股骨型髓内分叉钉的研制与临床应用

Development and clinical application of intramedullary tridentate nails for femoral shaft fractures

目的 研制一种新的简单有效的股骨骨折髓内固定器械 ,并分析其临床治疗特点。方法 将 3 6根成人尸体股骨标本随机分为 3组 ,做成股骨中下段横型骨折的模型 ,分别用股骨型髓内分叉钉、Ender钉和梅花钉固定。各组分别进行抗扭、抗弯和抗拉生物力学试验。临床应用髓内分叉钉治疗股骨骨折 3 4例 ,包括股骨各段的横形、斜形、螺旋形、粉碎性骨折 (其中 5例为陈旧性骨折 )。 结果 股骨型髓内分叉钉的生物力学性能明显优于Ender钉和梅花钉。全部病例经连续随访 ,随访时间 3～ 15个月 ,平均 8.6个月。 3 4例骨折全部愈合 ,无畸形、断钉。按Klemm等功能恢复分级标准 ,优良率为 10 0 %。 结论 ( 1)股骨型髓内分叉钉的设计符合股骨下段解剖特点 ,具有良好的生物力学性能 ,是治疗股骨骨折的新型髓内固定器械。 ( 2 )髓内分叉钉具有适应证广、手术操作简单、不扩髓。

Objective To explore the biomechanical property and clinical application of intramedullary tridentate nails (ITNs) for femoral shaft fractures. Methods Thirty six specimens of adult femur were randomly divided into 3 groups and were osteotomized transversely in the distal fourth of the femur. ITNs, Ender nails and cloverleaf nails were implanted into the femurs in each group respectively. Torsional, bending and axial tensile tests were made on the specimens in each group. A total of 34 patients with femoral shaft fractures, including transverse, oblique, comminuted and old fractures, were treated with ITNs. Results The biomechanical properties of ITNs in resistance to torsion, bending and stretch were significantly better than that of Ender nails and cloverleaf nails. Followed up for 3 15 months (with an average of 8.6 months), all the fractures had got good union without malunion or broken nails. The function of the affected legs recovered excellently according to Klemm grading scale. Conclusions (1) The design of ITNs accords with the special anatomical structure of the distal femur. And ITNs have good biomechanical properties. Therefore, ITN is a new kind of intramedullary nails. (2) ITNs can be applied to every kind of femoral shaft fractures, be operated easily and need no monitoring of X ray machine during the surgery. All of the patients can do functional exercises early and walk with part weight.