预防股骨颈骨折空心钉内固定术后股骨颈短缩空心螺纹钉优化选择的有限元分析
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作者Author单位AddressE-Mail
陈泽铭 CHEN Ze-ming 中国科学院大学宁波华美医院, 浙江 宁波 315010 Hua Mei Hospital, University of Chinese Academy of Sciences, Ningbo 315010, Zhejiang, China  
杨放 YANG Fang 宁波大学医学院, 浙江 宁波 315211  
余盛 YU Sheng 中国科学院大学宁波华美医院, 浙江 宁波 315010 Hua Mei Hospital, University of Chinese Academy of Sciences, Ningbo 315010, Zhejiang, China  
施泽文 SHI Ze-wen 宁波大学医学院, 浙江 宁波 315211  
余霄 YU Xiao 中国科学院大学宁波华美医院, 浙江 宁波 315010 Hua Mei Hospital, University of Chinese Academy of Sciences, Ningbo 315010, Zhejiang, China  
陈先军 CHEN Xian-jun 中国科学院大学宁波华美医院, 浙江 宁波 315010 Hua Mei Hospital, University of Chinese Academy of Sciences, Ningbo 315010, Zhejiang, China  
石林 SHI Lin 中国科学院大学宁波华美医院, 浙江 宁波 315010 Hua Mei Hospital, University of Chinese Academy of Sciences, Ningbo 315010, Zhejiang, China  
王诚浩 WANG Cheng-hao 中国科学院大学宁波华美医院, 浙江 宁波 315010 Hua Mei Hospital, University of Chinese Academy of Sciences, Ningbo 315010, Zhejiang, China  
庞清江 PANG Qing-jiang 中国科学院大学宁波华美医院, 浙江 宁波 315010 Hua Mei Hospital, University of Chinese Academy of Sciences, Ningbo 315010, Zhejiang, China pangqingjiang@ucas.ac.cn 
期刊信息:《中国骨伤》2022年,第35卷,第11期,第1042-1048页
DOI:10.12200/j.issn.1003-0034.2022.11.007
基金项目:浙江省医药卫生科技项目(编号:22KY1129);浙江省公益技术研究计划(编号:LGF19H060003);宁波市自然科学基金(编号:2019A610242);浙江省中医药科技计划(编号:2020ZB227)
中文摘要:

目的: 运用有限元分析法比较采用不同数量全螺纹空心钉在不同置钉位置内固定治疗Pauwels Ⅱ型股骨颈骨折,预防术后颈短缩的生物力学特性。

方法: 选取健康老年女性志愿者1名,年龄55岁,体重70 kg,身高165 cm。采用CT扫描,获取右侧股骨数据,在三维建模软件分别建立Pauwels Ⅱ型股骨颈骨折模型、全螺纹空心钉和半螺纹空心钉模型。按全螺纹空心钉数量和置入呈倒三角分布位置分为8组骨折内固定模型:3枚半螺纹钉组、1枚前上方全螺纹钉加2枚半螺纹钉组,1枚后上方全螺纹钉加2枚半螺纹钉组,1枚下方全螺纹钉加2枚半螺纹钉组,1枚前上方半螺纹钉加2枚全螺纹钉组,1枚后上方半螺纹钉加2枚全螺纹钉组,1枚下方半螺纹钉加2枚全螺纹钉组,3枚全螺纹钉组。在有限元分析软件中分别加载同样载荷,比较分析各组的内固定物的应力分布及应力峰值、股骨近端应力分布及应力峰值、骨折断端切面的应力分布及应力峰值、内固定物位移峰值,并比较术后股骨颈长度。

结果: 各组的内固定应力主要集中于骨折线处,且均位于下方螺钉的底部,应力峰值分别为239.71、213.44、199.37、230.82、201.63、215.72、185.65、192.64 MPa;各组股骨近端所受的应力主要集中于转子下内侧区域,应力峰值分别为269.48、241.62、249.43、269.69、271.60、346.64、236.97、439.62 MPa;骨折断端切面的应力主要集中于半螺纹钉道周围,全螺纹钉道周围应力相对较小,各组应力峰值分别为149.12、143.04、140.47、139.63、139.81、130.07、117.77、57.89 MPa;内固定物的位移基本沿股骨颈轴线方向,位移分布集中于螺钉尖端,各组螺钉位移峰值分别为5.52、5.43、5.32、5.17、5.05、5.13、5.28、5.04 mm;各组股骨颈长度分别为74.69、74.72、74.70、74.70、74.72、74.70、74.72、74.74 mm。

结论: 呈倒三角分布的前上方1枚半螺纹空心钉联合2枚全螺纹空心钉的置钉方案既可以满足促进股骨颈愈合的滑动加压作用,保证股骨近端稳定性,又能减少术后股骨颈短缩程度,有利于维持术后股骨颈长度,降低术后股骨颈短缩导致髋关节功能障碍的发生率,为临床空心钉治疗股骨颈骨折提供了新的优化置钉方案。
【关键词】股骨颈骨折  骨折固定术,内  有限元分析
 
Finite element analysis of optimal selection of cannulated threaded screw for the prevention of femoral neck shortening after internal fixation for femoral neck fracture
ABSTRACT  

Objective: To propose the an optimal screw placement scheme to prevent femoral neck shortening,finite element analysis was used to evaluate the biomechanical outcome of different numbers formed by full threaded screws at different positions in the treatment of femoral neck fractures of Pauwels type Ⅱ.

Methods: Recruited for this study was a 55-year-old female volunteer with a weight of 70 kg and a height of 165 cm. CT scan data of her right femur was collected. The models of femoral of Pauwels typeⅡ and fully threaded screw(FTS) and partially threaded screw(PTS) were constructed in three-dimensional modeling software. All these screw placement schemes were divided into eight groups simulated the inverted triangular configuration:three PTSs,an anterosuperior FTS and two PTSs,a posterosuperior FTS and two PTSs,an inferior FTS and two PTSs,an anterosuperior PTS and two FTSs,a posterosuperior PTS and two FTSs,an inferior PTS and two FTSs and three FTSs. All fracture internal fixation models were processed in finite element analysis software. Parameters of postoperative femoral neck length,displacement distribution and peak displacement of screws and VonMises stress distribution and peak stress of screws,the proximal femur and fracture section were collected.

Results: The maximum VonMises stress of screws was 239.71,213.44,199.37,230.82,201.63,215.72,185.65 and 192.64 MPa,respectively,which was concentrated in the inferior screw near the fracture line. The maximum Von Mises stress of the proximal femur was 269.48,241.62,249.43,269.69, 271.60,346.64,236.97 and 439.62 MPa,respectively,which was concentrated in the inferior medial area of subtrochanteric femur. The maximum Von Mises stress of fracture section was 149.12,143.04,140.47,139.63,139.81,130.07,117.77 and 57.89 MPa,respectively,which was concentrated around the partially threaded screw channel instead of the fully threaded screw channel. The maximum displacement of screws was 5.52,5.43,5.32,5.17,5.05,5.13,5.28 and 5.04 mm,respectively,which was along the axis of the femoral neck,and the displacement distribution was concentrated on the tip of the screw. The length of postoperative femoral neck length was 74.69,74.72,74.70,74.70,74.72,74.70,74.72 and 74.74 mm,respectively.

Conclusion: The placement of one anterosuperior partially threaded screw and two fully threaded screws with an inverted triangular distribution can not only meet the sliding compression effect to promote femoral neck healing and ensure the stability of the proximal femur,but also reduce the degree of postoperative femoral neck shortening and reduce the incidence of hip joint dysfunction. This study provides a new optimal screw placement solution for the treatment of femoral neck fractures.
KEY WORDS  Femoral neck fractures  Fracture fixation,internal  Finite element analysis
 
引用本文,请按以下格式著录参考文献:
中文格式:陈泽铭,杨放,余盛,施泽文,余霄,陈先军,石林,王诚浩,庞清江.预防股骨颈骨折空心钉内固定术后股骨颈短缩空心螺纹钉优化选择的有限元分析[J].中国骨伤,2022,35(11):1042~1048
英文格式:CHEN Ze-ming,YANG Fang,YU Sheng,SHI Ze-wen,YU Xiao,CHEN Xian-jun,SHI Lin,WANG Cheng-hao,PANG Qing-jiang.Finite element analysis of optimal selection of cannulated threaded screw for the prevention of femoral neck shortening after internal fixation for femoral neck fracture[J].zhongguo gu shang / China J Orthop Trauma ,2022,35(11):1042~1048
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