国人股骨胫骨髓腔的形态学研究及带锁髓内钉的改进

Morphological Study of Marrow Cavity of Femur and Tibia in Chinese and Improvement of Un-Reamed Interlocking Nail

为设计适合中国人使用的带锁髓内钉，对成年人新鲜不成对股骨１８根、胫骨２２根髓腔形态作一系统的观测和铸型研究。结果：股骨髓腔中轴有一向前弧度，于非松质骨区弧度半径为：８８．８８９ｃｍ±１６．０４７ｃｍ（７０～１２５ｃｍ）；髓腔两端松质骨区呈矢状径短、冠状径长的漏斗形，非松质骨区为矢状径长、冠状径短的类柱体，狭窄区集中于中上部，最狭窄部的矢冠状径分别为：１．４３５ｃｍ±０．１６６ｃｍ和１．２０２ｃｍ±０．１１３ｃｍ。胫骨髓腔的非松质骨区，中轴是一条直线，两端松质骨区髓腔宽大，亦似漏斗状。各部位的横断面近似圆形，狭窄区集中于中下部。最狭窄部矢冠状径分别为：１．１９２ｃｍ±０．１９６ｃｍ和１．２３０ｃｍ±０．１９４ｃｍ，胫骨结节上方的入钉点，距近端松质骨起处的距离是８．６３６ｃｍ±０．６９３ｃｍ，且与非松质骨区髓腔中轴成１１．５４５°±１．７１°（９°～１４°）的夹角。据所测结果，将股骨带锁髓内钉改为有弧度的，其弧度半径１２５ｃｍ，钉的直径为１．２０２ｃｍ±０．１１３ｃｍ；胫骨带锁髓内钉的弯曲部位改在上中１／４交界处，弯曲角度改为１１．５°，直径为１．１９２ｃｍ±０．１９６ｃｍ。在新鲜完整的和模拟骨折的尸体骨上试验?

Morphological study of the marrow cavity of 18 fresh femur and 22 fresh tibia was conducted. There is a forward curvature of femur, the average radius of the radian is 88.889cm±16.047cm(70～125cm). The sagittal diameter of the cavity is smaller than the coronal one in the proximal and distal ends of the femur. The diameter of the narrowest part of the femur is 1.435cm±0.166cm sagittally and 1.202cm±0.113cm coronally. The proximal and distal cavity of the tibia looks like a funnel. The diameter of the narrowest part of tibia is 1.190cm±0.196cm sagittally and 1.230cm±0.194cm coronally. On the basis of above data the interlocking nail of the femur should be curved with a radian that the radius is 125cm. The nail diameter is 1.202cm±0.113cm. The curved part of the interlocking nail of the tibia should be corrected to the intersection between the middle and upper 1/4 of tibia. The angle is 11.5°. The diameter is same as that of the femur. The anthors used the improved nails in some cadaver femurs and tibias and also some patients in this study, which proved the rationality of this design.