中国组织工程研究
中國組織工程研究
중국조직공정연구
Journal of Clinical Rehabilitative Tissue Engineering Research
2015年
22期
3584-3589
,共6页
桂曙光%李德彬%刘安平%胡小东
桂曙光%李德彬%劉安平%鬍小東
계서광%리덕빈%류안평%호소동
植入物%骨植入物%伽马钉三代(Gamma3)%股骨转子间骨折%植骨%股骨近端锁定钢板%生物力学
植入物%骨植入物%伽馬釘三代(Gamma3)%股骨轉子間骨摺%植骨%股骨近耑鎖定鋼闆%生物力學
식입물%골식입물%가마정삼대(Gamma3)%고골전자간골절%식골%고골근단쇄정강판%생물역학
背景：老年人股骨转子间骨折使用伽马钉三代(Gamma3)治疗时，可能使骨折块分离，难于固定小转子使稳定性差，易出现髋内翻畸形，则较难支撑及满意复位。目的：比较股骨近端锁定钢板与Gamma3治疗稳定型股骨转子间骨折后的效果及稳定性。方法：①纳入64例股骨转子间骨折患者，分别采用Gamma3内固定(n=32)和股骨近端锁定钢板内固定(n=32)进行治疗，通过X射线正、侧位片评估骨折复位及愈合情况，并对股骨转子内翻角、股骨转子内侧后倾角进行生物力学测试。②选取形态、大小近似的8对股骨标本，随机分为Gamma3组和股骨近端锁定钢板组(n=4)，分别采用Gamma3内固定和股骨近端锁定钢板内固定，轴向压缩试验和破坏试验后描绘载荷-位移曲线，采用扭转试验计算最大屈服载荷值。结果与结论：股骨近端锁定加压钢板内固定组患者手术时间、术中出血量多于Gamma3内固定组(P <0.05)。股骨近端锁定加压钢板内固定组患者骨折复位质量评定结果优于Gamma3内固定组(P <0.05)。股骨近端锁定加压钢板组股骨标本轴向刚度及各扭转角相应扭矩均小于Gamma3组(P <0.05)。说明在固定合并大转子骨折的股骨转子间骨折中，股骨近端锁定钢板更具有生物力学上的稳定性。
揹景：老年人股骨轉子間骨摺使用伽馬釘三代(Gamma3)治療時，可能使骨摺塊分離，難于固定小轉子使穩定性差，易齣現髖內翻畸形，則較難支撐及滿意複位。目的：比較股骨近耑鎖定鋼闆與Gamma3治療穩定型股骨轉子間骨摺後的效果及穩定性。方法：①納入64例股骨轉子間骨摺患者，分彆採用Gamma3內固定(n=32)和股骨近耑鎖定鋼闆內固定(n=32)進行治療，通過X射線正、側位片評估骨摺複位及愈閤情況，併對股骨轉子內翻角、股骨轉子內側後傾角進行生物力學測試。②選取形態、大小近似的8對股骨標本，隨機分為Gamma3組和股骨近耑鎖定鋼闆組(n=4)，分彆採用Gamma3內固定和股骨近耑鎖定鋼闆內固定，軸嚮壓縮試驗和破壞試驗後描繪載荷-位移麯線，採用扭轉試驗計算最大屈服載荷值。結果與結論：股骨近耑鎖定加壓鋼闆內固定組患者手術時間、術中齣血量多于Gamma3內固定組(P <0.05)。股骨近耑鎖定加壓鋼闆內固定組患者骨摺複位質量評定結果優于Gamma3內固定組(P <0.05)。股骨近耑鎖定加壓鋼闆組股骨標本軸嚮剛度及各扭轉角相應扭矩均小于Gamma3組(P <0.05)。說明在固定閤併大轉子骨摺的股骨轉子間骨摺中，股骨近耑鎖定鋼闆更具有生物力學上的穩定性。
배경：노년인고골전자간골절사용가마정삼대(Gamma3)치료시，가능사골절괴분리，난우고정소전자사은정성차，역출현관내번기형，칙교난지탱급만의복위。목적：비교고골근단쇄정강판여Gamma3치료은정형고골전자간골절후적효과급은정성。방법：①납입64례고골전자간골절환자，분별채용Gamma3내고정(n=32)화고골근단쇄정강판내고정(n=32)진행치료，통과X사선정、측위편평고골절복위급유합정황，병대고골전자내번각、고골전자내측후경각진행생물역학측시。②선취형태、대소근사적8대고골표본，수궤분위Gamma3조화고골근단쇄정강판조(n=4)，분별채용Gamma3내고정화고골근단쇄정강판내고정，축향압축시험화파배시험후묘회재하-위이곡선，채용뉴전시험계산최대굴복재하치。결과여결론：고골근단쇄정가압강판내고정조환자수술시간、술중출혈량다우Gamma3내고정조(P <0.05)。고골근단쇄정가압강판내고정조환자골절복위질량평정결과우우Gamma3내고정조(P <0.05)。고골근단쇄정가압강판조고골표본축향강도급각뉴전각상응뉴구균소우Gamma3조(P <0.05)。설명재고정합병대전자골절적고골전자간골절중，고골근단쇄정강판경구유생물역학상적은정성。
BACKGROUND:Being used in senile intertrochanteric fracture, the third generation of Gamma nail may isolate fracture fragments and it is difficult to be secured in the rotor, so the stability is poor. Varus deformity easily appears, which is difficult to support or satisfactorily reset. OBJECTIVE:To compare the effects and stability of the proximal femoral locking plate and the third generation of the gamma nail in the treatment of stable intertrochanteric fracture. METHODS:(1) A total of 64 patients with intertrochanteric fractures were respectively treated with the third generation of the gamma nail fixation (n=32) and proximal femoral locking plate fixation (n=32). Fracture reduction and healing were assessed using anteroposterior and lateral radiographs. Femoral rotor varus angle and intertrochanteric medial inclination received biomechanical measurement. (2) Eight femoral specimens whose shape and size were approximated were selected to be randomly assigned to Gamma 3 group and proximal femoral locking plate group (n=4), which respectively received Gamma 3 fixation and proximal femoral locking plate fixation. After axial compression test and destruction test, load-displacement curve was drawn. The maximum yield load value was calculated by torsion test. RESULTS AND CONCLUSION:Operative time and intraoperative blood loss were significantly more in the proximal femoral locking plate group than in the Gamma 3 group (P < 0.05). The fracture quality assessment results were better in the proximal femoral locking plate group than in the Gamma 3 group (P < 0.05). The axial stiffness and corresponding torque of various torsion angles were smaler in the proximal femoral locking plate group than in the Gamma 3 group (P < 0.05). Experimental results indicated that in the course of fixating intertrochanteric fracture merged with greater trochanter fracture, the proximal femur locking plate has obtained more biomechanical stability.
