Raas Christoph, Hofmann-Fliri Ladina, Hörmann Romed, Schmoelz Werner
Department of Trauma Surgery, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
AO Research Institute Davos, Clavadelerstr. 8, 7270, Davos Platz, Switzerland.
Arch Orthop Trauma Surg. 2016 Mar;136(3):345-51. doi: 10.1007/s00402-015-2400-x. Epub 2016 Jan 9.
Osteoporotic hip fractures are an increasing problem in an ageing population. They result in high morbidity, mortality and high socioeconomic costs. For patients with poor bone quality, prophylactic augmentation of the proximal femur might be an option for fracture prevention.
In two groups of paired human femora the potential of limited polymethyl-methacrylate (PMMA) augmentation (11-15 ml) in a V-shape pattern and the insertion of a proximal femur nail antirotation (PFNA) blade were investigated. The testing was carried out pair wise simulating the single leg stand. The untreated femur in each pair served as control. An axial load was applied until failure. Load displacement parameters and temperature increase during the augmentation process were recorded.
In the PMMA group no significant difference was found between the augmented and non-augmented specimen concerning load to failure (p = 0.35) and energy to failure (p = 0.9). A median temperature increase of 9.5 °C was observed in the augmented specimen. A significant correlation was found between the amount of applied PMMA and the temperature increase (Cor. Coef. = 0.82, p = 0.042). In the PFNA group, a significant decrease of load to failure and a non-significant decrease of energy to failure were observed (p = 0.037 and p = 0.075).
Limited V-shaped PMMA augmentation and PFNA blade insertion did not show any improvement in failure load or energy to failure. Volumes of up to 15 ml PMMA did not cause a critical surface temperature increase.
在老龄化人口中，骨质疏松性髋部骨折问题日益严重。它们导致高发病率、高死亡率以及高昂的社会经济成本。对于骨质量较差的患者，对股骨近端进行预防性强化可能是预防骨折的一种选择。
在两组配对的人股骨中，研究了呈V形模式有限注入聚甲基丙烯酸甲酯（PMMA，11 - 15毫升）以及插入股骨近端抗旋髓内钉（PFNA）刀片的潜力。测试成对进行，模拟单腿站立。每对中未处理的股骨作为对照。施加轴向载荷直至失效。记录强化过程中的载荷位移参数和温度升高情况。
在PMMA组中，强化和未强化标本在失效载荷（p = 0.35）和失效能量（p = 0.9）方面未发现显著差异。强化标本的温度中位数升高了9.5°C。观察到所注入的PMMA量与温度升高之间存在显著相关性（相关系数 = 0.82，p = 0.042）。在PFNA组中，观察到失效载荷显著降低，失效能量有不显著降低（p = 0.037和p = 0.075）。
有限的V形PMMA强化和PFNA刀片插入在失效载荷或失效能量方面未显示出任何改善。高达15毫升的PMMA量不会导致临界表面温度升高。
