中空松质骨螺钉治疗儿童股骨颈骨折的生物力学及临床研究

Cannulated cancellous screws for treatment of femoral neck fracture in children: a biomechanical and clinical study

目的 探讨中空松质骨螺钉治疗儿童股骨颈骨折的生物力学性能及临床疗效。方法 收集6具国人儿童新鲜股骨标本，分别采用3枚中空松质骨螺钉“品”字形固定，3枚克氏针“品”字形固定，并进行生物力学测试。临床应用经皮中空松质骨螺钉内固定治疗儿童股骨颈骨折15例。结果 中空松质骨螺钉固定使股骨颈在抗压、抗扭等生物力学性能上较克氏针优越（P〈0．05）。随访1～2年，平均1．3年，15例患者均愈合，其中1例股骨颈骨折股骨头变扁坏死。功能评价：优12例（80％），良3例（20％）。结论 中空松质骨螺钉治疗儿童股骨颈骨折比克氏针固定更具有生物力学优势，而且使骨折断端嵌插紧密，能加速骨折愈合，减少并发症，是治疗少儿股骨颈骨折理想的方法。

Objective To investigate the biomechanical property and clinical effect of cannulated cancellous screws used in children with femoral neck fracture. Methods A model of femoral neck fracture was produced on 6 femur specimens of fresh children cadavers, in which three cannulated cancellous screws and three Kirschner wires were respectively applied to strengthen the fracture and conduct biomechanical test. Fifteen children with femoral neck fracture were also treated with triple cannulated cancellous screws. Results Trilple cannulated cancellous screw fixation showed advantage over Kirschner wire fixation in biological capability including anti-compression and anti-torsion （ P 〈 0. 05 ）. The follow up for 1-2 years showed fracture healing in 15 cases and femoral head necrosis in one. Functional result was excellent in 12 cases （80%） and good in three （20%）. Conclusion In comparison with Kirschner wire fixation, percutaneous triple cannulated cancellous screw fixation is an ideal method for treatment of femoral neck fracture in children, for it has advantage of biomechanics, can tightly compact fracture end, accelerate fracture healing and reduce complications.