Den Hartog B D, Bartal E, Cooke F
Department of Surgery, University of Kansas School of Medicine-Wichita.
J Bone Joint Surg Am. 1991 Jun;73(5):726-33.
We created unstable intertrochanteric fractures with a large posteromedial defect in eighteen pairs of fresh-frozen femora from cadavera, and used the femora to evaluate the stability of six combinations of treatment with sliding compression screws and sideplates. The variables that were tested were high (150-degree) angle plates compared with low (130-degree) angle plates, the position of the lag-screw in the femoral head and neck (in the center of the head as seen on both anteroposterior and lateral roentgenograms compared with posteroinferiorly), and whether or not medial cortical contact had been re-established with a limited osteotomy of the greater trochanter. The femora were loaded to the point of failure. The mode of failure, maximum load to failure, and bending rigidity of each method of fixation were measured. Of the six types of treatment, the use of a 150-degree-angle plate, position of the lag-screw in the center of the head as seen on both anteroposterior and lateral roentgenograms, and osteotomy of the greater trochanter resulted in the highest mean load to failure and the greatest rigidity. Over-all, re-establishment of medial cortical contact by means of an osteotomy of the greater trochanter significantly improved the mean load to failure and the rigidity of the fixation. The higher-angle plate, although more difficult to insert, increased the mean load to failure but had no effect on rigidity. The position of the lag-screw (in the center of the head as seen on both anteroposterior and lateral roentgenograms or posteroinferiorly) had no bearing on the mean load to failure, but it significantly affected the mode of failure.
我们在取自尸体的18对新鲜冷冻股骨上制造了伴有大的后内侧缺损的不稳定型转子间骨折，并使用这些股骨评估滑动加压螺钉和侧板六种治疗组合的稳定性。所测试的变量包括：与低角度（130度）钢板相比的高角度（150度）钢板；拉力螺钉在股骨头和颈部的位置（在前后位和侧位X线片上均位于股骨头中心与后下位置相比）；以及通过大转子有限截骨术是否重新建立了内侧皮质接触。将股骨加载至失效点。测量每种固定方法的失效模式、最大失效载荷和抗弯刚度。在六种治疗类型中，使用150度角钢板、拉力螺钉在前后位和侧位X线片上均位于股骨头中心以及大转子截骨术导致最高的平均失效载荷和最大的刚度。总体而言，通过大转子截骨术重新建立内侧皮质接触显著提高了平均失效载荷和固定的刚度。角度更高的钢板虽然更难插入，但增加了平均失效载荷，但对刚度没有影响。拉力螺钉的位置（在前后位和侧位X线片上位于股骨头中心或后下位置）与平均失效载荷无关，但它显著影响失效模式。
