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生物力学比较：螺钉与环扎固定在老年髋部小转子骨折中的应用：尸体研究。

Biomechanical comparison of screw vs. cerclage refixation in orthogeriatric lesser trochanteric fractures: a cadaveric study.

机构信息

Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.

出版信息

Eur J Trauma Emerg Surg. 2023 Feb;49(1):181-188. doi: 10.1007/s00068-022-02116-5. Epub 2022 Sep 27.

DOI:10.1007/s00068-022-02116-5
PMID:36167986
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9925468/
Abstract

PURPOSE

Osteoporosis-related proximal femur fractures continue to increase significantly due to demographic change. This study was designed to evaluate the biomechanical stability of two different fixation methods (cerclage vs. screw) for refixation of a trochanter minor fragment in the pertrochanteric fractures in cadaveric bones.

METHODS

Artificial bones (n = 14) and human bones (n = 16) were treated with a DHS and the trochanter minor fragment was reduced by cerclage wiring or direct screw fixation. After preloading the simulated iliopsoas with 10 N, a tensile test was performed, ending with either a 70% loss of strength or avulsion of the fragment. The mean values of the avulsion force and the surface strain were recorded.

RESULTS

All tensile tests showed no significant differences between refixation using a direct screw or wire cerclage, for both artificial bones and human specimens. Absolute values showed higher avulsion forces after direct screw fixation than refixation with a wire cerclage. The surface tension of specimens treated with direct screw fixation was lower than that of specimens treated with wire cerclage. An opposite effect was seen in artificial bones. Both effects were not statistically significant.

CONCLUSION

Based on the equal stability after lag screw placement compared to cerclage wiring, we promote the placement of a lag screw into the lesser trochanter fragment in pertrochanteric femur fractures when using a dynamic hip screw.

LEVEL OF EVIDENCE

Level III.

摘要

目的

由于人口结构的变化，与骨质疏松症相关的股骨近端骨折仍在显著增加。本研究旨在评估两种不同固定方法（环扎与螺钉）在固定股骨转子下骨折中较小转子碎片的生物力学稳定性。

方法

对人工骨（n=14）和人骨（n=16）进行 DHS 治疗，并通过环扎或直接螺钉固定来复位较小转子碎片。在模拟髂腰肌预加载 10 N 后，进行拉伸试验，直至强度损失 70%或碎片撕脱。记录平均撕脱力和表面应变值。

结果

所有拉伸试验均表明，在人工骨和人标本中，直接螺钉固定与环扎固定相比，再固定时没有显著差异。直接螺钉固定后的绝对撕脱力高于环扎固定。直接螺钉固定的标本表面张力低于环扎固定的标本。在人工骨中则观察到相反的效果。这两种效果均无统计学意义。

结论

基于与环扎固定相比，拉力螺钉固定后的稳定性相等，我们提倡在使用动力髋螺钉治疗股骨转子下骨折时，将拉力螺钉置入较小转子碎片。

证据水平

III 级。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bce9/9925468/22e58ed1aae8/68_2022_2116_Fig9_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bce9/9925468/897891a8a02f/68_2022_2116_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bce9/9925468/86d9c477902b/68_2022_2116_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bce9/9925468/287dcdadaf09/68_2022_2116_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bce9/9925468/038a497a05b9/68_2022_2116_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bce9/9925468/c914a5b6b918/68_2022_2116_Fig5_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bce9/9925468/7acc20f23e86/68_2022_2116_Fig6_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bce9/9925468/4759f2a3a534/68_2022_2116_Fig7_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bce9/9925468/9151ee93a08e/68_2022_2116_Fig8_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bce9/9925468/22e58ed1aae8/68_2022_2116_Fig9_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bce9/9925468/897891a8a02f/68_2022_2116_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bce9/9925468/86d9c477902b/68_2022_2116_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bce9/9925468/287dcdadaf09/68_2022_2116_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bce9/9925468/038a497a05b9/68_2022_2116_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bce9/9925468/c914a5b6b918/68_2022_2116_Fig5_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bce9/9925468/7acc20f23e86/68_2022_2116_Fig6_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bce9/9925468/4759f2a3a534/68_2022_2116_Fig7_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bce9/9925468/9151ee93a08e/68_2022_2116_Fig8_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bce9/9925468/22e58ed1aae8/68_2022_2116_Fig9_HTML.jpg

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