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一枚失败的伽马钉的实验分析：病例报告及文献综述

Experimental Analysis of a Failed Gamma Nail: A Case Report and Literature Review.

作者信息

Cordunianu Mihai Alexandru, Vulcu Cordunianu Alina Georgiana, Antoniac Iulian, Luca Andrei, Niculescu Marius, Chiriac Cristian Ovidiu, Corneschi Iuliana, Mohor Cosmin Ioan

机构信息

Faculty of Medicine, Titu Maiorescu University, 67A Gheorghe Petrascu, 031593 Bucharest, Romania.

Faculty of Material Science and Engineering, University Politehnica of Bucharest, 313 Splaiul Independentei, 060042 Bucharest, Romania.

出版信息

Healthcare (Basel). 2024 Aug 8;12(16):1578. doi: 10.3390/healthcare12161578.

DOI:10.3390/healthcare12161578
PMID:39201137
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11353889/
Abstract

The Gamma Nail represents one of the most popular and efficient implants for treating proximal femoral fractures. Our paper reports a case of a failed Gamma Nail which was used for the surgical treatment of a 69-year-old woman with a right femoral trochanteric fracture due to a car accident. After the surgical intervention, 6 months later, the patient presented to the hospital reporting pain and limited mobility of the right hip. An X-ray was performed at the level of the pelvis, which highlighted the fracture nonunion and the implant failure. The implant removal and its replacement with a dynamic condylar screw system (DCS) was decided. Because Gamma Nail failures are rare occurrences, the implant was subjected to analyses and experimental determinations to find out the cause. For the implant analyses, a stereomicroscope, an optical microscope, and scanning electron microscopy were used. After the tests were conducted, preparation and processing irregularities as causes of the implant failure were eliminated. Also, the experimental analyses showed that the Gamma Nail did comply with chemical composition and microstructure regulations. Thus, it was concluded that the implant failed due to the mechanical overloading caused by surgical technique errors.

摘要

Gamma钉是治疗股骨近端骨折最常用且有效的植入物之一。我们的论文报告了一例Gamma钉失败的病例，该钉用于手术治疗一名因车祸导致右侧股骨转子间骨折的69岁女性。手术干预6个月后，患者因右髋疼痛和活动受限前来医院就诊。在骨盆水平进行了X线检查，结果显示骨折不愈合和植入物失败。决定取出植入物并用动力髁螺钉系统（DCS）进行置换。由于Gamma钉失败的情况很少见，因此对该植入物进行了分析和实验测定以找出原因。对于植入物分析，使用了体视显微镜、光学显微镜和扫描电子显微镜。测试完成后，排除了制备和加工不规范作为植入物失败原因的可能性。此外，实验分析表明Gamma钉确实符合化学成分和微观结构规定。因此，得出结论，植入物失败是由于手术技术错误导致的机械过载。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/160c/11353889/c351f1423392/healthcare-12-01578-g009.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/160c/11353889/8d597dd535e8/healthcare-12-01578-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/160c/11353889/5c4576914dcd/healthcare-12-01578-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/160c/11353889/69c8a79801f5/healthcare-12-01578-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/160c/11353889/f25fde9d7730/healthcare-12-01578-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/160c/11353889/bac6eb69de16/healthcare-12-01578-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/160c/11353889/93c78500cbe6/healthcare-12-01578-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/160c/11353889/a71a51e841e6/healthcare-12-01578-g007a.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/160c/11353889/9b8c866db09c/healthcare-12-01578-g008a.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/160c/11353889/c351f1423392/healthcare-12-01578-g009.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/160c/11353889/8d597dd535e8/healthcare-12-01578-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/160c/11353889/5c4576914dcd/healthcare-12-01578-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/160c/11353889/69c8a79801f5/healthcare-12-01578-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/160c/11353889/f25fde9d7730/healthcare-12-01578-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/160c/11353889/bac6eb69de16/healthcare-12-01578-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/160c/11353889/93c78500cbe6/healthcare-12-01578-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/160c/11353889/a71a51e841e6/healthcare-12-01578-g007a.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/160c/11353889/9b8c866db09c/healthcare-12-01578-g008a.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/160c/11353889/c351f1423392/healthcare-12-01578-g009.jpg

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本文引用的文献

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Epidemiology and treatment of proximal femoral fractures in the elderly U.S. population.美国老年人群股骨近端骨折的流行病学和治疗。
Sci Rep. 2023 Aug 5;13(1):12734. doi: 10.1038/s41598-023-40087-8.
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The intra- and interobserver reliability of five commonly used intertrochanteric femur fracture classification systems.五种常用的股骨转子间骨折分类系统的组内和组间可靠性。
Jt Dis Relat Surg. 2022;33(1):187-192. doi: 10.52312/jdrs.2022.498. Epub 2022 Mar 28.
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Risk factors for implant failure of intertrochanteric fractures with lateral femoral wall fracture after intramedullary nail fixation.
股骨干髓内钉固定后外侧股骨壁骨折的转子间骨折内固定失败的危险因素。
Injury. 2021 Nov;52(11):3397-3403. doi: 10.1016/j.injury.2021.07.025. Epub 2021 Jul 18.
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The new AO classification system for intertrochanteric fractures allows better agreement than the original AO classification. An inter- and intra-observer agreement evaluation.新的 AO 股骨转子间骨折分类系统比原始 AO 分类系统具有更好的一致性。一项观察者间和观察者内一致性评估。
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Risk factors for implant failure in reverse oblique and transverse intertrochanteric fractures treated with proximal femoral nail antirotation (PFNA).反斜形和横断转子间骨折采用股骨近端防旋髓内钉（PFNA）治疗的失败的风险因素。
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Numerical Simulation of an Intramedullary Elastic Nail: Expansion Phase and Load-Bearing Behavior.髓内弹性钉的数值模拟：扩张阶段与承载行为
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