BIOMECHANICAL RESEARCH OF LESS INVASIVE STABILIZATION SYSTEM AND DYNAMIC CONDYLAR SCREW IN FIXING SUBTROCHANTERIC FRACTURES OF FEMUR_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YANG Yang ¹ , MA Xinlong ^1,2 , MA Jianxiong ² , ZHU Shaowen ¹ , MA Baoyi ¹ , JI Shuqing ³ , MA Tao ² , CHEN Yang ²

1Department of Orthopedics, Tianjin Hospital, Tianjin, 300211, P.R.China;;
2Department of Orthopedics, General Hospital of Tianjin Medical University;;
3Department of Orthopedics, Tianjin Jixian People’s Hospital. Corresponding author: MA Xinlong, E-mail: maxinlong8686@sina.com;

Corresponding author：

Keywords：

Biomechanics; Subtrochanteric fracture of femur Less invasive stabilization system; Dynamic condylar screw; Internal fixation

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Objective To compare the biomechanical characteristics of the less invasive stabilization system (LISS) and the dynamic condylar screw (DCS) in the fixation of subtrochanteric fractures of the femur so as to provide theoretical basis for choosing internal fixator in clinical application. Methods Twelve cadaveric human femurs (35-50 years old) were selected with similar proximal femur, excluding deformities, fractures, and other lesions. The twelve femur specimens were randomly divided into 2 groups, 6 specimens per group. An 1 cm gap of osteotomy model was made in the proximal femur up to 1 cm below the lesser trochanter to simulate a comminuted subtrochanteric fracture of femur, and the distal end was embedded with denture acrylic and liquid for denture acrylic. Fracture was fixed by LISS in group A, and was fixed by DCS in group B. The specimens were fixed on Instron-8874 servo-hydraulic mechanical testing machine in a single-leg standing position, and the axial compression test and dynamic fatigue test were carried out to compare the compressive strength and the strain distribution at both sides of the fracture line. Results Axial compression test: the strain values of the 2 strain gauges in group A were significantly smaller than those in group B (P lt; 0.01); the vertical down displacement of the femoral head in group A was significantly smaller than that in group B (P lt; 0.01) under the same load; when the load was 600 N, the axial rigidity of group A was (209.06 ± 18.63) N/mm, which was significantly higher than that of group B [(65.79 ± 7.26) N/mm] (t=3.787, P=0.004). Dynamic fatigue test: the vertical down displacement of the femoral head in group A was significantly smaller than that in group B in the same cyclic loading cycle (P lt; 0.01); when the vertical down displacement of the femoral head was 0.5 mm, the force and the cyclic loading cycles in group A were significantly larger than those in group B (P lt; 0.01). Conclusion LISS, which has good mechanical stability, can meet the requirements for subtrochanteric fracture of femur fixation in biomechanics and anatomical structures. It can be proven that the LISS internal fixator is firmer than the DCS internal fixator by biomechanical comparison.

Citation： YANG Yang,MA Xinlong,MA Jianxiong,ZHU Shaowen,MA Baoyi,JI Shuqing,MA Tao,CHEN Yang. BIOMECHANICAL RESEARCH OF LESS INVASIVE STABILIZATION SYSTEM AND DYNAMIC CONDYLAR SCREW IN FIXING SUBTROCHANTERIC FRACTURES OF FEMUR. Chinese Journal of Reparative and Reconstructive Surgery, 2012, 26(10): 1213-1217. doi: Copy

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2.	Kim JW, Oh CW, Byun YS, et al. A biomechanical analysis of locking plate fixation with minimally invasive plate osteosynthesis in a subtrochanteric fracture model. J Trauma, 2011, 70(1): E19-23.
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9.	许纬洲, 王以进, 徐献忠, 等. 应力调控型带锁髓内钉治疗股骨骨折的应力水平研究. 中华创伤骨科杂志, 2007, 9(7): 670-674.
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11.	张宏军, 刘又文, 高书图, 等. 自控微动带锁髓内钉在股骨干骨折中的应用. 中国修复重建外科杂志, 2008, 22(6): 696-699.
12.	喻鑫罡, 张先龙, 曾炳芳, 等. 低频微动后转化生长因子β1与胰岛素样生长因子Ⅰ在新骨组织中的表达研究. 中国修复重建外科杂志, 2006, 20(7): 685-689．.
13.	Claes LE, Heigele CA. Magnitudes of local stress and strain along bone surfaces predict the course and type of fracture healing. J Biomech, 1999, 32(3): 255-266.
14.	McAllister TN, Frangos JA. Steady and transient fluid shear stress stimulate No release in osteoblasts through distinct biochemical pathways. J Bone Miner Res, 1999, 14(6): 930-936.
15.	Gómez-Benito MJ, González-Torres LA, Reina-Romo E, et al. Influence of high-frequency cyclical stimulation on the bone fracture-healing process: mathematical and experimental models. Philos Transact A Math Phys Eng Sci, 2011, 369(1954): 4278-4294.
16.	Sigurdsen U, Reikeras O, Utvag SE. The influence of compression on the healing of experimental tibial fractures. Injury, 2011, 42(10): 1152-1156.
17.	González-Torres LA, Gómez-Benito MJ, Donlaré M, et al. Influence of the frequency of the external mechanical stimulus on bone healing: a computational study. Med Eng Phys, 2010, 32(4): 363-371.
18.	严雪港, 鲍同柱, 赵卫东, 等. TiNi 形状记忆锯齿臂环抱接骨板的生物力学测试及其对骨折愈合影响的研究. 中国修复重建外科杂志, 2010, 24(2): 219-222.
19.	张嘉, 翁习生. 股骨转子下骨折的诊断和治疗. 中国骨与关节外科, 2008, 1(1): 77-81.
20.	周伟, 刘阳, 王效东, 等. 动力髁螺钉治疗股骨粗隆下骨折．实用骨科杂志, 2009, 15(7): 535-536.
21.	徐炜, 王能兴, 卢晓栋, 等. LISS钢板治疗股骨粗隆下严重粉碎性骨折体会. 天津医药, 2009, 37(9): 803-804.
22.	王国喜, 王静成, 陶玉平. 多功能股骨板生物力学测试及其在股骨粗隆间骨折的应用研究. 中华现代临床医学杂志, 2004, 2(3): 200-202.
23.	曹培锋, 洪勇平, 王以近, 等. 股骨小转子缺损及复位固定的生物力学比较. 中国矫形外科杂志, 2009, 17(22): 1722-1724.
24.	Freeman AL, Craig MR, Schmidt AH. Biomechanical comparison of tibial nail stability in a proximal third fracture: do screw quantity and locked, interlocking screws make a difference? J Orthop Trauma, 2011, 25(6): 333-339.
25.	Kanchanomai C, Muanjan P, Phiphobmongkol V. Stiffness and endurance of a locking compression plate fixed on fractured femur. J Appl Biomech, 2010, 26(1): 10-16.
26.	Floyd JC, O’Toole RV, Stall A, et al. Biomechanical comparison of proximal locking plates and blade plates for the treatment of comminuted subtrochanteric femoral fractures. J Orthop Trauma, 2009, 23(9): 628-633.

1. 卢世壁. 坎贝尔骨科手术学. 9版. 济南: 山东科学技术出版社, 2004: 2148-2158.
2. Kim JW, Oh CW, Byun YS, et al. A biomechanical analysis of locking plate fixation with minimally invasive plate osteosynthesis in a subtrochanteric fracture model. J Trauma, 2011, 70(1): E19-23.
3. Mahomed MN, Harrington IJ, Hearn TC. Biomechanical analysis of the Medoff sliding plate. J Trauma, 2000, 48(1): 93-100.
4. Bong MR, Patel V, Iesaka KA, et al. Comparison of a sliding hip serew with a troehanterie lateral support plate to an intramedullary hip screw for fixation of unstable intertroehanterie hip fractures: a cadaver study. J Trauma, 2004, 56(4): 791-794.
5. 段智霞, 白玉, 张善莲. 股骨颈骨折几种内固定方法的生物力学研究. 中医正骨, 2007, 19(5): 1-3.
6. Strauss E, Frank J, Lee J, et al. Helical blade versus sliding hip screw for treatment of unstable intertrochanteric hip fractures: a biomechanical evaluation. Injury, 2006, 37(10): 984-989.
7. 付青格, 许硕贵, 刘欣伟, 等. 镍钛合金天鹅记忆接骨器对成人上肢骨骨折愈合应力遮挡效应的评价. 中国组织工程研究与临床康复, 2008, 12(26): 5023-5027.
8. 赖金平, 魏刚, 李秀波, 等. 低应力遮挡效应接骨板的研究与设计. 生物骨科材料与临床研究, 2007, 4(3): 51-52.
9. 许纬洲, 王以进, 徐献忠, 等. 应力调控型带锁髓内钉治疗股骨骨折的应力水平研究. 中华创伤骨科杂志, 2007, 9(7): 670-674.
10. 许纬洲, 杜靖远, 郑毅, 等. 自控微动带锁髓内钉内固定对骨折愈合影响的组织学实验研究. 中国矫形外科杂志, 2003, 11(23): 1621-1624.
11. 张宏军, 刘又文, 高书图, 等. 自控微动带锁髓内钉在股骨干骨折中的应用. 中国修复重建外科杂志, 2008, 22(6): 696-699.
12. 喻鑫罡, 张先龙, 曾炳芳, 等. 低频微动后转化生长因子β1与胰岛素样生长因子Ⅰ在新骨组织中的表达研究. 中国修复重建外科杂志, 2006, 20(7): 685-689．.
13. Claes LE, Heigele CA. Magnitudes of local stress and strain along bone surfaces predict the course and type of fracture healing. J Biomech, 1999, 32(3): 255-266.
14. McAllister TN, Frangos JA. Steady and transient fluid shear stress stimulate No release in osteoblasts through distinct biochemical pathways. J Bone Miner Res, 1999, 14(6): 930-936.
15. Gómez-Benito MJ, González-Torres LA, Reina-Romo E, et al. Influence of high-frequency cyclical stimulation on the bone fracture-healing process: mathematical and experimental models. Philos Transact A Math Phys Eng Sci, 2011, 369(1954): 4278-4294.
16. Sigurdsen U, Reikeras O, Utvag SE. The influence of compression on the healing of experimental tibial fractures. Injury, 2011, 42(10): 1152-1156.
17. González-Torres LA, Gómez-Benito MJ, Donlaré M, et al. Influence of the frequency of the external mechanical stimulus on bone healing: a computational study. Med Eng Phys, 2010, 32(4): 363-371.
18. 严雪港, 鲍同柱, 赵卫东, 等. TiNi 形状记忆锯齿臂环抱接骨板的生物力学测试及其对骨折愈合影响的研究. 中国修复重建外科杂志, 2010, 24(2): 219-222.
19. 张嘉, 翁习生. 股骨转子下骨折的诊断和治疗. 中国骨与关节外科, 2008, 1(1): 77-81.
20. 周伟, 刘阳, 王效东, 等. 动力髁螺钉治疗股骨粗隆下骨折．实用骨科杂志, 2009, 15(7): 535-536.
21. 徐炜, 王能兴, 卢晓栋, 等. LISS钢板治疗股骨粗隆下严重粉碎性骨折体会. 天津医药, 2009, 37(9): 803-804.
22. 王国喜, 王静成, 陶玉平. 多功能股骨板生物力学测试及其在股骨粗隆间骨折的应用研究. 中华现代临床医学杂志, 2004, 2(3): 200-202.
23. 曹培锋, 洪勇平, 王以近, 等. 股骨小转子缺损及复位固定的生物力学比较. 中国矫形外科杂志, 2009, 17(22): 1722-1724.
24. Freeman AL, Craig MR, Schmidt AH. Biomechanical comparison of tibial nail stability in a proximal third fracture: do screw quantity and locked, interlocking screws make a difference? J Orthop Trauma, 2011, 25(6): 333-339.
25. Kanchanomai C, Muanjan P, Phiphobmongkol V. Stiffness and endurance of a locking compression plate fixed on fractured femur. J Appl Biomech, 2010, 26(1): 10-16.
26. Floyd JC, O’Toole RV, Stall A, et al. Biomechanical comparison of proximal locking plates and blade plates for the treatment of comminuted subtrochanteric femoral fractures. J Orthop Trauma, 2009, 23(9): 628-633.

Chinese Journal of Reparative and Reconstructive Surgery

BIOMECHANICAL RESEARCH OF LESS INVASIVE STABILIZATION SYSTEM AND DYNAMIC CONDYLAR SCREW IN FIXING SUBTROCHANTERIC FRACTURES OF FEMUR

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