Layher Frank, Matziolis Georg, Kayhan Leos N, Bungartz Matthias, Brinkmann Olaf
Orthopaedic Department Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, 07607 Eisenberg, Germany.
Schulthess Clinic, Lengghalde 2, 8008 Zürich, Switzerland.
Life (Basel). 2021 Nov 17;11(11):1254. doi: 10.3390/life11111254.
(1) Background: In polytrauma patients, femur fractures are usually stabilised by external fixation for damage control, later being treated with definitive plate or nail osteosynthesis. Screw/rod systems established in spinal surgery might be inserted for internal fixation, providing sufficient fracture stability that subsequent intervention is unnecessary. This was to be investigated biomechanically. (2) Methods: The unilaterally applied spinal internal fixator (IF) was subjected to load and deformation analysis on artificial femurs with 32-A3 fracture according to AO classification. Distance of screws to fracture and rod to cortical bone were analysed as parameters influenced surgically as stiffness and deformation of the treated fracture. In addition, the stability of another construct with a second screw/rod system was determined. The axial load in stance phase during walking was simulated. The results were compared against an established fixed-angle plate osteosynthesis (IP). (3) Results: There were no implant failures in the form of fractures, avulsions or deformations. All unilateral IF combinations were inferior to IP in terms of stability and stiffness. The bilateral construct with two screw/rod systems achieved biomechanical properties comparable to IP. 4) Conclusion: Biomechanically, a biplanar screw/rod system is suitable for definitive fracture stabilisation of the femur, despite a damage control approach.
(1) 背景：在多发伤患者中，股骨骨折通常通过外固定进行损伤控制，随后采用确定性钢板或髓内钉内固定治疗。脊柱手术中使用的螺钉/棒系统可用于股骨骨折的内固定，提供足够的骨折稳定性，从而无需后续干预。本研究对此进行生物力学研究。(2) 方法：根据AO分类，对具有32 - A3骨折的人工股骨施加单侧脊柱内固定器（IF），并进行载荷和变形分析。分析螺钉至骨折处的距离以及棒至皮质骨的距离，作为受手术影响的参数，如治疗骨折的刚度和变形。此外，确定了另一种带有第二个螺钉/棒系统的结构的稳定性。模拟了行走站立阶段的轴向载荷。将结果与已确立的固定角度钢板内固定术（IP）进行比较。(3) 结果：未出现骨折、撕脱或变形等植入物失效情况。所有单侧IF组合在稳定性和刚度方面均劣于IP。具有两个螺钉/棒系统的双侧结构实现了与IP相当的生物力学性能。(4) 结论：在生物力学方面，尽管采用损伤控制方法，但双平面螺钉/棒系统适用于股骨骨折的确定性稳定。
