OBJECTIVES:The aim of the present study was to examine biomechanically 5 different construct combinations for fixation of ipsilateral intertrochanteric and femoral shaft fractures. METHODS:Twenty-five fresh-frozen adult human femora (age range = 58-91 years, average age = 75.4 years) were tested in physiological bending and in torsion to characterize initial bending and torsional stiffness and stiffness following fixation of combined intertrochanteric and femoral shaft fractures. Five fracture fixation device constructs were assessed-construct A: long dynamic hip screw (long DHS); construct B: reconstruction nail; construct C: DHS plus low-contact dynamic compression plate; construct D: DHS plus retrograde intramedullary nail; and construct E: long intramedullary hip screw. Axial stiffness, torsional stiffness, and axial load-to-failure were the main measurements recorded. RESULTS:There were no differences between constructs in terms of axial stiffness (P = 0.41), external rotation stiffness (P = 0.13), and axial load-to-failure (P = 0.16). However, there was a borderline statistically significant difference in internal rotation stiffness between the constructs (P = 0.048). Specifically, construct C was significantly stiffer than construct E (P = 0.04). CONCLUSIONS:All constructs showed no statistical differences when compared with one another, with the exception of construct E, which provided the least torsional stiffness. However, the current in vitro model did not simulate fracture healing or support offered by soft tissues, both of which would affect the stiffness and load-to-failure levels reached.

译文

目的:本研究的目的是用生物力学方法检查5种不同的结构组合,以固定同侧股骨粗隆间和股骨干骨折。
方法:对二十五个新鲜冷冻的成人股骨(年龄范围为58-91岁,平均年龄= 75.4岁)进行了生理弯曲和扭转测试,以表征股骨转子间和股骨固定后的初始弯曲和扭转刚度和刚度。轴骨折。评估了五种骨折固定装置的构造。构造A:长动髋螺钉(长DHS);构造B:重建钉;结构C:DHS加低接触动态压缩板;结构D:DHS加逆行髓内钉;并构造E:长髓内髋螺钉。记录的主要测量指标是轴向刚度,扭转刚度和轴向破坏载荷。
结果:结构之间在轴向刚度(P = 0.41),外部旋转刚度(P = 0.13)和轴向破坏载荷(P = 0.16)方面没有差异。但是,在构造之间,内部旋转刚度在统计学上有明显的界线差异(P = 0.048)。具体而言,构建体C明显比构建体E坚硬(P = 0.04)。
结论:所有结构在相互比较时均无统计学差异,但结构E除外,其扭转刚度最小。但是,当前的体外模型并未模拟软组织提供的骨折愈合或支撑,这两者都会影响刚度和达到的负荷-破坏水平。

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