Rizzo E, Ghisellini F, Cordey J, Wahl D, Perren S, Cannas M
University of Torino, Department of Medical Sciences, Medical School of Novara, Italy.
Injury. 1998 Jul;29(6):451-6. doi: 10.1016/s0020-1383(98)00085-0.
The incidence of fractures in the distal femur is becoming more frequent and they are often associated to complex lesions with potential complications. Operative treatment is mandatory for elderly people and several methods of internal fixation with appropriate implants have been developed, generally approaching the lateral aspect of the femur. An alternative antero-medial access was proposed several years ago but the biomechanical aspects of its application must be debated. The aim of the present study is to establish if adverse biomechanical effects should be expected when the plate is affixed at the medial side of the femur metaphysis, by analysing the strain pattern of a human cadaver femur submitted to loads simulated in different experimental conditions. Application of load resulted, as expected, in tension in the lateral aspect and compression in the medial aspect of the femur diaphysis but it turned more and more toward the anterior aspect and the compression turned toward the posterior aspect when the levels measured changed from proximal to distal. The plate was next to the neutral axis and produced a moderate stress protection effect (approx. 70 per cent). No biomechanical disadvantages have been observed as a result of the plate being apposed at the medial aspect instead of the conventional lateral aspect of the distal femur.
股骨远端骨折的发生率正变得越来越高，并且它们常常与具有潜在并发症的复杂损伤相关。对于老年人而言，手术治疗是必不可少的，并且已经开发出了几种使用合适植入物的内固定方法，通常是从股骨外侧进行操作。几年前有人提出了一种替代性的前内侧入路，但对其应用的生物力学方面仍需进行讨论。本研究的目的是通过分析在不同实验条件下模拟加载的人体尸体股骨的应变模式，来确定当钢板固定在股骨干骺端内侧时是否会产生不利的生物力学影响。如预期的那样，加载导致股骨干的外侧出现拉伸，内侧出现压缩，但当测量水平从近端向远端变化时，拉伸越来越偏向于前方，压缩则转向后方。钢板靠近中性轴，并产生了适度的应力保护作用（约70%）。未观察到由于将钢板置于股骨远端的内侧而非传统的外侧而产生的生物力学劣势。
