北京生物医学工程

股骨前弓角在股骨粗隆间骨折髓内钉内固定生物力学临床实践研究

The biomechanical analysis of anterior femoral arch angle in the intramedullary nail fixation of intertrochanteric fracture

作者：韩晓斌王建光田明李玉民

单位：民航总医院骨科(北京100123)

关键词：股骨前弓角；股骨粗隆间骨折；髓内钉内固定；生物力学分析

分类号：R318.01； R683.42

出版年·卷·期（页码）：2021·40·1（79-84）

摘要：

目的通过对股骨前弓角在股骨粗隆间骨折（intertrochanteric fracture,IF）髓内钉内固定的生物力学分析，探讨股骨前弓角在股骨粗隆间骨折临床治疗中的意义。方法对股骨粗隆间骨折进行生物力学分析，然后对2013年1月至2019年1月民航总医院骨科收治的股骨粗隆间骨折手术患者266例进行回顾性研究。患者分为70岁以上年龄组和70岁以下年龄组，均行髓内钉内固定手术治疗，对股骨前弓角、股骨大粗隆顶点至股骨前弓角顶点的距离（顶尖距）及术后恢复Harris评分进行统计学分析。结果股骨前弓角及Harris评分两组比较有统计学意义（P<0.05），顶尖距两组比较无统计学意义（p>0.05）。70岁以上年龄组女性股骨前弓角（7.71±1.94°）大于男性股骨前弓角（6.41±2.05°）（P<0.05），而男性顶尖距（184.65 cm±19.31cm）大于女性顶尖距（176.50 cm±17.83cm）（P<0.05），术后恢复harris评分未见明显差别（p>0.05）。结论股骨前弓角在股骨粗隆间骨折髓内钉内固定生物力学固定中具有重要意义，临床治疗中股骨前弓角和顶尖距可作为重要参考以取得最佳的临床效果。

Objective To study the main factors influencing the curative effect of intertrochanteric fracture （IF）through the biomechanical analysis of the fixation of the anterior arch angle of femur with intramedullary nail. Methods The biomechanical analysis of intertrochanteric fracture was carried out. From January 2013 to January 2019, 266 patients with intertrochanteric fracture in orthopaedic ward of civil aviation general hospital were studied retrospectively. All patients were treated with intramedullary nail fixation, divided into the age group over 70 years old and the age group under 70 years old. In the age group over 70 years old, the anterior arch Angle of femur was greater than that of male femur, while the distance between the apex of femur greater trochanter and the apex of femoral anterior arch angle of male femur was greater than that between the apex of femur greater trochanter and the apex of femur anterior arch angle of female femur.No significant difference was found in postoperative recovery Harris score. Results There was significant difference in anterior femoral arch angle and Harris score between the two groups (P < 0.05), but there was no significant difference in apical distance between the two groups (P > 0.05).Conclusions The angle of anterior arch of femur is of great significance in the biomechanical fixation of intramedullary nail for intertrochanteric fracture of femur. It can be used as an important reference to select the appropriate intramedullary nail in the clinical treatment to obtain the best clinical effect.

参考文献：

1. Ruecker AH, Rupprecht M, Gruber M, et al. The treatment of intertrochanteric fractures: results using an intramedullary nail with integrated cephalocervical screws and linear compression[J].Journal of Orthopaedic Trauma, 2009, 23(1): 22-30.

2. Bhandari M, Swiontkowski M. Management of acute hip fracture[J]. The New England Journal of Medicine，2017，377(21):2053-2062.

3. 宋德磊，张世民.亚洲型股骨近端防旋髓内钉与国人股骨前弓匹配性的影像学研究[J].中华创伤骨科杂志，2012，14（2）：103-107.

Song DL，Zhang SM. Mismatch between the short celphalomeduallary nail and the anterior femoral bow in Chinese intertrochanteric fractures[J]. Chinese Journal of Orthopaedic Trauma，2012，14（2）：103-107.

4. Pankaj A, Malhotra R, Bhan S. Penetration of the distal femoral anterior cortex during intramedullary nailing for subtrochanteric fractures[J].Journal of Orthopaedic Trauma,2006,20(4):299.

5. Bazylewicz DB,Egol KA,Koval KJ.Cortical encroachment after cephalomedullary nailing of the proximal femur,evaluation of a more anatomic radius of curvature[J].Journal of Orthopaedic Trauma,2013,27：303-307..

6. Schmuta B,Kmiec S,Wullschleger M E,et al.3D Computer graphical anatomy study of the femur:a bias for a new nail design[J].Archives of Orthopaedic and Trauma Surgery,2017,137(3):321-331.

7. Johnson KD, Tencer A. Mechanics of intramedullary neils for femoral fractures[J].Unfallchirurg,1990,93(11):506-511.

8. Egol KA,Chang EY,Cvitkovic J,et al. Mismatch of current intramedullary nails with the anterior bow of the femur[J]. Journal of Orthopaedic Trauma,2004,18(7):410-415.

9. Kwak DK, Kim WH, Lee SJ, et al. Biomechanical comparison of three different intramedullary nails for fixation of unstable basicervical intertrochanteric fractures of the proximal femur:experimental studies[J]. BioMed Research International，2018，2018:7618079.

10. Kleweno C, Morgan J, Redshaw J, et al. Short versus long cephalomedullary nails for the treatment of intertrochanteric hip fractures in patients older than 65 years[J]. Journal of Orthopaedic Trauma，2014，28:391–397.

11. Boone C, Carlberg KN, Koueiter DM, et al. Short versus long intramedullary nails for treatment of intertrochanteric femur fractures (OTA 31-A1 and A2) [J]. Journal of Orthopaedic Trauma，2014，28:96–100.

12. Kanakaris NK, Tosounidis TH, Giannoudis PV. Nailing intertrochanteric hip fractures: short versus long; locked versus nonlocked[J]. Journal of Orthopaedic Trauma ，2015，29:S10–S16.

13. Lindvall E, Ghaffar S, Martirosian A,et al. Short vs long intramedullary nails in the treatment of pertrochanteric hip fractures[J]. Journal of Orthopaedic Trauma，2016，30:119–124.

14. 陈心敏，江腾，杨威，等. 不同长度股骨近端防旋髓内钉治疗老年A3.3型股骨转子间骨折的有限元分析[J].

中国医药导报，2020, 17 (27): 92-95.

Chen XM，Jiang T，Yang W, et al. Finite element analysis of proximal femoral nail anti-rotation with different length in the treatment of type A3.3 femoral intertrochanteric fracture in elderly[J]. China Medical Herald，2020, 17 (27): 92-95.

15. Krigbaum H, Takemoto S, Kim HT,et al. Costs and complications of short versus long cephalomedullary nailing of OTA 31-A2 proximal femur fractures in U.S. Veterans[J]. Journal of Orthopaedic Trauma，2016，30:125–129.

16. Socci AR, Casemyr NE, Leslie MP,et al. Implant options for the treatment of intertrochanteric fractures of the hip: rationale, evidence, and recommendations[J]. Bone & Joint Journal，2017 ，99(1):128-133.

17. Matre K, Vinje T, Havelin LI, et al. Trigen intertan intramedullary nail versus sliding hip screw: a prospective, randomized multicenter study on pain, function, and complications in 684 patients with an intertrochanteric or subtrochanteric fracture and one year of follow-up[J]. Journal of Bone and Joint Surgery，2013，95:200–208.

18. Roberts KC, Brox WT, Jevsevar DS,et al. Management of hip fractures in the elderly[J]. Journal of the American Academy of Orthopaedic Surgeons，2015，23:131–137.

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