中国组织工程研究

中国组织工程研究 ›› 2022, Vol. 26 ›› Issue (9): 1313-1317.doi: 10.12307/2022.420

• 骨与关节生物力学 bone and joint biomechanics •    下一篇

斯氏针置入股骨头不同方式的生物力学分析

许新忠，吴钟汉，余水生，赵  耀，徐春归，张  鑫，郑嵋戈，荆珏华   

  1. 安徽医科大学第二附属医院骨科，安徽省合肥市   230000
  • 收稿日期:2021-05-31 修回日期:2021-06-02 接受日期:2021-07-17 出版日期:2022-03-28 发布日期:2021-12-09
  • 通讯作者: 荆珏华，博士，主任医师，教授，博士生导师，安徽医科大学第二附属医院骨科，安徽省合肥市 230000
  • 作者简介:许新忠，男，2021年苏州大学毕业，博士，副主任医师，副教授，硕士生导师，主要从事创伤骨科方向的研究。
  • 基金资助:
    国家自然科学基金青年项目(81801220)，项目负责人：郑嵋戈

Biomechanical analysis of different ways of inserting Steinmann Pins into the femoral head

Xu Xinzhong, Wu Zhonghan, Yu Shuisheng, Zhao Yao, Xu Chungui, Zhang Xin, Zheng Meige, Jing Juehua   

  1. Department of Orthopedics, Second Hospital of Anhui Medical University, Hefei 230000, Anhui Province, China
  • Received:2021-05-31 Revised:2021-06-02 Accepted:2021-07-17 Online:2022-03-28 Published:2021-12-09
  • Contact: Jing Juehua, MD, Chief physician, Professor, Doctoral supervisor, Department of Orthopedics, Second Hospital of Anhui Medical University, Hefei 230000, Anhui Province, China
  • About author:Xu Xinzhong, MD, Associate chief physician, Associate professor, Master’s supervisor, Department of Orthopedics, Second Hospital of Anhui Medical University, Hefei 230000, Anhui Province, China
  • Supported by:
    National Natural Science Foundation of China, No. 81801220 (to ZMG)

PDF

107

摘要：

文题释义：
斯氏针置入方式：斯氏针是一种广泛使用的金属骨针，在骨折的术前牵引及术中辅助复位中发挥着重要作用。在使用斯氏针术中辅助复位时，随着置入数目的不同以及置入方向的不同，手术过程中牵引复位的质量和治疗效果也不相同。
生物力学分析：是指运用力学原理及生物力学方法对研究对象的力学特点进行定量研究。通过对8种斯氏针置入组合的力学特点进行测试，得出的结果能为临床实践提供指导意义。

背景：对于不同年龄段的人群，股骨颈骨折有其不同的骨折线走向特点，有着不同的治疗策略。如何在手术治疗中提高复位质量、避免股骨头坏死及内固定失效，成为骨科学者面对的共同挑战。通过对股骨头颈部模型进行力学测试，期望获得相关数据，为提高复位稳定性及复位质量指明方向。
目的：通过静态拉伸实验和疲劳实验得出斯氏针不同方式置入股骨头的力学特点。
方法：选取天津正天医疗器械有限公司生产型号为ZLW02SJA的斯氏针，规格φ3.5*300 mm，样品材质为317不锈钢，按照2个步骤进行研究。步骤一：静态拉伸实验，使用1枚或者2枚斯氏针，按照前方或者侧方打入股骨头的方式组合，共计8种方案，每一方案将斯氏针打入Sawbone股骨头相应深度，以20 mm/min的速度对斯氏针进行拔出力测试，记录拔出力值。步骤二：疲劳拉伸实验，汇总前8次实验拔出力的平均值，取2个最大拔出力的75%值分别进行疲劳拉伸测试。
结果与结论：①经过静态抗拔出力测试，得出抗拔出力最佳的2种方案为方案五和方案七，其中方案五的打入方式为自前而后，皮质骨厚度为4.3 mm，松质骨厚度为25.7 mm，斯氏针数量为2枚，置入深度为股骨头2/3；方案七的打入方式为侧方大转子，皮质骨厚度为3.0 mm，松质骨厚度为26.3 mm，斯氏针数量为2枚，置入深度为股骨头2/3；②然后选用这2种方案的最大拔出力的75%分别进行至少300次疲劳循环，2种方案均能完成疲劳测试，斯氏针最稳定的打入方式为方案五，其具有较大的拔出力，在斯氏针打入股骨头复位过程中可以与股骨头相对稳定的产生牵引；③结果显示：抗拔出力实验和疲劳实验均提示打入2枚斯氏针强于1枚斯氏针，而打入2枚斯氏针的情况下自前而后方向进针优于侧方大转子进针。

https://orcid.org/0000-0001-5951-184X (许新忠) ；https://orcid.org/0000-0001-5599-5672 (荆珏华)

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

关键词: 斯氏针, 股骨头, 力学, 股骨颈骨折, 静态拉伸, 疲劳拉伸, 股骨模型

Abstract: BACKGROUND: For people of different ages, femoral neck fractures have different fracture line characteristics and different treatment strategies. It has become a common challenge for orthopedic scholars that how to improve the quality of reduction and avoid osteonecrosis of the femoral head and failure of internal fixation in surgical treatment. Through mechanical tests of models of the femoral head and neck, we expect to obtain the relevant data and point out the direction for the improvement of reduction stability and reduction quality.  
OBJECTIVE: To obtain the mechanical characteristics of different ways of inserting Steinmann Pins into the femoral head through the static anti-pull-out test and the fatigue test.
METHODS:  The Steinmann Pins with model ZLW02SJA produced by Tianjin Zhengtian Medical Equipment Co., Ltd., with a specification of φ3.5*300 mm, and a sample material of 317 stainless steel, were selected for the study according to two steps. Step 1: Static tensile test was the test that inserted one or two Steinmann Pins into the Sawbone with corresponding depth in the femoral head. The direction could be from front to back or from greater trochanter of femur into the femoral head, and the total kind of solution combinations was eight. The Steinmann Pins were injected into the specified depth. The pullout force of the Steinmann Pins was tested with the speed of 20 mm/min, and the pullout force was recorded. Step 2: Fatigue tensile test. The average pullout force of the first eight tests was summarized; 75% of the two maximum pullout forces were taken for fatigue tensile test.  
RESULTS AND CONCLUSION: (1) Through static tensile tests, it is concluded that the two schemes with the best pullout force were scheme 5 and scheme 7. In scheme 5 whose direction was from front to back into the femoral head: the thickness of cortical bone was 4.3 mm. The thickness of cancellous bone was 25.7 mm. The number of Steinmann Pins was 2. Insertion depth was 2/3 of femoral head. In scheme 7 whose direction was from greater trochanter of femur into the femoral head, the thickness of cortical bone was 3.0 mm; the thickness of cancellous bone was 26.3 mm; and the number of Steinmann Pins was 2. Insertion depth was 2/3 of femoral head. (2) After that, 75% of the maximum pullout force of the two schemes was selected for at least 300 fatigue cycles, and both schemes could complete the fatigue test. The most stable inserting mode of Steinmann Pins was scheme 5, which had a large pullout force, so it could produce stable traction relatively with the femoral head in the process of reduction of the femoral head. (3) Results verified that static tensile tests and fatigue tests showed that the insertion of two Steinmann Pins was better than that of one Steinmann Pin, and the insertion of two Steinmann Pins behaved better in inserting from front to back rather than inserting from lateral greater trochanter.

Key words: Steinmann Pin, femoral head, mechanics, femoral neck fracture, static tensile test, fatigue tensile test, model of the femur

中图分类号: