Vancouver B2型股骨假体周围骨折锁定板或皮质骨板不同内固定方式的生物力学分析  

Biomechanical analysis of different internal fixation methods of locking plate or cortical bone plate for Vancouver type B2 fracture

作　　者：董巍 张天一 路博 王一凤 宫树森 樊国峰 Dong Wei;Zhang Tianyi;Lu Bo;Wang Yifeng;Gong Shusen;Fan Guofeng(Department of Orthopedics,Hebei PetroChina Central Hospital,Langfang 065000,Hebei Province,China;Wen’an Country Hospital,Langfang 065000,Hebei Province,China)

机构地区：[1]河北中石油中心医院骨科,河北省廊坊市065000 [2]河北省文安县医院,河北省廊坊市065000

出　　处：《中国组织工程研究》2021年第30期4787-4792,共6页Chinese Journal of Tissue Engineering Research

基　　金：河北省医学科学研究重点课题计划(20160906),课题名称:基于定量CT与定量超声的骨质疏松治疗早期疗效评估,项目负责人:樊国峰;廊坊市科技支撑计划项目(2017013045),课题名称:基于有限单元法的人工髋关节股骨假体周围骨折手术治疗的优化仿真研究,项目负责人:董巍。

摘　　要：背景:股骨假体周围骨折是髋关节置换后的严重并发症,有多种治疗方案,但目前对各种治疗方案疗效的对比尚无针对性研究。目的:基于有限元分析方法,对Vancouver B2型股骨假体周围骨折不同手术方案进行比较。方法:采集30例健康志愿者的股骨数据,并扫描初次、翻修髋关节假体及锁定板外形数据。将所采集的数据进行三维建模,模拟Vancouver B2型股骨假体周围骨折的不同手术方式,模拟不同类型下的载荷,记录皮质骨板组、锁定板组、皮质骨板+皮质骨板组、皮质骨板+锁定板组在不同载荷下的骨折端位移,并进行统计学分析。结果与结论:(1)在2300 N压力载荷作用下,皮质骨板组的位移显著大于其他3组,差异有显著性意义(P<0.05);锁定板组的位移显著大于皮质骨板+皮质骨板组、皮质骨板+锁定板组,差异有显著性意义(P<0.05);而皮质骨板+皮质骨板组与皮质骨板+锁定板组的位移相比差异无显著性意义(P>0.05);(2)在40 N·m扭矩载荷作用下,皮质骨板组与皮质骨板+皮质骨板组的位移相比差异无显著性意义(P>0.05);锁定板组与皮质骨板+锁定板组的位移相比差异无显著性意义(P>0.05);皮质骨板组、皮质骨板+皮质骨板组的位移显著大于锁定板组、皮质骨板+锁定板组,差异有显著性意义(P<0.05);(3)提示对于Vancouver B2型股骨假体周围骨折,在更换翻修假体后,若稳定性较差,应尽量选择锁定板内固定,并依据骨量情况,选择是否加用同种异体皮质骨板捆扎固定。BACKGROUND:Periprosthetic fractures are severe complications after hip arthroplasty.The treatments could be varied.However,there is still a lack of validated comparison of these treatments.OBJECTIVE:To compare different treatments of Vancouver type B2 fracture based on finite element analysis.METHODS:The data of femurs of 30 healthy volunteers,primary and revision prosthesis and locking compress plate were collected.The data were input into finite element analysis software.Different surgeries for Vancouver type B2 fracture and different types of loads were simulated.The fracture end offset of the cortical bone plate group,locking plate group,cortical bone plate+cortical bone plate group,and cortical bone plate+locking plate group under different loads were recorded,and statistical analysis was performed.RESULTS AND CONCLUSION:(1)Under 2300 N force load,the offset of cortical bone plate group was significantly greater than that of the other three groups(P<0.05).The offset of locking plate group was significantly greater than that of cortical bone plate+cortical bone plate group and cortical bone plate+locking plate group(P<0.05).However,the offset of cortical bone plate+cortical bone plate group was not significantly different from that of cortical bone plate+locking plate group(P>0.05).(2)Under 40 N·m torque load,there was no significant difference in offset between cortical bone plate group and cortical bone plate+cortical bone plate group(P>0.05).There was no significant difference in the offset between the locking plate group and the cortical bone plate+locking plate group(P>0.05).The offset of cortical bone plate group and cortical bone plate+cortical bone plate group was significantly greater than that of locking plate group and cortical bone plate+locking plate group(P<0.05).(3)For Vancouver type B2 fracture,after stem revision,if it is not stable enough,locking plate should be used as first choice,and adding a allograft strut could be sensible if necessary.

关 键 词：股骨 假体周围骨折 Vancouver分型 内固定 有限元分析 

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