中国组织工程研究

中国组织工程研究 ›› 2010, Vol. 14 ›› Issue (4): 698-701.doi: 10.3969/j.issn.1673-8225.2010.04.030

• 骨与关节综述 bone and joint review • 上一篇    下一篇

骨水泥填塞动力髋螺钉主钉孔：抗弯曲和抗扭转强度

郑  海，李  祎，郭艳龙   

  1. 河北北方学院第三附属医院骨科，河北省张家口市 075000
  • 出版日期:2010-01-22 发布日期:2010-01-22
  • 作者简介:郑 海★，男，1969年生，汉族，在读硕士，副主任医师，主要从事创伤及脊柱外科研究。 zh3084586@sohu.com

Dynamic hip screw hole filled by bone cement: Anti-flexion and anti-torsion strength

Zheng Hai, Li Yi, Guo Yan-long   

  1. Department of Orthopedics, Third Affiliated Hospital of Hebei North University, Zhangjiakou   075000, Hebei Province, China
  • Online:2010-01-22 Published:2010-01-22
  • About author:Zheng Hai★, Studying for master’s degree, Associate chief physician, Department of Orthopedics, Third Affiliated Hospital of Hebei North University, Zhangjiakou 075000, Hebei Province, China zh3084586@sohu.com

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摘要：

目的：评价髋关节后侧入路加骨水泥填塞后内侧支撑植骨治疗转子间骨折的临床效果。
方法：应用计算机检索Science Direct 数据库、Ei数据库1960-01/2009-10期间的相关文章，检索词为“bone cement，Intertrochanteric  fracture”，并限定文章语言种类为English。同时计算机检索中国期刊全文数据库、中国生物医学文献数据库等1994-01/2009-10期间的相关文章，检索词为“转子间骨折，髋内翻，髋关节后侧入路，主钉孔植入骨水泥”，并限定文章语言种类为中文。此外还手工查阅相关专著数部。纳入有关股骨转子间骨折治疗方式研究，骨水泥治疗股骨转子间骨折的基础与临床实验。
结果：股骨转子间骨折手术治疗方法都为外侧或前侧入路行动力髋钢板系统、动力髋螺钉、股骨近端髓内钉常规内固定。动力髋螺钉是治疗股骨转子间骨折的标准内固定，具有较强的抗旋转功能，符合生物力学要求。但螺钉松动、拔出和断裂等并发症发生率较高。采用骨水泥强化松质骨钉道后，骨水泥强化不仅增加螺钉把持力，有利于尾钉加压；同时也扩大了骨-钉接触界面，应力被分散传递至更大的钉-骨界面区域，明显提高动力髋螺钉固定的抗弯曲和抗扭转强度，整体提高骨折稳定性。骨水泥的强化机制在于通过充填于骨小梁闯隙与周围松质骨微观交锁，形成松质骨-骨水泥-螺钉的整体结构。
结论：使用骨水泥填塞动力髋螺钉，可明显增强动力髋螺钉固定的抗弯曲和抗扭转强度，整体提高骨折稳定性。

关键词: 转子间骨折, 髋内翻, 髋关节后侧入路, 主钉孔植入骨水泥, 后内侧支撑植骨

Abstract:

OBJECTIVE: To evaluate the clinical outcomes of medical supporting bone graft following posterior approach and bone cement implantation in the hip joint in treating intertrochanteric fracture.
METHODS: A computer-based online search of Science Direct, Ei databases was performed for English articles published between January 1960 and October 2009, with the key words “bone cement, intertrochanteric fracture”. In addition, CNKI and CBM were searched for related Chinese articles published between January 1994 and October 2009, with the key words “intertrochanteric fracture, coxa vara, posterior approach of hip joint, bone cement implantation in major screw hole”. Moreover, related books were manually searched. Treatment of intertrochanteric fracture, basic and clinical experiment of intertrochanteric fracture treated by bone cement was included.
RESULTS: Intertrochanteric fracture treatment includes lateral or anterior approach for dynamic hip plate system, dynamic hip screw, and femoral proximal intramedullary screw internal fixation. Dynamic hip screw is standard internal fixation to treat intertrochanteric fracture, with strong anti-rotation function, and meets the biomechanical requirements. However, screw loosening, extraction and breakage frequently occur. Cancellous bone screw track enhanced by bone cement increases screw retention force, benefits screw compression, enhances bone-screw interface to transfer the stress to screw-bone regions, which significantly increases the anti-flexion and anti-torsion strength of dynamic hip screw and improves fracture stability. The mechanism involves the integral formation of cancellous bone, bone cement and screw by the micro-interlocking of bone trabecula and surrounding cancellous bone.
CONCLUSION: Dynamic hip screw filled by bone cement significantly enhances the anti-flexion and anti-torsion strength of internal fixation and improves fracture stability.

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