以鋼絲鎖定骨釘骨板固定器治療人工髖關節置換後鄰近股骨柄骨折之生物力學研究

The Biomechanical Study of a Modified Wire-locked Screw and Plate Fixator for Femoral Periprosthetic Fracture After Total Hip Arthroplasty

陳俊步(Jiung-Bu Chen)

指導教授 ： 陳文斌

中原大學/工學院/生物醫學工程學系/碩士(2008年)

https://doi.org/10.6840/cycu200900047

摘要

鄰近股骨柄的股骨骨折，是一種較常發生於接受過髖關節置換手術之老年人的併發症，此種骨折股骨柄已佔據股骨上半端的骨髓腔，因此髓內釘.鋼板加上螺絲釘幾乎不可能使用。目前處理此類骨折的常用方式，常以特別設計的鋼板加上特別的環狀固定鋼纜或固定帶加以固定，需特殊器械及固定器，一般醫院大多沒有常備，且價格上也相當昂貴。
本研究以力學測試的方法，探討三種臨床骨折固定方式- 1.Dall–Miles Cable-plate system固定；2.骨板在遠端雙側皮質骨固定而近端不銹鋼絲固定；3.骨板在遠端雙側皮質骨固定而近端鋼絲鎖定之骨螺釘固定。進行四個不同參數之測試: 1.壓縮測試 2.彎曲測試3.扭轉測試 4.破壞強度測試，驗證我們發展的螺絲釘可提供足夠的固定力量，結果顯示鋼絲鎖定螺絲釘力學特性優於現行常用的其他固定方式，適合於臨床應用。如此一來醫院不需另外準備其他器械，只要增加本研究所研發的螺絲釘，即可處理此類骨折。

關鍵字

鄰近股骨柄的股骨骨折 ； 髖關節置換 ； 鋼絲鎖定螺絲釘 ； 力學測試

並列摘要

Periprosthetic hip fractures are common complications in hip arthroplasty. Treatment of these special fractures is difficult because the canal is occupied by stem. Therefore traditional plate-screw system and intramedullary nail are not suitable. Several specially designed cable-plate systems are developed for the situation, but they are usually expensive and not ordinarily available. Wire-locked screw is developed by our team. 4.5 mm cortical screw is adapted and the screw head is elongated with holes, providing better fixation of circlage wire and avoiding wire slippage. In combination with 4.5mm DCP, unicortical purchase is achieved, and circlage wire is applied, providing better fixation of the fracture. In the study, three different fixation methods are investigated: 1.Doll-Miles cable plate system, 2.wire-locked screw and plate fixation, 3.Simple proximal wire fixation. By way of biomechanical testing, three loading condition including compression, bending, and rotation are tested. Then failure test is done by rotational moment. Stiffness of different fixators is compared. Results of biomechanical testing reveal that stiffness of wire-locked screw and plate fixation is better than another 2 fixation methods. Therefore, periprosthetic hip fractures can be handled properly by it.

並列關鍵字

hip arthroplasty ； periporosthetic fracture ； wire-locked screw and plate fixator ； biomechanical testing

參考文獻

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