肱骨近端锁定接骨板固定治疗Vancouver B1型股骨假体周围骨折生物力学特性的有限元分析  

A finite element analysis of biomechanical performance of Proximal Humeral Internal Locking Plate System in treatment of femoral periprosthetic fracture of Vancouver type B1

作　　者：恽常军[1,2] 钱文杰 张杰[1,2] 吴俊义 朱小国[1,2] 石岩 张文[3] Yun Changjun;Qian Wenjie;Zhang Jie;Wu Junyi;Zhu Xiaoguo;Shi Yan;Zhang Wen(Department of Orthopaedics,Affiliated Wujin Hospital,Jiangsu University,Changzhou 213002,China;The Wujin Clinical College of Xuzhou Medical University,Changzhou 213002,China;Orthopedic Institute,Soochow University,Suzhou 215006,China)

机构地区：[1]江苏大学附属武进医院骨科,常州213002 [2]徐州医科大学武进临床学院,常州213002 [3]苏州大学骨科研究所,215006

出　　处：《中华创伤骨科杂志》2021年第9期798-803,共6页Chinese Journal of Orthopaedic Trauma

摘　　要：目的通过三维有限元分析探讨肱骨近端锁定接骨板(PHILOS)固定治疗Vancouver B1型股骨假体周围骨折的力学稳定性。方法在1名志愿者(男性,34岁,身高173 cm,体重65 kg)股骨CT数据基础上,通过Mimics 21.0、3-matic12.0、Geomagic12.0、Hypermesh 2017.0等数字医学软件建立股骨三维有限元模型,在股骨模型上切割股骨转子,植入股骨柄,分别行PHILOS(PHILOS组)和Cable-Ready GTR钛缆钩板系统(Cable组)固定。对两组模型分别施加700、1400和2100 N的压缩载荷和约束,研究不同内固定模型的Von Mises应力及变形分布,比较两组模型的力学稳定性。结果两组模型的最大变形量均发生在假体的股骨球头上。在2100 N载荷时,PHILOS组模型的最大变形量为3.77 mm,高于Cable组模型的3.58 mm;最大应力峰值为491.54 MPa,较Cable组模型(733.61 MPa)低约49.2%。PHILOS组模型的最大应力峰值主要分布于接骨板的第4、5枚固定螺钉尾端,而Cable组模型的应力峰值主要分布于骨折线下第2根钛缆上。结论在各种载荷作用下,PHILOS和Cable-Ready GTR钛缆钩板系统均能提供足够的力学稳定性。PHILOS固定的应力峰值远低于Cable-Ready GTR钛缆钩板系统,可作为Vancouver B1型股骨假体周围骨折的有效固定方式。Objective To explore mechanical stability of Proximal Humeral Internal Locking Plate System(PHILOS)in the treatment of Vancouver B1 femoral periprosthetic fractures by three-dimensional finite element analysis.Methods A three-dimensional finite element model of the femur was established by digital medical software(Mimics 21.0,3-maticl2.0,Geomagic 12.0 and Hypermesh 2017.0)using the CT data of a femur from a volunteer(male,34 years old,173 cm in height and 65 kg in weight).After the femoral trochanter was cut in the femoral models,a femoral stem was implanted.PHILOS fixation(PHILOS group)and Cable-Ready GTR fixation(Cable group)were applied respectively.Loads of 700 N,1,400 N and 2,100 N were applied to the 2 groups of finite element models.Distributions of Von Mises stress and deformation were investigated in the finite element models of 2 internal fixations;the mechanical stability was compared between the 2 groups of models.Results The maximum deformation occurred on the femoral ball head in the 2 groups of models.At the load of 2,100 N,the maximum deformation was 3.77 mm in the PHILOS group,larger than 3.58 mm in the Cable group,and the maximum stress peak value in the PHILOS group was 491.54 MPa,about 49.2%lower than that in the Cable group(733.61 MPa).The peak stress in the PHILOS group was mainly distributed on the 4th and 5th fixation ends at the bone plate while the peak stress in the Cable group was mainly distributed on the second titanium cable under the fracture line.Conclusions Under various loads,both PHILOS fixation and Cable-Ready GTR fixation can provide sufficient mechanical stability.As the peak stress of PHILOS fixation is much lower than that of Cable-Ready GTR fixation,PHILOS can be used as an effective fixation method for Vancouver F51 femoral periprosthetic fractures.

关 键 词：股骨骨折 骨折固定术 内 骨板 假体周围骨折 有限元分析 

分 类 号：R687.3[医药卫生—骨科学]