利用光学测量法研究股骨干骨折交锁髓内钉内固定的生物力学特点
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摘要
目的：将光学测量法应用到股骨干骨折交锁髓内钉内固定的基础生物力学研究中,本课题通过测量股骨干标志线处髓内钉和四枚锁钉在不同拉力条件和不同分组下的位移值和应变值,分析位移和应变变化,为交锁髓内钉内固定的优化方案提供力学依据。
材料和方法：1.实验对象：选用昆明医学院人体解剖教研室提供的10%甲醛常规固定的年龄在20-40岁的成年男性股骨标本4根,左右侧随机。2.实验模型和分组：将标本解剖后剔除所有软组织,分别测量股骨干的全长、外径与内径,平均值分别为(45.25±3.54)cm,(2.69±0.32)cm,(1.11±0.16)cm,交锁髓内钉在髁间窝外侧自下而上插入而置于股骨髓内腔,四枚锁钉穿透4层骨皮质,两端用牙托粉包埋固定,定出中点位置后以线锯垂直于骨干长轴横行截断,制造股骨干中段骨折模型。股骨骨折中点定位为标志线,交锁髓内钉锁定自上到下依次命名为Ⅰ、Ⅱ、Ⅲ、Ⅳ。本实验每具标本分5种状态：A.模拟骨折愈合后的交锁髓内钉固定组。B.在A组基础上股骨中段横形锯断,模拟稳定型骨折。C.模拟多发骨折交锁髓内钉固定组(即在B组的基础上,距离中间骨折线下5cm处再横行锯断,即再造一次骨折)；D.在C组的基础上去掉近端Ⅰ锁钉；E.在D组的基础上去掉远端Ⅳ锁钉；将各组实验模型固定在电子万能试验机上,股骨头夹(固定)在上端,股骨髁夹在下端。安装好载荷,首先进行预载荷50N,以消除骨的松弛、蠕变等时间效应影响,再轴向加载ON-500N,加载速度为10N／S,计算机自动记录位移情况,通过数字散斑相关软件进行计算处理即可得出位移、应变测量值。采用SPSS11.5软件对实验数据进行统计分析,计量资料以均数±标准差(x±s)表示,采用方差分析,P<0.05认为有显著性差异。
结果：
1.方差分析股骨干骨折标志线处髓内钉的位移和应变：拉力载荷在100N-500N时,A组与D、E组比较；B组与D、E组比较；C组与E组比较；拉力载荷在200N-500N时,C组与A、D组比较,均有显著性差异(P<0.05)。其余各组间比较均无显著性差异(P>0.05)。
2.方差分析四枚锁钉的位移和应变：拉力载荷在100N-500N,锁定Ⅰ和Ⅱ比较无显著性差异(P>0.05),余两两比较均有显著性差异(P<0.05),且四枚锁钉的位移和应变与加载力的大小呈正比。在500N加载拉力下,A、B、C三种状态中,四枚锁钉的位移和应变值表现为Ⅲ>Ⅳ>Ⅱ>Ⅰ。
结论：
1.数字散斑相关方法是一种有效的光学测量技术,将此方法应用到生物医学实验研究中,能更精确的指导实验结果,从而推动医学研究的发展,是一种值得推广的研究手段。
2.采用髓内钉进行股骨干骨折内固定治疗时,远端的两枚锁钉易于发生断裂,尤其是靠近骨折线的锁定。
Objective:Optical measurement method was applied to basic biomechanical study on the femoral shaft fracture in the internal fixation with interlocking intramedullary nail,the value of the displacement and deformation of intramedullary nail at the mark line of femoral shaft and four locking nails under the conditions of different tensile and different group in this issue were measured,and the changes of displacement and deformation were analysed. Aimed at providing the mechanical basis for optimization program of the femoral shaft fracture in the internal fixation with interlocking intramedullary nail.
Materials and Methods:1.experimental object:Four native femoral specimens of male corpses aged 20-40 which were fixed by 10% formalin provided by Department of human anatomy of Kunming Medical College were used, left or right side was at random.2. experimental model and group:After all soft tissues of the samples were removed,and emoral full-length, outside diameter and inside diameter on average were measured respectively by (45.25±3.54) cm, (2.69±0.32) cm, (1.11±0.16) cm. Interlocking intramedullary nails were placed inside the femoral shaft marrow located in the lateral of intercondylar fossa from bottom to top,and four locking nails were through four layers of cortical bone.The distal tips were coated by dental base acrylic resin powder. The femoral shaft midpositions were desected vertically by the scroll saw to make the fracture model. The locking nails namedⅠ、Ⅱ、Ⅲ、Ⅳfrom top to bottom.In this experiment,five conditions were designed for every specimen:A The femur was not sawed with interlocking intramedullary nail placed inside the femur shaft marrow (simulation of the cured fracture); B The femur was sawed on the basis of A in order to simulating a stable fracture (the center point of femoral shaft was sawed up one time);C The more complicated fracture was made on the basis of B in order to making the bone fracture 5cm far from the middle fracture line based on group B;D The locking nailⅠof the upper distal end was removed based on C; E The locking nailⅣof the lower distal end was removed based on D; Then specimens were fixed and installed on CSS-44100-electronic universal testing machine.The load of 50N was applied in advance to remove the loosening and creeping. Subsequently, the axial load was applied 0～500N at 10N/s and the computer recorded the bias automatically. The calculation of the displacement and deformation was based on the digital speckle correlation method (DSCM) when it was applied 500N.In the experiment,we could attain some data which were dealed with by statistical software SPSS 11.5 and were denoted in the form of (x±s).We evaluated these data by analysis of variance with repeated measures for overall statistical analysis. P<0.05 was considered significant.
Results:
1.Analysis of the displacement and the deformation of intramedullary nail at the mark line of femoral shaft by analysis of variance:Tensile load at 100N-500N, the comparison of group A and group D、E; the comparison of group B and group D、E; the comparison of group C and group E; tensile load at 200N-500N, the comparison of group C and group A、E; there were significantly different(P<0.05); the comparison of the other groups were no significant difference (P>0.05)
2. Analysis of the displacement and deformation of four locking nails by analysis of variance:the comparison of locking nailsⅠandⅡ, there was no significant difference at 100N-500N (P>0.05),and the comparison of the other locking nails are no significant difference (P<0.05),and the displacement and deformation of four locking nails and the tensile load were positively correlated.Then the value of displacement and deformation of four locking nails wasⅢ>Ⅳ>Ⅱ>Ⅰunder condition A、B、C when it applied a tensile load of 500N.
Conclusion:
1.Digital Speckle Correlation Method was an effective optical measurement technique. By introducing this method to the empirical study of biomedicine, the development of medical research could be improved, which implied DSCM was an important method deserving generalization.
2.When the treatment of femoral shaft fracture with interlocking intramedullary nail was used,the two distal locking nails were easy to collapse,especially the one was beside the mark line of femoral fracture.
材料和方法：1.实验对象：选用昆明医学院人体解剖教研室提供的10%甲醛常规固定的年龄在20-40岁的成年男性股骨标本4根,左右侧随机。2.实验模型和分组：将标本解剖后剔除所有软组织,分别测量股骨干的全长、外径与内径,平均值分别为(45.25±3.54)cm,(2.69±0.32)cm,(1.11±0.16)cm,交锁髓内钉在髁间窝外侧自下而上插入而置于股骨髓内腔,四枚锁钉穿透4层骨皮质,两端用牙托粉包埋固定,定出中点位置后以线锯垂直于骨干长轴横行截断,制造股骨干中段骨折模型。股骨骨折中点定位为标志线,交锁髓内钉锁定自上到下依次命名为Ⅰ、Ⅱ、Ⅲ、Ⅳ。本实验每具标本分5种状态：A.模拟骨折愈合后的交锁髓内钉固定组。B.在A组基础上股骨中段横形锯断,模拟稳定型骨折。C.模拟多发骨折交锁髓内钉固定组(即在B组的基础上,距离中间骨折线下5cm处再横行锯断,即再造一次骨折)；D.在C组的基础上去掉近端Ⅰ锁钉；E.在D组的基础上去掉远端Ⅳ锁钉；将各组实验模型固定在电子万能试验机上,股骨头夹(固定)在上端,股骨髁夹在下端。安装好载荷,首先进行预载荷50N,以消除骨的松弛、蠕变等时间效应影响,再轴向加载ON-500N,加载速度为10N／S,计算机自动记录位移情况,通过数字散斑相关软件进行计算处理即可得出位移、应变测量值。采用SPSS11.5软件对实验数据进行统计分析,计量资料以均数±标准差(x±s)表示,采用方差分析,P<0.05认为有显著性差异。
结果：
1.方差分析股骨干骨折标志线处髓内钉的位移和应变：拉力载荷在100N-500N时,A组与D、E组比较；B组与D、E组比较；C组与E组比较；拉力载荷在200N-500N时,C组与A、D组比较,均有显著性差异(P<0.05)。其余各组间比较均无显著性差异(P>0.05)。
2.方差分析四枚锁钉的位移和应变：拉力载荷在100N-500N,锁定Ⅰ和Ⅱ比较无显著性差异(P>0.05),余两两比较均有显著性差异(P<0.05),且四枚锁钉的位移和应变与加载力的大小呈正比。在500N加载拉力下,A、B、C三种状态中,四枚锁钉的位移和应变值表现为Ⅲ>Ⅳ>Ⅱ>Ⅰ。
结论：
1.数字散斑相关方法是一种有效的光学测量技术,将此方法应用到生物医学实验研究中,能更精确的指导实验结果,从而推动医学研究的发展,是一种值得推广的研究手段。
2.采用髓内钉进行股骨干骨折内固定治疗时,远端的两枚锁钉易于发生断裂,尤其是靠近骨折线的锁定。
Objective:Optical measurement method was applied to basic biomechanical study on the femoral shaft fracture in the internal fixation with interlocking intramedullary nail,the value of the displacement and deformation of intramedullary nail at the mark line of femoral shaft and four locking nails under the conditions of different tensile and different group in this issue were measured,and the changes of displacement and deformation were analysed. Aimed at providing the mechanical basis for optimization program of the femoral shaft fracture in the internal fixation with interlocking intramedullary nail.
Materials and Methods:1.experimental object:Four native femoral specimens of male corpses aged 20-40 which were fixed by 10% formalin provided by Department of human anatomy of Kunming Medical College were used, left or right side was at random.2. experimental model and group:After all soft tissues of the samples were removed,and emoral full-length, outside diameter and inside diameter on average were measured respectively by (45.25±3.54) cm, (2.69±0.32) cm, (1.11±0.16) cm. Interlocking intramedullary nails were placed inside the femoral shaft marrow located in the lateral of intercondylar fossa from bottom to top,and four locking nails were through four layers of cortical bone.The distal tips were coated by dental base acrylic resin powder. The femoral shaft midpositions were desected vertically by the scroll saw to make the fracture model. The locking nails namedⅠ、Ⅱ、Ⅲ、Ⅳfrom top to bottom.In this experiment,five conditions were designed for every specimen:A The femur was not sawed with interlocking intramedullary nail placed inside the femur shaft marrow (simulation of the cured fracture); B The femur was sawed on the basis of A in order to simulating a stable fracture (the center point of femoral shaft was sawed up one time);C The more complicated fracture was made on the basis of B in order to making the bone fracture 5cm far from the middle fracture line based on group B;D The locking nailⅠof the upper distal end was removed based on C; E The locking nailⅣof the lower distal end was removed based on D; Then specimens were fixed and installed on CSS-44100-electronic universal testing machine.The load of 50N was applied in advance to remove the loosening and creeping. Subsequently, the axial load was applied 0～500N at 10N/s and the computer recorded the bias automatically. The calculation of the displacement and deformation was based on the digital speckle correlation method (DSCM) when it was applied 500N.In the experiment,we could attain some data which were dealed with by statistical software SPSS 11.5 and were denoted in the form of (x±s).We evaluated these data by analysis of variance with repeated measures for overall statistical analysis. P<0.05 was considered significant.
Results:
1.Analysis of the displacement and the deformation of intramedullary nail at the mark line of femoral shaft by analysis of variance:Tensile load at 100N-500N, the comparison of group A and group D、E; the comparison of group B and group D、E; the comparison of group C and group E; tensile load at 200N-500N, the comparison of group C and group A、E; there were significantly different(P<0.05); the comparison of the other groups were no significant difference (P>0.05)
2. Analysis of the displacement and deformation of four locking nails by analysis of variance:the comparison of locking nailsⅠandⅡ, there was no significant difference at 100N-500N (P>0.05),and the comparison of the other locking nails are no significant difference (P<0.05),and the displacement and deformation of four locking nails and the tensile load were positively correlated.Then the value of displacement and deformation of four locking nails wasⅢ>Ⅳ>Ⅱ>Ⅰunder condition A、B、C when it applied a tensile load of 500N.
Conclusion:
1.Digital Speckle Correlation Method was an effective optical measurement technique. By introducing this method to the empirical study of biomedicine, the development of medical research could be improved, which implied DSCM was an important method deserving generalization.
2.When the treatment of femoral shaft fracture with interlocking intramedullary nail was used,the two distal locking nails were easy to collapse,especially the one was beside the mark line of femoral fracture.
引文
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[1]Stimson LA. A treatise on fractures.1st eds. Philadelphia:Lea's Son& Co.,1883.593.
[2]Hey-Groves EW. Methods and results of transplantation of bone in the repair of defects caused by injury or disease. Br J Surg,1918,5:185-242.
[3]Rush LB.The humerus Inatlas of rush pin technics 1st eds.Meridian:Berivon Company,1976. 243.
[4]Kuntscher GB. The Kuntscher method of intramedullary fixation. Jone Joint Surg (Am),1958, 40:17-26.
[5]Maatz R, Lentz W, Arens W. Intramedullary nailing and other intramedullary osteosynthesis. Philadelphia:W. B. Saunders Company,1986.283.
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[1]Stimson LA. A treatise on fractures.1st eds. Philadelphia:Lea's Son& Co.,1883.593.
[2]Hey-Groves EW. Methods and results of transplantation of bone in the repair of defects caused by injury or disease. Br J Surg,1918,5:185-242.
[3]Rush LB.The humerus Inatlas of rush pin technics 1st eds.Meridian:Berivon Company,1976. 243.
[4]Kuntscher GB. The Kuntscher method of intramedullary fixation. Jone Joint Surg (Am),1958, 40:17-26.
[5]Maatz R, Lentz W, Arens W. Intramedullary nailing and other intramedullary osteosynthesis. Philadelphia:W. B. Saunders Company,1986.283.
[6]ModnyMT. The perforated cruciate intramedullary nail:a preliminary report of it use in geriatric patients. J Am Geriatr Soc,1953,1:579.
[7]Bone LB, Johnson KD. Treatment of tibial fractures by reaming and intramedullary nailing. J Bone Joint Surg (Am),1986,68:877-887.
[8]王新伟,吴岳篙,赵杰,等.矩形髓内钉治疗胫胖骨骨折生物力学研究.骨与关节损伤杂志,1999,14(6)：384-387.
[9]朱建民,金宗达,张庆宏,等.髓内钉及其骨折内固定的力学研究.上海生物医学工程,1996,17(1)：16-21
[10]Kuntseher GDie Marlmagelung Trurnmer Bruehes.Langenbeehs. ArchKlin Chir,1968, 322:1063-1068.
[11]Josephschatzker,姜春岩.AO／ASIF原则与方法的变迁.创伤骨科学报,1996,25(3)：205-207.
[12]Klerlun K.Sehellman WD.The interlocking intramedullary nail.Int CongressSer,1974, 291:1078-1081.
[13]Kempf, Grosse A, Abalo C.Locked intramedullary nailing:Its apPlieation to femoral and tibial axial rotational,lengthening,and shortening osteolomies.Clin OrthoP,1986,212:165-169.
[14]MeMuler,M Allgower,Rschneider,等.骨折内固定[M].第三版,北京：人民卫生出版社,1995：210
[15]吴乃庆,陶松年,沈家维,等.鱼口交锁髓内钉应用及扩孔影响皮质血供研究[J].中华骨科杂志,1993,3：168-169.
[16]Huckesfep RL.Rigid intramedullary fixation of femoral shaft fractures with compression.J Bone Joint Surg(Br),1972,54:204-208.
[17]吴岳篙,徐卫东,陈舰,等.交锁髓内钉的设计与临床应用.中华骨科杂志,1997,4：248-249.
[18]White GM, Healy WL, Brumback RJ.Treatment of Fracture of the Femoral shaft with the Brooker Wills distal locking intramedullary nail.J Boneand Joint Surg(Am),1986,68:86-89.
[19]SeidelH.Hmerallockingnail:a Praliminary report.orthopedies,1989,12:219-223.
[20]徐耀增,董天华,董启榕.叶子交锁髓内钉的研制和三种髓内钉的生物力学比较.骨与关节损伤杂志,1993,2：115-118.
[21]李健民,肯少汀,李铁防,等.组合式防旋髓内钉的研制及临床应用.中华骨科杂志,1996,9：547-549.
[22]李健民,青少汀,邹德威,等.髓内扩张自锁钉的结构特点及力学行为.中华骨科杂志,1998,12：728-730.
[23]A Darder Garcia, Adarder Parts, F Gomar Saneho.Unreamed flexible locked intramedullary nailing in tibial open fractures.Clin Orthop,1998,350:97-104.
[24]Van-der-ElstM, Bramer JA, Klein CP, et al.Biodegradable interlocking nails for fracture fixation.Clin orthop,1998,357:192-204.
[25]Taylor D C, Erpelding M, Whitman C S, et al. Treatment of cimminuted subtrochanteric femoral fractures in young population with a reconstruction nail [J].Mil Med,1996,161 (12):735-738.
[26]Dominguez I, Moro Rodriguez E, De Pedro Moro JA,et al. Antegrade nailing for fractures of the distal femur[J]. Clin Orthop,1998 (350):74-79.
[27]Cubberlyw H, Unterweiser P, Benjamin D,et al. Metals Handbook vol,3[M].9th Ed. Metals park:American Society for Metals,1998:389.
[28]Helefet D,Lorich D G. Retrograde intramedullary nailing of supracondylar femoral fractures [J]. Clin Orthop,1998, (350):80-84.
[29]Court B C M, Keating J F. Exchange intramedullary nailing[J]. Bone Joint Surg(Br),1995, 77:407-411.
[30]Corut-Broen C M, Keating J F. Exchange intramedullary nailing[J]. BJS,1995,77 (3):407.
[31]Kingsley, R. Chin, Daniel T. AltmanL,et al. Retrograde nailing of femour fractures in patients with myelopathy and who are nonambulatory[J]. Clinical Orthopaedics and Related Research,1999,373:218-226.
[32]Wenda K,undelm M. Systemic complications in intramedullary nailing[J]. Orthopade,1996, 25 (3):292.
[33]Pape H, Regal G. Influence of thoracictrauma and primary femuralin tramedullary nailing on the incidence of ARDS inmulipletrauma patients[J]. Injury,1993,24 (Suppl 3):82-103.
[34]Furlonga J, Grannoudis P U, Smith R M. Heterotopic ossification:a comparison between reamed and undreamed femoral nailing[J]. Injury,1997,28 (1):9-14.
[35]Doenhoff R M, Dainton J N, Hutchins PM. Proximal thigh pain after femoral nailing[J]. Joural of Bone and Joint Surgery,1997,79B:738-741.
[36]印心奇,徐根宝.交锁髓内钉的临床应用体会[J].中国矫形外科杂志,1998,5(5)：410-411.
[37]Tornetta P3rd, Tiburzil D. The treatment of femoral shaft fractures using intramedullary interlocked nails with and without reaming:a preliminary report [J]. Orthop Trauma,1997, 11(2):89-92.
[38]Erich Schineid AR, Marjus C, Michel, et al. Loads acting in an intramedullary nail during fracture healing in the human femure[J]. Joural of Biomedanics,2001,34:849-557.
[39]Wu CC, Shih C H. Biomechanical analysis of the mechanism of interlocking nail failure[J]. Arch Orthop Trauma Surg,1992,111:268.
[40]De Casas R, Lagoro FJ, Garcia M R, et al. Artereovenous fistula after locking nailing og the femur [J].Trauma,1995,38 (2):303.
[41]Lin J, Inoue N,Valdevit A, et al. Biomechanical comparicon of antegrade and retrograde nailing of humeral shaft fractures[J]. Clin Orthop,1998,351:203-203.
[42]Lin J, Son-Lin J YH. Stress analysis of the distal locking screws for femoral interlocking nailing[J]. Joural of Orthopaedie Research,2001,19:57-63.
[43]Fencer A F, Johnson KD. Low extremity fixation. In:Biomechanics in orthopedic trauma bone frature and fixation[M]. Philadelphia:JB. Lippinlott,1994:249-304.
[44]吕刚,丁卫,金成壁,等.高强度可吸收内固定物治疗实验性骨折的形态计量学研究.中国医科大学学报.1998；27(4)：347-349
[45]Lin J. Treatment of humeral shaft fractures with humeral locked nail and comparison with plate fixation[J]. Trauma,1998,44:859-864.