚强内固定,但是对于正常骨质,骨水泥强化是否有效还缺少报道.目的:选取正常骨密度的股骨转子间骨折标本,观察骨水泥强化对DHS固定的生物力学影响.设计、时间及地点:同一标本两侧对比观察实验,于2005-03/05在河北省骨科研究所生物力学实验室完成.材料:选取河北医科大学解剖教研室提供的成年男性防腐尸体双侧股骨上段标本.X射线证实无结核、畸形、肿瘤.方法:取成年男性防腐尸体双侧股骨上段标本24对48侧,制备A2型股骨转子间骨折模型.右侧标本行骨水泥强化DHS固定(在股骨头近端钉道用刮匙扩大.股骨头朝下,注入2mL低黏稠度骨水泥,拧入拉力螺钉,保持位置不变直至骨水泥凝固.置入套筒,拧紧尾钉适当加压,皮质骨螺钉固定钢板),为强化组;左侧行DHS常规固定,为对照组.两组标本进行弯曲强度试验及扭转强度试验.主要观察指标:两组标本的最大负荷及最大扭矩.结果:强化组最大负荷及最大扭矩与对照组比较,差异均无统计学意义[最大负荷分别为:(3852.1602±143.6031)N和(3702.9667±133.8601)N;最大扭矩分别为(15.5±2.6)N·m,(14.7±3.4)N·m, P>0.0⑤.结论:对于正常骨密度的股骨转子间骨折,骨水泥强化对DHS固定强度及骨折整体稳定性无显著的影响.
배경:DHS시치료고골전자간골절적표준내고정,대우반유골질소송적골절,용역발생랍력라정절할.국내외문헌건의골수니강화DHS이체도견강내고정,단시대우정상골질,골수니강화시부유효환결소보도.목적:선취정상골밀도적고골전자간골절표본,관찰골수니강화대DHS고정적생물역학영향.설계、시간급지점:동일표본량측대비관찰실험,우2005-03/05재하북성골과연구소생물역학실험실완성.재료:선취하북의과대학해부교연실제공적성년남성방부시체쌍측고골상단표본.X사선증실무결핵、기형、종류.방법:취성년남성방부시체쌍측고골상단표본24대48측,제비A2형고골전자간골절모형.우측표본행골수니강화DHS고정(재고골두근단정도용괄시확대.고골두조하,주입2mL저점주도골수니,녕입랍력라정,보지위치불변직지골수니응고.치입투통,녕긴미정괄당가압,피질골라정고정강판),위강화조;좌측행DHS상규고정,위대조조.량조표본진행만곡강도시험급뉴전강도시험.주요관찰지표:량조표본적최대부하급최대뉴구.결과:강화조최대부하급최대뉴구여대조조비교,차이균무통계학의의[최대부하분별위:(3852.1602±143.6031)N화(3702.9667±133.8601)N;최대뉴구분별위(15.5±2.6)N·m,(14.7±3.4)N·m, P>0.0⑤.결론:대우정상골밀도적고골전자간골절,골수니강화대DHS고정강도급골절정체은정성무현저적영향.
BACKGROUND: Dynamic hip screw (DHS) is a standard internal fixation for intertrochanteric fracture, whereas the patient combined with osteoporosis, cut-out incidence of lag screw is common. The articles in China and abroad indicate bone cement augmentation of DHS to achieve firm fixation. As for normal bone, no reports is published that whether bone cement augmentation is effective.OBJECTIVE: To investigate the biomechanics of DHS with bone cement augmentation for the fixation of intertrochanteric fracture specimen that has a normal bone density.DESIGN, TIME AND SETTING: Bilateral contrast observation study of the same sample was performed in the Laboratory of Biomechanics, Hebei Orthopaedic Research Institute (Shijiazhuang, Hebei Province, China) between March and April In 2005.MATERIALS: Bilateral upper femora from the embalmed male cadaver were provided by Anatomy Department of Hebei Medical University (China). X-ray scan results proved the absence of tuberculosis, anatomical deformity and tumor.METHODS: Twenty-four matched pairs of the upper femora (48 sides) were used to make the specimens of the intertrochanteric fracture of type A2. The right femur specimens were fixed with DHS augmented by bone cement, as the augmentation group (The screw track of femoral neck was expended by curette, and the femoral head facing upwards were injected with 2mL low viscosity bone cement. Then lag screw was wrested to keep the position unchanged till the bone cement coagulated. Placing barrel, compressing through tighten tail screw, and cortical screw fixing side-plate were. followed). And the left femur specimen was fixed with DHS conventional fixation, as the control group. The bending and torsional tests were performed in the two groups.MAIN OUTCOME MEASURES: The maximum load and the maximum torque in the two groupsRESULTS: The maximum load and the maximum torque were (3852.1602±143.6031) N and (15.5+2.6) Nm in the augmentation group, and (3702.9667±133.8601) N and (14.7±3.4) Nm in the control group. There was no significant difference in the biomechanical effects between the two groups (P>0.05).CONCLUSION: The augmenting fixation with bone cement for intertrochanteric fracture specimen has no significant effect on the strength of DHS fixation or on the overall stability of the fractured bone in normal bone density.