建立股骨远端C3型骨折有限元模型并提出股骨远端“双柱理论”  

The foundation of finite element model of type C3 femoral distal fractures and theorizing the femoral distal “double columns theory”

作　　者：吴慧敏 陈彦胜 唐华 彭金柯 熊志 文勇 WU Hui-min;CHEN Yan-sheng;TANG Hua;PENG Jin-ke;XIONG Zhi;WEN Yong(Dept of Knee,the Orthopaedic Hospital of TCM Zhuzhou City,Zhuzhou,Hunan 412007,China)

机构地区：[1]株洲市中医伤科医院膝关节科,湖南株洲412007

出　　处：《临床骨科杂志》2018年第5期631-635,共5页Journal of Clinical Orthopaedics

基　　金：株洲市科技局社科基金(编号:2014YW26)

摘　　要：目的用计算机软件建立C3型骨折有限元模型,在此基础上提出股骨远端内外侧"双柱理论",并以此指导C3型骨折的临床治疗。方法通过股骨全长CT扫描获得数据,用MIMICS-HYPERMESH-Ls-Dyna软件模拟75 kg体重成人从6 m高空坠落,作用力缓冲时间300 ms,以机械轴为载荷方向建立C3型骨折有限元模型,明确内侧柱、外侧柱的分界线。结果股骨远端C3型骨折有限元模型显示,主要骨折线分布在股骨远端内侧、内后侧区域,机械轴与股骨下端内侧皮质交界点附近,这个交界点在载荷下应力变形最集中,所得出的结果与临床X线片表现一致。在股骨远端内外侧"双柱理论"指导下,对股骨远端C3型骨折进行内外侧双钢板固定,其疗效明显优于单钢板固定。结论以机械轴与股骨下端内侧皮质交界点为基础,划分股骨远端内、外侧柱分界线,得出股骨远端内外侧"双柱理论"的概念是合理、可行的。临床治疗股骨远端C3型骨折,手术中需要重建内、外侧柱,尤其要重视内侧柱的稳定性。Objective To establish the finite element model of type C3 femoral distal fractures by computer, based on this model, theorize the “double columns theory”with medial and lateral columns, and use this theory to guide the treatment of type C3 femoral distal fractures. Methods The femurs overall length data was gained by CT scans, then constituted the adult model with 75 kg weight falling from 6 m high by using MIMICS-HYPERMESH-Ls-Dyna software, the force buffering time was 300 ms, the payload direction was the femurs mechanical axis, finally established the finite element model of the femoral distal fractures of type C3, and confirmed the demarcation lines to lateral column and medial column. Results The finite element model of type C3 femoral distal fractures showed, the main fractures lines were lumped on the medial and posterior medial area of distal femur, at the near junctional point of the mechanical axis and the medial wall of the distal femurs, this junctional point was the forces concentration area under payload, this kept the results of the clinical X-rays observation. Guided at the theory of “double columns” femurs distalend, the fractures of type C3 distal femurs were treated with lateral and medial plates internal fixation, the effects obviously were better than only lateral plate internal fixation. Conclusions Based on the junctional point between the mechanical axis and the femurs distal medial wall, confirming the demarcation line to the lateral and medial columns of the distal femur, it is reasonable and feasible to theorize the concept of “double columns theory”. In the treatment of type C3 femoral distal fractures, this need to reconstruct the stability of the lateral and medial columns, mostly to reconstruct the stability of medial column.

关 键 词：股骨远端骨折 C3型骨折 有限元模型 双柱理论 内外侧柱 

分 类 号：R683.42[医药卫生—骨科学] R33[医药卫生—外科学]