前言：
对Pauwls III型股骨颈骨折，传统三枚螺钉固定无法有效抵抗剪切，通常需采用DHS固定。如何加强DHS内固定的强度，避免内固定失效，仍是一个亟待解决难题。
参考文献：Nwankwo CD,
Schimoler P, Greco V, Kharlamov A, Westrick ER, Miller MC. Medial
Plating of Pauwels Type III Femoral Neck Fractures Decreases Shear and
Angular Displacement Compared to Derotational Screw. J Orthop Trauma.
2020 May 30. 在2020.12 JOT（Journal of Orthopadic tuauma）期刊上，美国学者对Pauwels III型股骨颈骨折采用DHS内固定，同时采用防旋螺钉或内侧支撑钢板加强进行了生物力学分析。以探讨两种加强方式在角度稳定性和抵抗剪切上的差异。
Objectives
此生物力学研究的目的是对比Pauwels III型股骨颈骨折的两种加强稳定方法。（The purpose of this mechanical study was to compare 2 methods of augmented stabilization of Pauwels type III femoral neck fractures. ）
十对匹配的年轻股骨尸体标本，自小转子远端22cm切断。所有标本均接受70°截骨，并用135度滑动髋螺钉固定。 配对股骨其中之一接受6.5mm全螺纹空心螺钉增强固定，另一个标本在股骨颈前内侧应用的3.5 mm的5孔管状钢板进行了加强固定。 在循环轴向载荷条件下（200-1400 N之间，以2循环/秒循环5000次）对每个试样进行测试，然后将其加载至失效。计算了角位移（内翻），骨折间（剪切）位移和失效载荷。
（Ten matched pairs of young cadaveric femurs were cut 22 cm distal to the lesser trochanter. All specimens received a 70-degree osteotomy, which was stabilized with a 135-degree sliding hip screw. One of each pair received augmented fixation with a 6.5 mm fully threaded cannulated screw. The other specimen in the matched pair had additional fixation with a 3.5 mm 5-hole tubular plate placed at the inferior-medial femoral neck. Each specimen was tested under cyclic axial loading conditions (5000 cycles between 200 and 1400 N at 2 cycles/sec) and subsequently loaded to failure. The angular displacement (varus), interfragmentary (shear) displacement, and failure loads were calculated. ）
图1：70°截骨。
在钢板加强组，7例因成角移位失效，3例因剪切移位失效。在螺钉加强组，8例因成角移位失效，2例因剪切移位失效。钢板加强组有显著的低成角移位和低剪切移位。尽管钢板平均失效符合大于螺钉组，但两组无统计学差异。（In the augmented plate group, 7 specimens failed by angular displacement and 3 failed by shear displacement. In the augmented screw group, 8 specimens failed by angular displacement and 2 by shear displacement. The plate group was found to have significantly less angular displacement, regardless of completed cycles, than the augmented screw group (0.75±0.35 degrees vs. 2.15±1.99 degrees averaged across completed cycles, P＜0.01). Similarly, the plate group was found to have significantly less shear displacement, regardless of completed cycles, than the augmented screw group (0.77±0.70 mm vs. 1.22±0.92 mm averaged across completed cycles, P = 0.01). The average failure load of the plate group (4930 6 1578 N) was also larger but not significantly different from the screw group (3824 6 2140 N), P = 0.12. ）滑动髋螺钉（sliding hip screw）内固定治疗Pauwels III型股骨颈骨折，于防旋螺钉相比，采用内侧钢板加强可以显著降低角移位和剪切移位。（Augmenting sliding hip screw stabilization of a Pauwels type III fracture with a medial plate applied to the femoral neck significantly decreases angular displacement and shear displacement compared with augmentation with a derotational screw. ）
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