中文摘要
同側髖部骨折(股骨頸骨折或股骨轉子間骨折)合併股骨骨折在過去並不多見，但在工業社會來臨後，車禍事故的增加，高能量的傷害外傷也與日俱增，因此此類同側髖部及股骨折的病患也漸漸增加。其中常見的類型則以中段股骨股折合併股骨頸骨折及轉子間骨折為主。處理此類骨折的原則主要可分為髓外固定及髓內固定。髓外固定則以合併滑動式髖螺釘及動態壓力式骨板組(DHS+DCP)為主，髓內固定則以重建式髓內骨釘(Reconstruction nail)為主。以文獻回顧而言，髓內固定的力學上有較好的負載傳導效應，但是在抗扭轉的方面較差，而髓外固定則是在抗扭轉較好，而其抵抗軸向負載傳導則較差。但是在臨床病例上，使用髓內固定的病例反而發生股骨頸內收變形的情況較多，雖然髓內骨釘在抗軸向的負載效應較好，但是卻有較多的變形發生率。
本研究利用力學實驗（壓力）的方法，以及數位影像比對(Digital ImageCorrelation, DIC)方法來探討兩種固定方式：1. 合併滑動式髖螺釘及動態壓力式骨板組，2. 重建式髓內骨釘組在同側髖部骨折的力學表現。除了固定骨材外，骨折處的復位條件也是探討參數。結果初步顯示兩組固定骨材在骨折達到良好的復位時，勁度並無明顯的差異。但是在骨折處有間隙的情況下，重建式髓內骨釘組的勁度就比合併滑動式髖螺釘及動態壓力式骨板組要高。另外以數位影像比對方法來探討個別髖部骨折的位移分佈，可以初步發現不論是重建式髓內骨釘組或者是滑動式髖螺釘及動態壓力式骨板組的股骨頸部分的位移量都比轉子間的位移量要來的大，位移量也與股骨頭內鋼釘的方向性有關。經由初步的分析結果發現，重建式髓內骨釘組優於滑動式髖螺釘及動態壓力式骨板組，尤其在骨折後復位不佳的條件下。以DIC進行力學量測可以獲得更多的變形資訊，有利於進一步分析探討。

Ipsilateral fractures of the hip and femoral shaft are relatively rare and mostly result of high-energy injuries. However, as the increasing of motor vehicle accidents, this issue becomes important. About 2.5-6% of femoral shaft fractures will combine with ipsilateral hip fracture. On these cases femoral neck fractures are often neglected initially and the rate of misdiagnosis varying from 19% to 31%. Although more than 60 methods are recommended for management of these concomitant fractures, none has been accepted as the gold standard. The most usd procedure can be divided to intra-medullary and extra-medullary. From Reviewing , the most used for the intra-medullary is the reconstruction nail while for extra-medullary device is the dynamic hip screw (DHS) combined with dynamic compression plate(DCP). In general, the reconstruction nail is better in load-sharing. However, neck varus deformity can be found in the reconstruction nail group. The purpose of this study was to compare the biomechanical behavior of these two different device by mechanical test. Digital Image Correlation (DIC) analysis was also used to identified the displacement on the femoral neck and intertrochanteric region. The result showed that there is no difference in these two device when the fracture site had good reduction. But the reconstruction nail group had better stiffness than DHS plus DCP group when the gap presented in fracture site. The displacement amount is bigger in the neck region then trochanter region after fracture reduction obtained from DIC. Besides, the direction of the displacedment seems to be related to the screw direction in both groups. However, due to the limited specimen number, further validation such as finite element analysis may be required.

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