摘要
目的通过比较股骨近端防旋髓内钉（PFNA）、亚洲型PFNA（PFNA-Ⅱ）及InterTan3种股骨近端髓内固定系统与国人股骨近端解剖学的匹配性，探讨适合亚洲人群的股骨近端髓内钉形态学参数。方法对120例国人股骨进行CT扫描后以Mimics10．01图像处理软件重建3D模型，并测量其股骨近端髓内钉设计相关参数。使用proE4．0软件构建出PFNA、PFNA-Ⅱ及InterTan的3D模型，并从120例样本中随机抽取20例与其进行解剖学匹配实验，通过观察3种内固定物与股骨外侧壁和股骨大转子顶端的相对关系，比较其与国人股骨近端的匹配性。结果PFNA、PFNA-Ⅱ及InterTan突破股骨外侧壁的厚度平均分别为（1．51±0．58）、（0．12±0．21）、（0．33±0．26）mm，差异有统计学意义（F=57．189，P〈0．001），PFNA分别与PFNA-Ⅱ、InterTan比较差异有统计学意义（P〈0．05）；主钉顶端突破大转子的长度平均分别为（3．47±0．85）、（4．11±0．92）、（0．25±0．34）mm，差异有统计学意义（F=67．600，P〈0．001），InterTan分别与PFNA、PFNA-Ⅱ比较差异有统计学意义（P〈0．05）。结论PFNA-Ⅱ对PFNA的改进明显降低了术中对股骨外侧壁损伤的几率，然而对于近端较长的问题尚未解决。InterTan不但能够有效减少了对股骨近端外侧壁的损伤，而且近端长度适中，与国人股骨近端解剖学匹配性较好。
Objective To obtain morphologic parameters of intramedullary nailing appropriate for proximal femur fractures in Chinese population by assessing the geometric match between 3 kinds of intramedullary nailing and Chinese proximal femurs. Methods One hundred and twenty Chinese femurs were scanned by computed tomography. 3D models of Chinese femur were reconstructed on a collection of the CT data using Mimics 10. 01 software. Parameters of intramedullary nailing designed for proximal femur fractures were measured on the 3D models. 3D models of internal fixation of the proximal femur with 3 kinds of intramedullary nailing, Proximal Femoral Nail Antirotation （PFNA）, PFNA-Ⅱ and InterTan, were recon- structed using proE 4. 0 software. The 3D models of 3 intramedullary nailing systems were imported into the Mimics software to match the 3D models of Chinese femur. The geometric match was assessed between the 3 nailing systems and 20 Chinese femurs, which were randomly selected from 120 samples. The relative positions between the nail and the lateral wall of femur as well as between the nail and the top of greater trochanter were observed. Results The average protrusion of the nail into the lateral femoral cortex was significantly thicker in PFNA （1.51 ± 0.58 mm） than in PFNA- Ⅱ（0. 12 ± 0.21 mm） and InterTan （0.33 ± 0.26 mm） （ F = 57. 189, P 〈 0. 001） . The average extension distance of the nail beyond the top of the proximal femur was significantly shorter in InterTan （0.25 ±0. 34 mm） than in PFNA （3.47 ±0.85 mm） and PFNA-Ⅱ（4. 11 ± 0.92 mm） （F=67. 600, P 〈0. 001） . Conclusions PFNA-Ⅱ, as an improvement of PFNA, has evidently reduced intraoperative invasion to the lateral wall of femur, but does not solve the problem of proximal length. InterTan, with evidently reduced invasion to the lateral wall of femur and an appropriate proximal length, has a better anatomic match for the Chinese femur.
出处
《中华创伤骨科杂志》
CAS
CSCD
2011年第11期1029-1033,共5页
Chinese Journal of Orthopaedic Trauma
基金
国家自然科学基金（81071233）
关键词
股骨
骨折固定术
髓内
骨钉
解剖学
比较
Femur
Fracture fixation, intramedullary
Bone nails
Anatomy, comparative
