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中华肩肘外科电子杂志 ›› 2021, Vol. 09 ›› Issue (04) : 293 -297. doi: 10.3877/cma.j.issn.2095-5790.2021.04.002

创新与争鸣

肱骨近端骨折内固定治疗的新思考——支撑牵张效应
张殿英1,()   
  1. 1. 100044 北京大学人民医院创伤骨科;100044 北京,国家创伤医学中心;100044 北京,创伤救治与神经再生教育部重点实验室;300450 天津,北京大学滨海医院骨科
  • 收稿日期:2021-09-15 出版日期:2021-11-05
  • 通信作者: 张殿英
  • 基金资助:
    教育部创新团队项目(IRT_16R01); 北京大学医学部学院建设项目(2020)——国家创伤医学中心(BMU2020XY005-01); 北京大学医学部学院建设项目(2020)——创伤救治与神经再生教育部重点实验室(BMU2020XY005-03)

New views on the internal fixation of proximal humeral fractures—— the buttress and stretch effect

Dianying Zhang1()   

  • Received:2021-09-15 Published:2021-11-05
  • Corresponding author: Dianying Zhang
引用本文:

张殿英. 肱骨近端骨折内固定治疗的新思考——支撑牵张效应[J]. 中华肩肘外科电子杂志, 2021, 09(04): 293-297.

Dianying Zhang. New views on the internal fixation of proximal humeral fractures—— the buttress and stretch effect[J]. Chinese Journal of Shoulder and Elbow(Electronic Edition), 2021, 09(04): 293-297.

图1 股骨距内侧皮质支撑完整的股骨转子间骨折内固定术后螺旋刀片受力顺序示意图注:①为股骨距内侧皮质支撑发挥主压力骨小梁作用;②为螺旋刀片受股骨头内翻应力牵张发挥主张力骨小梁作用,产生内移趋势
图2 股骨距内侧皮质粉碎的股骨转子间骨折内固定术后螺旋刀片受力顺序示意图注:①为股骨距内侧皮质粉碎缺乏支撑,螺旋刀片承担主压力骨小梁并产生退钉趋势;②为股骨距内侧骨质接触后产生支撑应力,螺旋刀片受股骨头内翻应力牵张发挥主张力骨小梁作用,产生内移趋势
图3 杂技表演者双臂牵张支撑的受力示意图注:①为下方手臂为压力臂,受到的是挤压应力;②为上方手臂为张力臂,受到的是牵张应力
图4 肩关节外展位肱骨头内螺钉受力示意图注:绿色箭头表示近端和远端螺钉的受力方向,近端2枚螺钉产生支撑应力,远端2枚螺钉产生牵张应力
图5 肩关节内收位肱骨头内螺钉受力示意图注:绿色箭头表示近端和远端螺钉的受力方向,近端2枚螺钉产生牵张应力,远端2枚螺钉产生支撑应力
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