钉道强化股骨近端防旋髓内钉治疗老年A3.3型股骨转子间骨折:最佳骨水泥量有限元分析  

Type A3.3 femoral intertrochanteric fracture with augmented proximal femoral nail anti-rotation in the elderly:finite element analysis of the optimal amount of bone cement

作　　者：陈心敏 李文标 熊凯凯 熊晓燕 郑利钦 李木生 郑永泽 林梓凌[3] Chen Xinmin;Li Wenbiao;Xiong Kaikai;Xiong Xiaoyan;Zheng Liqin;Li Musheng;Zheng Yongze;Lin Ziling(Fengcheng Hospital of Traditional Chinese Medicine,Fengcheng 331100,Jiangxi Province,China;Guangzhou University of Chinese Medicine,Guangzhou 510405,Guangdong Province,China;First Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510405,Guangdong Province,China)

机构地区：[1]丰城市中医院,江西省丰城市331100 [2]广州中医药大学,广东省广州市510405 [3]广州中医药大学第一附属医院,广东省广州市510405

出　　处：《中国组织工程研究》2021年第9期1404-1409,共6页Chinese Journal of Tissue Engineering Research

基　　金：国家自然科学基金资助项目(81673996),项目负责人:林梓凌。

摘　　要：背景:骨质疏松和骨折类型是影响股骨近端防旋髓内钉内固定后失效的两个重要原因,而钉道强化股骨近端防旋髓内钉治疗老年AO31-A3.3型股骨转子间骨折可以有效降低术后失败率,但注入骨水泥的具体数量仍有待商榷。目的:探讨钉道强化股骨近端防旋髓内钉治疗老年A3.3型股骨转子间骨折的最佳骨水泥量。方法:选取1名志愿者CT资料导入Mimics 19.0和Geomagic studio 2017软件中进行提取、优化得到右侧股骨三维模型;运用Solidworks 2017软件画出内固定模型并与股骨模型按照标准手术技术装配,再导入Hypermesh 14.0软件中截骨得到AO31-3.3型股骨转子间骨折模型,将螺旋刀片近端周围松质骨重新定义为骨水泥,分别得到A(2.2 mL)、B(4.2 mL)、C(6.4 mL)3个不同骨水泥注入量的钉道强化股骨近端防旋髓内钉模型,设置材料属性参数、边界条件、施加载荷,分别导入LS-DYNA软件求解。结果与结论:①3个模型头颈骨块内翻和旋转角度、股骨近端整体应力无明显差异,但B、C模型螺旋刀片切割严重且出现螺旋刀片断裂,A模型螺旋刀片切割轻微无断裂;②骨水泥强大的锚固力能稳定螺旋刀片,但容易导致局部应力集中;③钉道强化股骨近端防旋髓内钉治疗老年A3.3型股骨转子间骨折注入的骨水泥量不宜过多,可能不超过3 mL具有最佳的生物力学效果。BACKGROUND:Osteoporosis and fracture type are two important reasons for the postoperative failure of proximal femoral nail anti-rotation.The treatment of elderly patients with type AO31-A3.3 femoral intertrochanteric fractures by bone cement augmented proximal femoral nail anti-rotation can effectively reduce the failure rate,but the specific amount of bone cement injected remains to be discussed.OBJECTIVE:To investigate the optimal amount of bone cement in the treatment of type A3.3 intertrochanteric femur fracture with augmented proximal femoral nail anti-rotation in elderly.METHODS:CT data of one volunteer were imported into Mimics 19.0 and Geomagic studio 2017 to extract and optimize the three-dimensional model of the right femur.Internal fixation model was drawn and assembled with femur model according to the standard operation technology,then imported into Hypermesh 14.0 software to simulate type AO31-3.3 intertrochanteric femur fracture.The spongy bone around the proximal helical blade was redefined as bone cement,obtaining A,B and C models with 2.2 mL,4.2 mL,and 6.4 mL of bone cement,respectively.The material property parameters,boundary conditions,and applied loads were set and imported into LS-DYNA software for solution.RESULTS AND CONCLUSION:(1)There was no significant difference in the inversion and rotation angles of the head and neck fragment and the overall stress in three models,but the blade cutting in model B and model C was severe and the helical blade was broken,while the blade cutting in model A was slight and did not break.(2)The strong anchoring force of bone cement could stabilize the helical blade,but easily led to local stress concentration.(3)The amount of bone cement injected into the proximal femoral nail anti-rotation for the treatment of type A3.3 intertrochanteric femur fracture in elderly should not be too much,and less than 3 mL may have the best biomechanical effect.

关 键 词：骨 股骨 骨折 骨水泥 髓内钉 有限元分析 生物力学 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学]