改进型股骨交锁髓内钉瞄准器设计的实验研究

发布时间：2019-02-16 04:12

【摘要】：目的:本研究拟对股骨髓腔进行解剖学测量,分析其在三维空间上的走行轨迹,将其与股骨交锁髓内钉参数进行比较,分析股骨髓腔与交锁髓内钉的匹配度及引起股骨远端锁钉置入困难的原因,并对股骨交锁髓内钉瞄准器进行改良,以解决股骨交锁髓内钉远端锁钉置入困难问题。方法:选取干燥股骨标本30具进行CT扫描,每一股骨平均提取20幅图像,分别测量中轴点及髓腔壁一周8个点在X、Y轴上的数据。用三维画图软件画出每一根股骨及其平均值的髓腔壁、中轴线和髓内钉在三维空间上的形态,将髓腔与髓内钉重叠后进行比较。分别绘出髓腔中轴冠状面及矢状面的折线型数据图表,与髓内钉数据结合模拟髓内钉插入髓腔,观察髓内钉切出髓腔壁情况。结果:将股骨髓腔中轴线的平均值与髓内钉重叠后进行比较,在冠状面上两者较一致,其表面的重叠率达到了约80%;而在矢状面上髓腔弧度明显较髓内钉大,其表面重叠率为约40%。股骨髓腔中轴线向内成角11例,向外成角19例;6根成角小于1.5°,15根成角1.5°~3°,9根成角大于3°,最大为向内成角5.7°。模拟髓内钉插入每一根髓腔,在冠状面上30根髓内钉中有6根切出髓腔内侧或外侧壁,切出率为20%,矢状面上有13例髓内钉从前缘切出,切出率为43.3%。根据测量结果分析后对股骨交锁钉瞄准器进行改进,增加其压杆的宽度,理论上能从根本上解决股骨交锁髓内钉远端锁钉置入困难问题。结论:常规股骨交锁髓内钉能与大多数髓腔相匹配,但髓腔解剖结构有一定的变异性,部分髓腔成角过大使髓内钉发生变形是引起髓内钉远端锁钉置入困难的主要原因。通过增加瞄准器顶杆的宽度能解决股骨交锁髓内钉远端锁钉置入困难问题。
[Abstract]:Objective: the purpose of this study was to measure the femoral medullary cavity anatomically, analyze its path in three dimensional space, and compare it with the parameters of femoral interlocking intramedullary nail. The matching degree between femoral medullary cavity and interlocking intramedullary nail and the reasons for the difficulty of interlocking nail placement in distal femur were analyzed, and the improvement of the sight device of femoral interlocking intramedullary nail was carried out to solve the problem of placement of distal locking nail in femoral interlocking intramedullary nail. Methods: 30 dry femur specimens were scanned by CT, and 20 images were extracted from each femur on average, and the data of the midaxis and 8 points of the medullary cavity wall were measured on the XY axis. The three-dimensional drawing software was used to draw out the shape of each femur and its average medullary cavity, the central axis and the intramedullary nail in three dimensional space, and then to compare the medullary cavity with the intramedullary nail after the superposition of the medullary cavity and the intramedullary nail. The curves of coronal and sagittal plane of the central axis of the medullary cavity were drawn respectively, and the intramedullary nail was combined with the data of the intramedullary nail to insert the intramedullary nail into the medullary cavity to observe the wall of the medullary cavity cut out by the intramedullary nail. Results: the average value of the central axis of the femoral medullary cavity was compared with that of the intramedullary nail. The curvature of the medullary cavity on the sagittal plane was significantly larger than that of the intramedullary nail, and the surface overlap rate was about 40. The central axis of femoral medullary cavity was diagonal in 11 cases and outward in 19 cases, 6 in less than 1.5 掳, 15 in 1.5 掳~ 3 掳, 9 in more than 3 掳, and the maximum was 5.7 掳in inward. Six of the 30 intramedullary nails on the coronal plane were cut out of the medial or lateral wall of the medullary cavity, and the excision rate was 20. On the sagittal plane, 13 cases of the intramedullary nail were removed from the anterior edge, with an excision rate of 43.3%. Based on the analysis of the measurement results, the femoral interlocking nail sight was improved to increase the width of the compression rod, and the problem of placing the distal locking nail in the femoral interlocking intramedullary nail could be solved theoretically. Conclusion: the conventional interlocking intramedullary nail can match most of the intramedullary cavity, but the anatomical structure of the medullary cavity has certain variability. The deformation of some intramedullary interlocking nails is the main reason for the difficulty of insertion of the distal interlocking nail in the intramedullary nail. The problem of distal interlocking nail placement can be solved by increasing the width of the bumper rod.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687

【参考文献】