| 内侧支撑髓内钉和股骨近端抗旋髓内钉治疗股骨转子间骨折A3.3型的生物力学研究 |
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投稿时间：2020-07-12
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| 作者 | Author | 单位 | Address | E-Mail |
| 聂少波 |
NIE Shao-bo |
中国人民解放军总医院第一医学中心骨科, 北京 100853
国家骨科与运动康复临床医学研究中心, 北京 100853 |
Department of Orthopaedics, the First Medical Center, Chinese PLA General Hospital, Beijing 100853, China |
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| 李建涛 |
LI Jian-tao |
中国人民解放军总医院第一医学中心骨科, 北京 100853
国家骨科与运动康复临床医学研究中心, 北京 100853 |
Department of Orthopaedics, the First Medical Center, Chinese PLA General Hospital, Beijing 100853, China |
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| 赵燕鹏 |
ZHAO Yan-peng |
中国人民解放军总医院第一医学中心骨科, 北京 100853
国家骨科与运动康复临床医学研究中心, 北京 100853 |
Department of Orthopaedics, the First Medical Center, Chinese PLA General Hospital, Beijing 100853, China |
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| 赵喆 |
ZHAO Zhe |
清华长庚医院, 北京 102218 |
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| 朱保璋 |
ZHU Bao-zhang |
北京纳通医学科技研究院有限公司, 北京 100094 |
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| 闫云超 |
YAN Yun-chao |
中国人民解放军总医院第一医学中心放射科, 北京 100853 |
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| 张里程 |
ZHANG Li-cheng |
中国人民解放军总医院第一医学中心骨科, 北京 100853
国家骨科与运动康复临床医学研究中心, 北京 100853 |
Department of Orthopaedics, the First Medical Center, Chinese PLA General Hospital, Beijing 100853, China |
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| 唐佩福 |
TANG Pei-fu |
中国人民解放军总医院第一医学中心骨科, 北京 100853
国家骨科与运动康复临床医学研究中心, 北京 100853 |
Department of Orthopaedics, the First Medical Center, Chinese PLA General Hospital, Beijing 100853, China |
pftang301@163.com |
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| 期刊信息：《中国骨伤》2020年，第33卷，第12期，第1161-1165页 |
| DOI：10.12200/j.issn.1003-0034.2020.12.014 |
| 基金项目:首都卫生发展科研专项项目（编号：2016-1-5012） |
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中文摘要:目的：A3型股骨转子间骨折是极其不稳定的骨折，临床上常常采用髓内治疗，但是髓内固定失败率高，股骨后内侧结构不能重建是主要原因。介绍一种可以早期重建股骨内侧支撑的新型内侧支撑髓内钉，通过生物力学试验验证力学效果。
方法：利用人工股骨模型（Sawbones）制作内侧失支撑的A3.3型转子间骨折模型，分别用新型内侧支撑髓内钉（medial sustainable nail-Ⅱ，MSN-Ⅱ）和股骨近端抗旋髓内钉（proximal femoral nail anti-rotation，PFNA-Ⅱ）固定后，行轴向加载和轴向破坏试验，测定两种内固定物的轴向刚度、屈服载荷、头颈骨块的位移和断端扭转角度，比较两种内固定的生物力学差异，明确重建内侧支撑的髓内钉早期重建股骨内侧支撑的效果。
结果：MSN-Ⅱ的轴向刚度、屈服载荷、当轴向载荷为1 800 N时头颈骨块的位移、破坏试验后的骨折断端扭转角度分别为（222.76±62.46）N/mm，（4 241.71±847.42）N，（11.51±0.62）mm，（1.71±0.10）°；PFNA-Ⅱ分别为（184.58±40.59）N/mm，（3 058.76±379.63）N，（16.15±1.36）mm，（2.52±0.26）°，两组差异均有统计学意义。
结论：MSN-Ⅱ轴向刚度优于PFNA-Ⅱ，在固定A3.3型骨折时能耐受更大的载荷，具有更大的轴向和旋转稳定性，是重建A3型股骨转子间骨折内侧支撑有效的手段。 |
| 【关键词】股骨转子间骨折 内侧支撑 髓内钉 生物力学 |
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| Biomechanical study on the treatment of intertrochanteric fracture of A3.3 type with medial sustainable nail and proximal femoral anti-rotation nail |
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ABSTRACT Objective: A3 intertrochanteric fracture is an extremely unstable fracture,which is often treated with intramedullary nail,but the implant failure is common due to the posterior medial fragment cannot be reconstructed. A new medial sustainable nail(MSN-Ⅱ) which can reconstruct the femoral medial support by sustainable screw was introduced in this study. The mechanical effect was verified by biomechanical experiment.
Methods: The loss medial support model of intertrochanteric fracture (A3) was made by artificial Sawbones model,fixed with MSN-Ⅱ and PFNA-Ⅱ,underwent axial loading and axial failure tests. The axial stiffness,yield load,displacement of head-neck fragment and torsional angle of fracture site of these nails were recorded and compared for biomechanical differences. The effect of early reconstruction of medial support with MSN-Ⅱ was determined.
Results: The axial stiffness,yield load,the displacement of head and neck fragment when the axial load was 1 800 N and torsional angle of the fracture site after the axial failure test of MSN-Ⅱ were(222.76±62.46) N/mm,(4 241.71±847.42) N,(11.51±0.62) mm,(1.71±0.10)°respectively,while the PFNA-Ⅱ was (184.58±40.59) N/mm,(3 058.76±379.63) N,(16.15±1.36) mm,(2.52±0.26)°respectively. The difference between the two groups was statistically significant.
Conclusion: The axial stiffness of MSN-Ⅱ is better than that of PFNA-Ⅱ. The MSN-Ⅱ can bear more loads when fixed A3.3 intertrochanteric fracture and has greater axial and rotational stability. It is an effective means to reconstruct the medial support of A3 intertrochanteric fracture. |
| KEY WORDS Trochanteric fractures Medial support Intramedullary nail Biomechanical study |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 聂少波,李建涛,赵燕鹏,赵喆,朱保璋,闫云超,张里程,唐佩福.内侧支撑髓内钉和股骨近端抗旋髓内钉治疗股骨转子间骨折A3.3型的生物力学研究[J].中国骨伤,2020,33(12):1161~1165 |
| 英文格式: | NIE Shao-bo,LI Jian-tao,ZHAO Yan-peng,ZHAO Zhe,ZHU Bao-zhang,YAN Yun-chao,ZHANG Li-cheng,TANG Pei-fu.Biomechanical study on the treatment of intertrochanteric fracture of A3.3 type with medial sustainable nail and proximal femoral anti-rotation nail[J].zhongguo gu shang / China J Orthop Trauma ,2020,33(12):1161~1165 |
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