改良内固定治疗股骨颈骨折的研究

Experimental studies on treatment of femoral neckf racture by improved internal fixation

目的 改进股骨颈骨折内固定方法,并观察其治疗效果.方法 18只山羊采用手术方法造成双侧股骨颈移位骨折模型,实验侧采用改良内固定,对照侧采用传统髓内固定.术前及术后4、6、8、12周分5次行放射性核素三相骨显像检查 术后4、8、12周分3批处死动物行股骨头、颈组织学观察 同时结合X线检查客观评价改良内固定治疗股骨颈骨折的疗效.结果 （1）放射性核素骨显像：血流相及血池相显示实验侧股骨头不但动脉灌注较对照侧好,而且静脉回流也比对照侧通畅.骨静态相显示术后4、6周实验侧头/干比值大于对照侧（P〈0.01）,表明实验侧股骨头的血流量和骨代谢率高于对照侧,股骨头血供重建及骨组织修复过程较对侧快.（2）组织学观察结果显示在血管重建、编织骨生成及坏死骨清除等阶段实验侧均较对照侧提前.结论 改良内固定在力学稳定件增加的基础上,减轻了股骨颈髓内压力,保护了残留血供,有利于骨折愈合及股骨头血供的早期重建,促进了骨组织的修复.

Objective To observe the therapeutic effect of treating femoral neck fracture after improved the fixation methods. Methods The bilateral femoral neck fractures model of 18 goats were resulted by operation. The experimental side was fixed using a modified method, and the control side was fixed using the traditional internal fixation techniques. The three-phase radionuclide bone imaging examination was performed 5 times in the pre- and 4,6,8,12 weeks after operation. The femoral head and neck of the goats which were killed in the 4,8,12 weeks after operation were observated by histology. And the treatment effect of femoral neck fractures with modified fixation was evaluated through X-ray examination. Results（1） Blood flow and pool curve showed the blood flow in the artery and the vein of the experimental side was better than that of the control side. Radionuclide bone imaging appear the femoral head blood flow and me-tabolization rate of the experimental side was higher than that of the control side. In the 4th,6thweek after the operation,the bone tissue repaired process was quickly in the experimental side. （2） Histology observation results show that the vascular remodeling and woven bone formation in the experiment side was more rapid than thatof the control side. The clearance of necrosis bone chips in the experiment sidewas accelerated. Conclusion The modified fixation method which in the basis of increasing the stability reduced the intramedullary pressure of femoral neck and protected the residual blood supply, which was conducive to fracture healing, the early reconstruction of femoral head blood supply and promoting bone tissue repair.