治疗粉碎性转子下股骨骨折的内固定的生物力学评估。

Biomechanical evaluation of internal fixation for the treatment of comminuted subtrochanteric femur fractures.

机构信息

Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0374, Japan.

出版信息

J Orthop Sci. 2021 Mar;26(2):261-265. doi: 10.1016/j.jos.2020.03.002. Epub 2020 Mar 31.

DOI:10.1016/j.jos.2020.03.002

PMID:32245694

Abstract

BACKGROUND

Several biomechanical studies on subtrochanteric femur fractures have reported that use of an intramedullary nail is superior to extramedullary implant. However, the optimal choice of intramedullary nail for the treatment of comminuted subtrochanteric femur fracture remains unclear. Here, we evaluated the biomechanical properties of comminuted subtrochanteric femur fracture treated with four different internal fixations.

METHODS

A comminuted subtrochanteric femur fracture model was created with a 2-cm gap below the lessor trochanter in 20 synthetic femurs. The fractures were fixed with one of four implants - Antegrade Femoral Nail (AFN), Trochanteric Fixation Nail Advanced with a femoral neck blade (TFNA blade), TFNA with a femoral neck screw (TFNA screw), and the reversed distal femoral locking compression plate (DF-LCP) - all manufactured by DePuy Synthes. Axial compression tests and torsion tests were performed and the stiffness of each implant was compared.

RESULTS

For compression, the TFNA blade, TFNA screw, and AFN provided significantly higher stiffness than DF-LCP (p < 0.001, p < 0.001, p = 0.001, respectively), and the TFNA blade provided significantly higher stiffness than AFN (p = 0.049). For torsion, there were no significant differences among the groups in internal rotation, while the TFNA screw had significantly lower torsional stiffness than the AFN, TFNA blade and DF-LCP in external rotation (p = 0.036, p = 0.034, p = 0.037, respectively).

CONCLUSIONS

These findings could help to provide biomechanical evidence regarding choice of implant for the treatment of comminuted subtrochanteric femur fracture. The TFNA blade may be more suitable for the treatment of comminuted subtrochanteric femur fracture.

摘要

背景

几项关于股骨转子下骨折的生物力学研究报告称，髓内钉的使用优于髓外植入物。然而，对于粉碎性股骨转子下骨折的治疗，最佳的髓内钉选择仍不清楚。在这里，我们评估了四种不同内固定治疗粉碎性股骨转子下骨折的生物力学性能。

方法

在 20 个合成股骨中，在下小转子下方 2cm 处创建粉碎性股骨转子下骨折模型。骨折用四种植入物之一固定 - 顺行股骨髓内钉（AFN）、带股骨颈刀片的转子固定钉高级型（TFNA 刀片）、带股骨颈螺钉的 TFNA（TFNA 螺钉）和反向股骨远端锁定加压钢板（DF-LCP）- 均由 DePuy Synthes 制造。进行轴向压缩试验和扭转试验，并比较每个植入物的刚度。

结果

对于压缩，TFNA 刀片、TFNA 螺钉和 AFN 提供的刚度明显高于 DF-LCP（p<0.001、p<0.001、p=0.001，分别），TFNA 刀片提供的刚度明显高于 AFN（p=0.049）。对于扭转，各组内旋转时无显著差异，而外旋转时 TFNA 螺钉的扭转刚度明显低于 AFN、TFNA 刀片和 DF-LCP（p=0.036、p=0.034、p=0.037，分别）。