锁孔和锁钉杆过渡配合交锁髓内钉内固定骨折断端的生物稳定性

Keyhole and lockpin shank transition combined with interlocking intramedullary nail fixation improve the biological stability of fracture site

背景:随着交锁髓内钉的广泛使用,使骨折延迟愈合、交锁钉断裂等问题逐渐显露出来,在此情况下,一种锁孔和锁钉杆过渡配合交锁髓内钉应运而生。目的:观察新设计的锁孔和锁钉杆直径过渡配合交锁髓内钉和传统交锁髓内钉固定骨折稳定性的比较。方法:应用8具两侧股骨骨折标本,分别采用8根锁孔和锁钉杆直径过渡配合交锁髓内钉和传统交锁髓内钉固定骨折断端。实验组应用定制髓内钉远端瞄准微调装置配套安装器械锁钉,使用定制的直径4.3mm锁钉交锁固定;对照组应用常规的配套安装器械,常规的直径4.0mm锁钉交锁固定,给予两组股骨固定标本,分别记录测量两组股骨骨折断端左右、前后、旋转移位情况,来进行骨折固定稳定性比较。结果与结论:锁钉杆过渡配合髓内钉固定股骨中下段骨折,在10N受力的情况下,股骨骨折断端平均有左右移位1.22mm、前后移位1.2mm、旋转移位0.33mm;传统交锁髓内钉锁孔在10N受力的情况下,股骨骨折断端平均有左右移位3.26mm、前后移位3.37mm、旋转移位2.15mm,锁钉杆过渡配合髓内钉固定股骨骨折,骨折断端左右、前后、旋转移位明显小于传统交锁髓内钉,有显著性差异。说明锁孔和锁钉杆直径过渡配合交锁髓内钉置入内固定可明显提高骨折断端的稳定性。

OBJECTIVE： To observe the stability of keyhole and Iockpin shank diameter transition combined with interlocking intramedullary nail and traditional interlocking intramedullary nail fixation. METHODS： Eight bilateral femoral fracture specimens were used and the fracture sites were fixed with eight keyholes and Iockpin shanks diameter transition combined with interlocking intramedullary nail and traditional interlocking intramedullary nail fixation. In the experimental group, the customized intramedullary nail distal aiming fine-tuning device was used to install the matching equipment nail, and then interlocking fixed by customized interlocking nail with the diameter of 4.3 mm; in the control group, conventional matching installation equipment was used, and then interlocking fixed by interlocking nail with the conventional diameter of 4.0 mm. The specimens in two groups were fixed with the methods above respectively, and then the displacement from left to right, from forward to backward and the rotation displacement of the femoral fracture sites in two groups were recorded and measured, in order to compare the stability of the fracture fixation. RESULTS AND CONCLUSION： For the treatment of middle femur fracture with keyholes and Iockpin shanks transition combined with interlocking intramedullary nail fixation, when loaded with 10 N force, the femoral fracture sites had 1.22 mm displacement from left to right, 1.22 mm from forward to backward and 0.33 mm rotation displacement; when the traditional interlocking intramedullary nail keyhole loaded with 10 N force, the femoral fracture sites had 3.26 mm displacement from left to right, 3.37 mm from forward to backward and 2.15 mm rotation displacement. The displacement from left to right, from forward to backward and the rotation displacement of the fracture sites after fixed with Iockpin shanks transition combined with interlocking intramedullary nail were smaller than those after fixed with Iockpin shanks transition combined with traditional interlocking intramedullary nail, and the differences were significant. The results indicate that keyhole and Iockpin shank transition combined with interlocking intramedullary nail fixation can improve the stability of fracture site.