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矩形髓内钉与Ender钉治疗胫腓骨骨折的临床应用及生物力学比较 |
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王新伟 吴岳嵩 王建华 王文良
【摘要】 目的 为进一步探讨矩形髓内钉的生物力学机制，设计矩形髓内钉的临床应用及生物力学实验研究，并与Ender钉进行对比。方法 (1)临床应用研究：手术治疗胫腓骨骨折218例，其中矩形髓内钉固定132例(138侧)，Ender钉固定86例。比较两种钉术中窗口劈裂、钉端异位穿出率、插钉次数>2次率、术后成角畸形率及二次手术率等的差异。(2)生物力学实验：12对24根人体胫骨标本分为两组，以同一人体的左右侧作自身对照。左侧行矩形髓内钉固定，右侧行Ender钉固定。分别行扭转试验及三点弯曲试验，描绘负载-位移曲线，两组比较并统计学处理(t检验)，分别计算扭转刚度及弯曲刚度。结果 矩形髓内钉的窗口劈裂率、钉端异位穿出率、插钉>2次率、成角畸形率、二次手术率等均小于Ender钉(P<0.01)；矩形髓内钉的扭转负载及前、后弯曲负载大于Ender钉(P<0.01)，而侧方弯曲负载与Ender钉无显著性差异(P>0.05)，矩形髓内钉的内旋及外旋扭转刚度均为0.23N*m/度；Ender钉外旋刚度为0.06N*m/度，内旋刚度为0.07N*m/度。矩形髓内钉前→后弯曲刚度为205.40N*m/度，后→前弯曲刚度为78.00N*m/度，Ender钉前→后弯曲刚度为50.40N*m/度，后→前弯曲刚度为45.40N*m/度。结论 矩形髓内钉在手术操作及控制固定后再移位方面优于Ender钉，主要是由于其抗扭性能及前后抗弯性能的提高。
【关键词】 胫骨 腓骨 骨折固定术，髓内 矩形髓内钉 生物力学
Biomechanical and Clinical Study on Rectangle-shaped Intramedullary Nails and Ender Nails for Interfixation of Tibiofibular Fractures
WANG Xinwei, WU Yuesong, WANG Jianhua, et al.
Dept. of Orthopedics, Changhai Teaching Hospital, Second Military Medical University, Shanghai 200433
【Abstract】 Objective To evaluate the different biomechanical and clinical characteristics between Ender nail and rectangle-shaped intramedullary nail (RIN). Methods Clinical study: RIN was used in 138 tibiofibular fractures and Ender nailing in 86 tibiofibular fractures. The damage of nailing entry, deformity rate, and the rate of second operation, etc were evaluated. Biomechanical study: Twenty-four tibias of 12 healthy adult cadavers were fractured and fixed with Ender nail and RIN in the left and right sides separately. Torsion and three point bending tests were examined in two groups. The torsional moment-angle curve, bending load deflection curve and their stiffness were described and compared statistically. Results The rate of entry damage and deformity in RIN group was significantly less than that in the Ender nailing group (P<0.01). The torsional moment and anter-posterior loads of RIN were greater than[1] [2] [3] 下一页
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