肱骨自锁髓内钉的生物力学测试及临床应用研究
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摘要
目的:肱骨自锁髓内钉是在以往髓内钉基础上设计的一种新型髓内钉,分顺行钉和逆行钉两种类型。本课题的研究目的是对肱骨自锁髓内钉进行生物力学试验,为临床应用提供依据,并对其临床应用进行评价。方法:肱骨自锁髓内钉由主钉、芯柱、锁片(4个)和固定螺母四部分组成。取成人尸体肱骨标本共6根造成人工肱骨干骨折,采用317L不锈钢肱骨自锁髓内钉内固定,对钉骨复合体标本进行生物力学测试,并对肱骨自锁髓内钉单锁片和内芯的抗扭性能进行测试。临床应用39例,顺行插钉15例,逆行插钉24例,并对其临床效果进行评价。结果:肱骨自锁髓内钉抗弯、抗旋及抗拉伸性能均符合生物力学需要。病例随访6～24个月,平均13.4个月,肱骨干骨折均愈合良好。骨折临床愈合时间为9～24周,平均13周。参照评定标准,本组病例临床疗效:优27例,良10例,可2例,优良率94.9%。肩关节功能评定:优31例,良4例,差4例,优良率89.7%。有5例出现来自肱骨自锁髓内钉近端的肩关节撞击症状。本组逆行插钉24例,肘关节功能均恢复良好。结论:肱骨自锁髓内钉将坚强固定与弹性固定有机结合,符合人体生物学固定要求,与肱骨髓腔形态一致,应力遮挡小,利于骨折愈合。肱骨自锁髓内钉具有操作简单、无需X线精确定位、损伤小、疗效好等特点,是治疗肱骨干骨折的有效办法,值得推广。
Objective: To study the biomechanical characters of Humerus Self-locking Intramedullary Nail(HSLIN) which is a new type of intramedullary nail consisting of the antegrade and retrograde nail types designed on the basis of previous intramedullary nail and to provide the basic proof for clinical practice and to evaluate its preliminary clinical application. Methods: HSLIN is composed of a main nail, a interior mandril, four locking-sheets and a fixation nut.Six fresh humeral shafts of adult were fracture on purpose.Then fixed the fractures with HSLIN made of 317L stainless steel and took the test of biomechanics.The stiffness of single locking-sheet and interior mandril also were test to resist twisting momentum.39 cases patients of humerus shaft fracture were treated with HSLIN,of whom 15 cases were treated with antegrade HSLIN and 24 cases with retrograde HSLIN.The results were evaluated based on a criteria including clinical and radiographic parameters. Result: HSLIN resisted certain curving,twisting,pulling force,which might meet biomechanic needs.With an average of 13.4 months(range 6~24 months)of follow-up,all cases acquired bony union with mean union time 13 weeks(range 9~24 weeks).According to the criteria,27 patients were evaluated as having excellent result, 10 good.The overall excellent or good rate was 94.9%.The recovery of shoulder function was excellent in 27 cases,good in 4 cases,and fair in 2 cases,and the overall excellent or good rate was 94.9%.The recovery of elbow function was excellent in all cases.5 cases had shoulder impingement caused by the tail of HSLIN. Conclusion: HSLIN is in accordance with the humerus medullary cavity shape and biomechanics of human body. HSLIN belonging to the well-organized combination of flexible fixation and firm fixation,has lower shelter,benefits the bone,and has many other advantages,such as less trauma and good results, reasonable structure and simple manipulation , without X-ray guidance.
Objective: To study the biomechanical characters of Humerus Self-locking Intramedullary Nail(HSLIN) which is a new type of intramedullary nail consisting of the antegrade and retrograde nail types designed on the basis of previous intramedullary nail and to provide the basic proof for clinical practice and to evaluate its preliminary clinical application. Methods: HSLIN is composed of a main nail, a interior mandril, four locking-sheets and a fixation nut.Six fresh humeral shafts of adult were fracture on purpose.Then fixed the fractures with HSLIN made of 317L stainless steel and took the test of biomechanics.The stiffness of single locking-sheet and interior mandril also were test to resist twisting momentum.39 cases patients of humerus shaft fracture were treated with HSLIN,of whom 15 cases were treated with antegrade HSLIN and 24 cases with retrograde HSLIN.The results were evaluated based on a criteria including clinical and radiographic parameters. Result: HSLIN resisted certain curving,twisting,pulling force,which might meet biomechanic needs.With an average of 13.4 months(range 6~24 months)of follow-up,all cases acquired bony union with mean union time 13 weeks(range 9~24 weeks).According to the criteria,27 patients were evaluated as having excellent result, 10 good.The overall excellent or good rate was 94.9%.The recovery of shoulder function was excellent in 27 cases,good in 4 cases,and fair in 2 cases,and the overall excellent or good rate was 94.9%.The recovery of elbow function was excellent in all cases.5 cases had shoulder impingement caused by the tail of HSLIN. Conclusion: HSLIN is in accordance with the humerus medullary cavity shape and biomechanics of human body. HSLIN belonging to the well-organized combination of flexible fixation and firm fixation,has lower shelter,benefits the bone,and has many other advantages,such as less trauma and good results, reasonable structure and simple manipulation , without X-ray guidance.
引文
[1] 王亦璁.骨与关节损伤,北京:人民卫生出版社,2002,第3版.:553.
[2] 王亦璁.骨与关节损伤,北京:人民卫生出版社,2002,第3版:564.
[3] 尚天裕.医学论文集,北京:中国科技出版社,1999:252.
[4] 章祖林,毕大卫.58例肱骨干骨折不愈合原因分析.中医正骨,1993;(5):6.
[5] Sarmiento A, Kinman PB, Galvin EG, et al. Functional bracing of fractures of the shaft of the humerus. J Bone Joint Surg(Am), 1977; 59: 596.
[6] Zagorski JB, Latta LL, Zych GA, et al. Diaphyseal fractures of the humerus, treatment with prefabrieated braces. J Bone Joint Surg(Am), 1988; 70: 607.
[7] Mauch J, Renner IV, Rikli D. Intramedullary nailing of humeral shaft fractures-initial experiences with an unrearned humeral nail [J] .Swiss Surg, 2000; 6 (6): 299-303.
[8] Muller T, Seligson D, Sioen W, et al. Operative treament of humeral shaft fractures [J].Acta orthop Belg, 1997; 63: 17.
[9] Rush LB. The humerus. In Atlas of Rush pin technics. A system of fracture treatment M.Mississippi:Meridian, 1987; 112-3.
[10] Kunstcher, GBG. The Kunstcher method of intramedullary fixation. J Bone and Joint Surg, 1958; 40-A (1) :17-24.
[11] Kunstcher G. Intramedullary surgical techique and its place in orthopaedic surgery. My present concept. J Bone and Joint Surg, 1965; 47-A (7) :809-15.
[12] 王宗明,杨彬.矩形髓内钉内固定治疗肱骨干骨折32例临床分析.中华医学写作杂志,2003;10(23):2129-9.
[13] Seidel H. Humeral Locking Nail: A Preliminary report. Orthopedics. 1989; 12: 219.
[14] 朱通伯,戴尅戎.骨科手术学,北京:人民卫生出版社,2001,第2版:258
[15] 李颖,吴继明,邹昌旭,等.肱骨髓腔的形态学参数测量及临床意义.中国临床 解剖学杂志,2004:22(2):199-202.
[16] 冯德宏,郑祖根,董启榕,等.肱骨骨髓腔的解剖学测量和肱骨交锁髓内钉设计的相关性研究.中国矫形外科杂志,2000;7(9):862-5.
[17] 段满生,蒋电明,舒勇,等.肱骨近段髓腔CT测量与假体并设计的相关研究.中国临床解剖学杂志,2004;22(1):67-70.
[18] 李建武,王臻,宦怡,等.成人肱骨形态学三维CT测量.中国解剖与临床,2001;6(1):22-4.
[19] 罗先正,邱贵兴.髓内钉内固定术,北京:人民卫生出版社,第一版,1997:8-16.
[20] 王亦璁.骨与关节损伤,北京:人民卫生出版社,第三版,2002:100-5.
[21] 辛景义,张玉新,祈宝兴,等.激光定位在带锁髓内钉远端锁孔定位中的应用.中华骨科杂志,1999;19(5):302.
[22] Shazar N, Brumback RJ, Vanco B. Treatment of humeral fractures by closed reduction and retrograde intramedullary Ender nails. Orthopedics, 1998 3un;21(6):641-6.
[23] 王宗明,杨彬.矩形髓内钉内固定治疗肱骨干骨折32例临床分析.中华医学写作杂志,2003;10(23):2129-9.
[24] Farragos AF, Schemitsch EH, McKee-MD. Complications of intramedullary nailing for fractures of the humeral shaft :a review. J-Orthop-Trauma, 1999 May;13(4):258-67.
[25] 倪江东,谭进,董忠根,等.Russell-Taylor交锁髓内钉治疗肱骨干骨折.湖南医科大学学报.2003;28(2):159-161
[26] 冯德宏,郑祖根,董启榕,等.肱骨分叉交锁髓内钉的研制和临床应用.中华创伤杂志,2002;18(8):473-476.
[27] 陈春,雷廷文,段佳忠,等.分叉交锁髓内针治疗肱骨干骨折并发症原因分析.骨与关节损伤杂志,2004;19(5):329-330.
[28] 熊鹰,赵峰,熊竞明,等.旋入式自锁髓内针的研制及临床研究.骨与关节损伤杂志,2001;16(1):27-29.
[29] 李江龙,陈春,陈开阳,等.旋入式自锁髓内针治疗肪骨干骨折(附5例报告).右
[2] 王亦璁.骨与关节损伤,北京:人民卫生出版社,2002,第3版:564.
[3] 尚天裕.医学论文集,北京:中国科技出版社,1999:252.
[4] 章祖林,毕大卫.58例肱骨干骨折不愈合原因分析.中医正骨,1993;(5):6.
[5] Sarmiento A, Kinman PB, Galvin EG, et al. Functional bracing of fractures of the shaft of the humerus. J Bone Joint Surg(Am), 1977; 59: 596.
[6] Zagorski JB, Latta LL, Zych GA, et al. Diaphyseal fractures of the humerus, treatment with prefabrieated braces. J Bone Joint Surg(Am), 1988; 70: 607.
[7] Mauch J, Renner IV, Rikli D. Intramedullary nailing of humeral shaft fractures-initial experiences with an unrearned humeral nail [J] .Swiss Surg, 2000; 6 (6): 299-303.
[8] Muller T, Seligson D, Sioen W, et al. Operative treament of humeral shaft fractures [J].Acta orthop Belg, 1997; 63: 17.
[9] Rush LB. The humerus. In Atlas of Rush pin technics. A system of fracture treatment M.Mississippi:Meridian, 1987; 112-3.
[10] Kunstcher, GBG. The Kunstcher method of intramedullary fixation. J Bone and Joint Surg, 1958; 40-A (1) :17-24.
[11] Kunstcher G. Intramedullary surgical techique and its place in orthopaedic surgery. My present concept. J Bone and Joint Surg, 1965; 47-A (7) :809-15.
[12] 王宗明,杨彬.矩形髓内钉内固定治疗肱骨干骨折32例临床分析.中华医学写作杂志,2003;10(23):2129-9.
[13] Seidel H. Humeral Locking Nail: A Preliminary report. Orthopedics. 1989; 12: 219.
[14] 朱通伯,戴尅戎.骨科手术学,北京:人民卫生出版社,2001,第2版:258
[15] 李颖,吴继明,邹昌旭,等.肱骨髓腔的形态学参数测量及临床意义.中国临床 解剖学杂志,2004:22(2):199-202.
[16] 冯德宏,郑祖根,董启榕,等.肱骨骨髓腔的解剖学测量和肱骨交锁髓内钉设计的相关性研究.中国矫形外科杂志,2000;7(9):862-5.
[17] 段满生,蒋电明,舒勇,等.肱骨近段髓腔CT测量与假体并设计的相关研究.中国临床解剖学杂志,2004;22(1):67-70.
[18] 李建武,王臻,宦怡,等.成人肱骨形态学三维CT测量.中国解剖与临床,2001;6(1):22-4.
[19] 罗先正,邱贵兴.髓内钉内固定术,北京:人民卫生出版社,第一版,1997:8-16.
[20] 王亦璁.骨与关节损伤,北京:人民卫生出版社,第三版,2002:100-5.
[21] 辛景义,张玉新,祈宝兴,等.激光定位在带锁髓内钉远端锁孔定位中的应用.中华骨科杂志,1999;19(5):302.
[22] Shazar N, Brumback RJ, Vanco B. Treatment of humeral fractures by closed reduction and retrograde intramedullary Ender nails. Orthopedics, 1998 3un;21(6):641-6.
[23] 王宗明,杨彬.矩形髓内钉内固定治疗肱骨干骨折32例临床分析.中华医学写作杂志,2003;10(23):2129-9.
[24] Farragos AF, Schemitsch EH, McKee-MD. Complications of intramedullary nailing for fractures of the humeral shaft :a review. J-Orthop-Trauma, 1999 May;13(4):258-67.
[25] 倪江东,谭进,董忠根,等.Russell-Taylor交锁髓内钉治疗肱骨干骨折.湖南医科大学学报.2003;28(2):159-161
[26] 冯德宏,郑祖根,董启榕,等.肱骨分叉交锁髓内钉的研制和临床应用.中华创伤杂志,2002;18(8):473-476.
[27] 陈春,雷廷文,段佳忠,等.分叉交锁髓内针治疗肱骨干骨折并发症原因分析.骨与关节损伤杂志,2004;19(5):329-330.
[28] 熊鹰,赵峰,熊竞明,等.旋入式自锁髓内针的研制及临床研究.骨与关节损伤杂志,2001;16(1):27-29.
[29] 李江龙,陈春,陈开阳,等.旋入式自锁髓内针治疗肪骨干骨折(附5例报告).右