股骨转子间骨折内固定器材设计理念的发展与实践

The evolution and practice on design concepts of internal fixation devices for intertrochanteric femur fractures

手术是治疗老年股骨转子间骨折的首选方法,内固定物的设计是提高手术效果、减少术后并发症的关键。以优化生物力学性能和微创植入为核心,随着材料的不断改进,内固定物的设计理念也在不断演进。数十年间出现了多项里程碑式进展,如偏心固定转向中心固定、滑动加压固定的应用、传统螺钉改为螺旋刀片,单钉改为双钉(组合)等,但内固定相关并发症的发生率仍为5%~10%,难以实现质的突破。越来越多的证据表明,深入分析股骨近端的解剖、生理学特点及力学传导特性,有助于阐释内固定失败的根本原因。基于此,股骨近端仿生髓内钉应运而生,通过完全模拟股骨近端的解剖、力学、生物学特性,调节局部力学环境,为治疗股骨近端骨折提供了新思路,亦有助于带动其他骨折治疗策略的范式变革。

Surgical treatment has been established as the standard method for the treatment of intertrochanteric fractures in the elderly.The design of internal fixation devices has become the key to improve surgical outcomes and reduce postoperative complications.Centered on optimizing biomechanical performance and minimally invasive implantation,coupled with continuous material improvements,the design philosophy of internal fixation devices has also been constantly evolving.There have been several milestone advancements,such as the transition from eccentric fixation to central fixation,the adoption of sliding compression fixation,the replacement of traditional screws with spiral blades,and the shift from single to double(combination)nails.However,the incidence of internal fixation-related complications has remained at a relatively high level of 5%to 10%,without significant breakthroughs.Increasing evidence suggests that in-depth analysis of the anatomy,physiological mechanisms,and mechanical transmission characteristics of the proximal femur can help elucidate the root causes of internal fixation failures.Based on this,the proximal femoral bionic nail(PFBN)has emerged as a new design concept.By fully mimicking the anatomical,mechanical,and biological characteristics of the proximal femur,the PFBN can regulate the local mechanical environment,providing a revolutionary solution and a new approach for the treatment of proximal femoral fractures.This innovative design also has the potential to drive the paradigm shift in the treatment strategies of other fractures.