股骨干骨折钢板内固定术的优化方案

Excellent Project in Internal Fixation with Steel Plates for the Treatment of Femoral Shaft Fracture

目的研究钢板治疗股骨干骨折的优化方案.方法利用6根新鲜成人离体股骨标本制作骨折内固定模型,分别模拟2种受力状态:模拟骨折愈合后的受力状态(未锯断);骨折后加压钢板坚强内固定组(锯断后).利用力学测试仪,测试螺钉在最大受力500 N时的位移和应变情况.结果b状态下钢板上各枚螺钉的位移和应变均显著大于a状态(P<0.05).近骨折线两端的螺钉(第5、6枚螺钉)的位移和应变最大(P<0.05).结论采用钢板内固定治疗股骨干骨折时,应尽可能的保证每孔都固定螺钉,并且螺钉足够长均穿透双侧骨皮质;靠近骨折线两端的螺钉,应采用偏心固定,其余螺钉则骨孔钻在钢板孔的中央,使钉帽以最大面积与钉孔缘接触.

Objective To study an excellent project of steel plates for the treatment of femoral shaft fracture. Methods Six antiseptic adult femora were used to make samples of internal fixation with steel plates. Two conditions were simulated： a. cured fracture （integrity） ; b. internal fixation of compression steel plates （segmentation）. The bias and straining of screws under the axial load applied 500 N were tested by MTS machine. Results There was more obvious change about bias and straining of every screw under condition b than a （P 〈 0.05）. The two screws of 5, 6 which were near to fracture line had produced the most obvious change in the bias and straining （P 〈 0.05）. Conclusions When the treatment of femoral shaft fracture with steel plates is used, every bore should be fixed by screws with enough length to penetrate two cortical bone. The two screws which are near to fracture line should be fixed off center, while others should be fixed in the center of the pore with their cowls to touch the fringe of countersink for a maximum area.