股骨远端骨折三种内固定方法生物力学比较研究与临床应用

A Comparative Biomechanical Study and Clinical Application of Three Internal Fixation Methods for Distal Femoral Fractures

目的 对股骨远端骨折三种内固定方法进行定量生物力学评价 ,为临床选择有效的内固定方法提供理论依据。方法 取12具新鲜尸体股骨标本 ,制成股骨髁间骨折 (AO分类的C1型 ) ,采用股骨髁上交锁髓内钉、L形髁钢板、加压钢板三种内固定方法 ,进行实验应力分析 ,比较不同内固定方法的优劣 ,并以有限元理论分析进一步论证它的结果。结果 发现在受同等载荷条件下 ,髁上交锁髓内钉固定最佳 ,而采用加压钢板固定的股骨髁强刚度较差 (P <0 0 5 )。临床手术 47例 ,按Kolmert功能评定标准 ,优良率分别为 :股骨髁上交锁髓内钉 94 1% ,L形髁钢板 82 4% ,加压钢板 76 9%。结论 采用股骨髁上交锁髓内钉固定方法优于其它内固定方法 ,值得临床推广应用。

Objective To evaluate quantitative biomechanical compairson of three internal fixation methods for distal femoral fractures,choose suitable clinical internal fixation method according to experimental data.Methods The models of fracture of femoral condyle were made on 12 fresh cadaver femurs(C 1 of AO classification).The fractures have been fixed by using supracondylar intramedullary interlocking nail,L shaped condyle plate and compressed plate fixation.These three different internal fixation methods have been compared through experimental stress analysis.Their results have been further confirmed by theoretical analysis using finite element method(FEM).Results Under the same load condition,supracondylar intramedullary interlocking nail method is the best ,while compressed plate method,the femoral condyle strength and origidity is worse(P<0 05).Forty seven case of distal femoral fractures were operated.The evaluation of the results by Kolmerts functional rating scale revealed good and excellent are 94 1% for supracondylar intramedullary interlocking nail,82 4%for L shaped condyle plate,and 76 9% for compressed plate.Conclusion Supracondylar intramedullary interlocking nail method is the best method among different internal fixation methods.It deserves to be put into application and populatization.