CAJ | 학술논문

目的设计一种中空植骨式动力髋螺钉,探讨该植骨螺钉是否能促进猪股骨颈骨折愈合. 方法将动力髋螺钉设计成螺纹间带孔隙、中间扇叶状窗口的中空螺钉.选取16只健康实验猪(雌雄各半,平均月龄为3.5个月,平均体质量为25.1 kg),制作双侧股骨颈骨折(经颈型)动物模型,左后肢采用中空植骨式动力髋螺钉固定(实验组),右后肢采用普通动力髋螺钉固定(对照组).于术后4、8、12及16周分别行双侧髋关节X线片检查及CT平扫;于术后4、8、12周各处死4只猪取材,行生物力学测试;于术后16周处死4只猪,大体观察股骨颈骨折的愈合情况. 结果 X线片及CT平扫显示:术后4周实验组骨折线已部分模糊,新骨密度均匀;对照组骨折线清晰可见.术后16周实验组骨折线处周围骨密度与正常骨组织无明显区别,外周光滑,股骨头表面未见点状致密增生;对照组骨折线处骨密度增高,少量骨吸收和骨小梁融合.术后8、12、16周实验组猪的Lane-Sandhu评分均较对照组高,差异有统计学意义(P＜0.05).术后4、8、12周实验组猪标本的轴向刚度、三点弯曲刚度及抗扭转力均较对照组大,差异有统计学意义(P＜0.05).术后16周大体观察显示实验组猪骨断端表面愈合良好;对照组骨折端为骨质连接. 结论中空植骨式动力髋螺钉既能提供可靠固定,又能在骨折断端处植骨,可促进骨折早期愈合.本研究为此螺钉应用于临床治疗股骨颈骨折提供了实验依据.
목적 설계일충중공식골식동력관라정,탐토해식골라정시부능촉진저고골경골절유합. 방법 장동력관라정설계성라문간대공극、중간선협상창구적중공라정.선취16지건강실험저(자웅각반,평균월령위3.5개월,평균체질량위25.1 kg),제작쌍측고골경골절(경경형)동물모형,좌후지채용중공식골식동력관라정고정(실험조),우후지채용보통동력관라정고정(대조조).우술후4、8、12급16주분별행쌍측관관절X선편검사급CT평소;우술후4、8、12주각처사4지저취재,행생물역학측시;우술후16주처사4지저,대체관찰고골경골절적유합정황. 결과 X선편급CT평소현시:술후4주실험조골절선이부분모호,신골밀도균균;대조조골절선청석가견.술후16주실험조골절선처주위골밀도여정상골조직무명현구별,외주광활,고골두표면미견점상치밀증생;대조조골절선처골밀도증고,소량골흡수화골소량융합.술후8、12、16주실험조저적Lane-Sandhu평분균교대조조고,차이유통계학의의(P＜0.05).술후4、8、12주실험조저표본적축향강도、삼점만곡강도급항뉴전력균교대조조대,차이유통계학의의(P＜0.05).술후16주대체관찰현시실험조저골단단표면유합량호;대조조골절단위골질련접. 결론 중공식골식동력관라정기능제공가고고정,우능재골절단단처식골,가촉진골절조기유합.본연구위차라정응용우림상치료고골경골절제공료실험의거.
Objective To investigate the effect of a self-designed hollow-bone-graft dynamic hip screw on fracture healing in a pig model of femoral neck fracture.Methods We designed novel dynamic hip screws of titanium alloy which are hollow and have flabellum-like and round openings between screw threads.Sixteen healthy pigs (half males and half females,mean age of 3.5 months and mean body mass of 25.1 kg) were used to create models of bilateral femoral neck fractures.The left femurs were fixated with hollow-bone-graft dynamic hip screws as the experimental group,and the right femurs were fixated with conventional dynamic hip screws as the control group.At 4,8,12 and 16 weeks after surgery,the animals received X-ray and CT examinations and 4 animals were sacrificed each time to harvest both femurs for biomechanical test (4,8,12 weeks postoperation) or gross observation of fracture healing (16 weeks postoperation).The axial bending and torsional stiffness were assessed in the biomechanical test.Results The X-ray and CT examinations showed:at 4 weeks,the fracture lines were partially blurred and new bone grew evenly in the experimental group but the fracture lines were still clear in the control group; at 16 weeks,the bone density around the fracture line was similar to that of normal bone tissue and no punctiform dense hyperplasia was observed on the smooth surface of the femoral head in the experimental group while increased bone density at the fracture line and limited bone resorption and bone trabecula assimilation were observed in the control group.At 8,12,16 weeks after surgery.the experimental group had significantly higher Lane-Sandhu scores than the control group P ＜ 0.05).At 4,8,12 weeks postoperation,the experimental group had significantly greater stiffness against compression,bending and torsion than the control group(P ＜ 0.05).Gross observation at 16 weeks showed fine healing of the fracture ends in the experimental group but bony connection of the fracture ends in the control group.Conclusions Since the novel hollow-bone-graft dynamic hip screws can not only provide rigid internal fixation but also facilitate autogenous bone infusion at the fracture site,they promote early union of the fracture in an animal model.This experiment provides evidence for the clinical application of these screws.