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取出植入物的扫描电子显微镜研究表明，髋部骨折髓内钉固定术中内侧移位背后存在一种棘轮机制。

Scanning Electron Microscopy Study of Retrieved Implants Suggests a Ratcheting Mechanism Behind Medial Migration in Cephalomedullary Nailing of Hip Fractures.

作者信息

Law G W, Koh Jsb, Yew Aks, Howe T S

机构信息

Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.

出版信息

Malays Orthop J. 2020 Mar;14(1):7-17. doi: 10.5704/MOJ.2003.002.

DOI:10.5704/MOJ.2003.002
PMID:32296476
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7156168/
Abstract

INTRODUCTION

Medial migration is the paradoxical migration of the femoral neck element (FNE) superomedially against gravity with respect to the intramedullary component of the cephalomedullary device, increasingly seen in the management of pertrochanteric hip fractures with the intramedullary nail. We postulate that the peculiar anti-gravity movement of the FNE in the medial migration phenomenon stems from a ratcheting mechanism at the intramedullary nail-FNE interface, which should inadvertently produce unique wear patterns on the FNE that can be seen with high-powered microscopy. By examining the wear patterns on retrieved implants from patients with medial migration, our study aims to draw clinical correlations to the ratcheting mechanism hypothesis.

MATERIAL AND METHODS

Four FNEs were retrieved from revision surgeries of four patients with prior intramedullary nail fixation of their pertrochanteric hip fractures complicated by femoral head perforation. The FNEs were divided into two groups based on whether or not there was radiographic evidence of medial migration prior to the revisions. Wear patterns on the FNEs were then assessed using both scanning electron microscopy and light microscopy.

RESULTS

Repetitive, linearly-arranged, regularly-spaced, unique transverse scratch marks were found only in the group with medial migration, corresponding to the specific segment of the FNE that passed through the intramedullary component of the PFNA during medial migration. These scratch marks were absent in the group without medial migration.

CONCLUSION

Our findings are in support of a ratcheting mechanism behind the medial migration phenomenon with repetitive toggling at the intramedullary nail-FNE interface and progressive propagation of the FNE against gravity.

摘要

引言

内侧移位是指股骨颈部件（FNE）相对于头髓内固定装置的髓内部件超内侧逆重力移位，这种情况在使用髓内钉治疗转子间髋部骨折时越来越常见。我们推测，内侧移位现象中FNE独特的逆重力运动源于髓内钉 - FNE界面处的棘轮机制，这应该会在FNE上无意中产生独特的磨损模式，在高倍显微镜下可见。通过检查内侧移位患者取出的植入物上的磨损模式，我们的研究旨在得出与棘轮机制假说的临床相关性。

材料与方法

从4例转子间髋部骨折接受髓内钉固定并伴有股骨头穿孔的患者的翻修手术中取出4个FNE。根据翻修术前是否有内侧移位的影像学证据，将FNE分为两组。然后使用扫描电子显微镜和光学显微镜评估FNE上的磨损模式。

结果

仅在内侧移位组中发现了重复的、线性排列的、间隔规则的独特横向划痕，这些划痕对应于内侧移位期间FNE穿过PFNA髓内部件的特定节段。无内侧移位组中没有这些划痕。

结论

我们的研究结果支持内侧移位现象背后存在棘轮机制，即髓内钉 - FNE界面处反复切换，FNE逐渐逆重力移位。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4503/7156168/b87c0e555e11/moj-14-007-f12.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4503/7156168/93824ba4881c/moj-14-007-f1.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4503/7156168/5ad25347e96b/moj-14-007-f11.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4503/7156168/b87c0e555e11/moj-14-007-f12.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4503/7156168/93824ba4881c/moj-14-007-f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4503/7156168/38d8758d1ad8/moj-14-007-f2.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4503/7156168/646138e8e370/moj-14-007-f4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4503/7156168/0528c73a69e5/moj-14-007-f5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4503/7156168/b3d7e27fe174/moj-14-007-f6.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4503/7156168/1340f947fcf4/moj-14-007-f7.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4503/7156168/b7a140ae3732/moj-14-007-f8.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4503/7156168/bd5e456a5691/moj-14-007-f9.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4503/7156168/66b5e6e5fb4c/moj-14-007-f10.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4503/7156168/5ad25347e96b/moj-14-007-f11.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4503/7156168/b87c0e555e11/moj-14-007-f12.jpg

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