中空植骨式动力髋螺钉固定并促进股骨颈骨折愈合

Hollow-Bone-Graft Dynamic Hip Screw Can Fix and Promote Fracture Healing of Collum Femoris:An Experimental Study

目的研究中空植骨式动力髋螺钉与普通动力髋螺钉对股骨颈骨折愈合的影响。中空植骨式动力髋螺钉是普通动力髋螺钉的改进,是否防止股骨头坏死和促进骨折愈合,目前尚不清楚。方法本实验选取8只山羊（雌雄各半,40~50kg/只）纳入实验研究,制作股骨颈骨折动物模型,骨折间隙为0.5mm,分别采用中空钉和普通钉固定。术后6、12周进行X线、CT分析及髋关节活动度评分。结果术后6周及12周X线及CT检查发现中空钉组与普通钉组在骨小梁容积百分比及骨密度方面均存在统计学差异。术后6周骨小梁容积百分比：中空钉组为（0.891±0.014）%,普通钉组为（0.763±0.023）%,P〈0.001;骨密度：中空钉组张力侧为（138.68±2.58）mg/mL,压力侧为（139.46±2.11）mg/mL,普通钉组张力侧为（135.16±2.27）mg/mL,压力侧为（136.22±2.16）mg/mL,P〈0.05;两组比较差异有统计学意义。术后12周骨小梁容积百分比：中空钉组为（0.966±0.021）%,普通钉组为（0.835±0.037）%,P〈0.05;骨密度：中空钉组张力侧为（145.33±1.37）mg/mL,压力侧为（148.25±2.14）mg/mL,普通钉组张力侧为（141.73±2.26）mg/mL,压力侧为（143.53±3.71）mg/mL,P〈0.05;两组比较差异有统计学意义。术后6周及12周髋关节内收、外展、前屈、后伸、旋内、旋外活动度中空钉组与普通钉组相比P〈0.05,差异有统计学意义。结论中空钉能够稳定的固定股骨颈骨折端,可以刺激骨小梁形成及增加骨密度,促进骨折愈合和恢复髋关节活动度。本实验研究将为临床采用中空钉治疗青壮年股骨颈骨折起到一定的指导作用。

Objective As we know,after the fracture of the femoral neck in young adults,it may easily cause bone delayed union、nonunion or even osteonecrosis Second bone healing requires strong internal fixation、intramedullary reduced pressure and early rehabilitation functional exercise The animal experiment research may evaluate the fracture healing of the femoral neck between the Hollow-Bone-Graft Dynamic Hip Screw（Hb-DHS）and standard Dynamic Hip Screw（DHS）However,the Hb-DHS comes from the reform of the DHS.It is not known whether the Hb-DHS can prevent the osteonecrosis of the femoral head and promote the fracture healing Methods The Hb-DHS and DHS were designed to consistent with the femoral neck and head of the experimental animal Then eight young adults goats（regardless of male and female,40~50kg/each）were enrolled in this study Fracture models were successfully established on each goat,on which the both fracture gap was 0.5mm and the left femur was fixed with Hb-DHS,the right femur was fixed with DHS Radiographic Assessment and Activity Assessment of Hip Joint was done at 6and 1.weeks after surgery Results The X-ray and Computed Tomography examination showed the trabecular bone volume percentage（Vp）and bone mineral density（BMD）statistically differences between Hb-DHS group and DHS group 6week and 12 week after surgery,the differences of the Vp and the BMD in both groups were statistically significant（P0.001）,so was the activity assessment of hip joint（P0.05）In addition,we detect the fracture line in both group were visible at postoperative week 6,but at postoperative week 1.the fracture line was obscure in Hb-DHS group while it was indistinctly visible in DHS.Conclusion The Hb-DHS,which can stimulate the formation of trabecular bone,increase the BMD,promote the fracture healing and rehabilitate the activity of hip joint,have more advantages in internal fixation of femoral neck fractures than DHS Therefore,we can conclude that the Hb-DHS of this animal experiment will play an important role in clinical treatment of femoral neck fracture in young adults.