摘要
股骨干远段骨折应用Küntscher针常由于无法控制骨折远端旋转移位而造成治疗上的困难.内锁式髓针Interlockingnail则由于其配套设备要求较高及手术难度等原因,使其推广受到限制.基于以上原因,我们研制了组合式防旋转髓内针(combinedantirotationintramedularynail,CAIN).该针为分体式组合结构,通过内针的侧刃及远端分叉的两翼向外针传递扭矩,外针通过较高的刚度对断骨形成坚强约束.生物力学试验表明该针具备足够强度以对抗骨折部位的弯矩和扭矩,并由于运用侧刃传递扭矩,使扭矩均匀分布,克服了应力集中现象.自1992年1月~1993年5月应用治疗股骨干远段骨折45例(46侧),除1侧由于髓针植入过短失败外,其余45侧平均随访34.5个月,优良率达100%.作者认为CAIN具有力学结构合理、手术方法简单、效果可靠及不需在透视下操作等优点,对于大多数股骨干远段骨折病例,为一值得推荐的方法.
Thetreatmentoffracturesoverthedistalhalfofthefemurisdifficultbecausetherota-tionbetweenthetwoendsofthefracturesegmentscannotbecontroledbyküntscher'snail.Inrecentyears,interlockingnailshavebeenavailableforthetreatment,howevertheiruseislimitedbecauseoftherequirementofthecostlyspecialinstrumentationandthedificultiesoftheinsertiontechniques.Thecombinedantirotationintramedularynail(CAIN)designedbytheauthorsforthepurposeconsistedoftwoparts,theinnernailandtheouternail.Thetwistingmomentumafectingthefracturedsegmentswasbornebythelateraledgesandthetwobranchedendsoftheinnernail,sothetwoendsofthefrac-turewereheldfirmlybythehardouternail.Thebiomechanicalexperimentswithhumanfemoralspeci-mensshowedthat,thestifnessofCAINwasenoughtoresistthebendingandtwistingmomentumatthesiteofthefracture;thetwistingmomentumwastransmitedbybothofthelateraledgsthustheconcentrationofthestresscouldbeavoided.FromJanuary1992toMay1993,45cases(46femurs)withfracturesoverthedistalhalfofthefemoralshaftweretreatedbyCAIN.Exceptonefailureduetoincorrectpositionofthenail.Altheother45femursobtaindexcelentresultswithanaverage34.5mouthsoffolow-up.TheauthorsconsideredthattheCAINisefectiveforthetreatmentofthedistalhalfofthefemoralshafts.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
1996年第9期547-551,共5页
Chinese Journal of Orthopaedics
关键词
股骨骨折
内固定
髓内针
DistalfemonalshaftfractureInternalfixationCombinedantirotationin-tramedularynail