三种空心钉构型固定PauwelsⅢ型股骨颈骨折的有限元分析  

Finite element analysis of Pauwels type Ⅲ femoral neck fracture fixed with three configurations of cannulated screws

作　　者：严坤[1] 牟利民 杨晓辉[1] 王建[1] 冉建[1] Yan Kun;Mou Limin;Yang Xiaohui;Wang Jian;Ran Jian(Department of Trauma Orthopaedics,the Sixth Affiliated Hospital of Xinjiang Medical University,Urumqi 830002,Xinjiang Uygur Autonomous Region,China)

机构地区：[1]新疆医科大学第六附属医院创伤骨科,新疆维吾尔自治区乌鲁木齐市830002

出　　处：《中国组织工程研究》2022年第18期2807-2811,共5页Chinese Journal of Tissue Engineering Research

基　　金：新疆医科大学第六临床医学院(第六附属医院)科研专项基金(LFYKJ2020011),项目负责人:严坤。

摘　　要：背景:临床中广泛使用空心钉治疗股骨颈骨折,传统的倒三角构型治疗PauwelsⅢ股骨颈骨折失效率较高,有学者提出使用“F”构型及偏轴构型能获得较好的治疗效果。从生物力学角度对以上3种构型的比较分析目前鲜有报道。目的:使用三维有限元法比较倒三角构型、“F”构型、偏轴构型3种空心钉置入方法对于PauwelsⅢ股骨颈骨折固定的生物力学性能。方法:选取1名35岁健康的男性志愿者,体质量70 kg,CT扫描获取其右侧股骨近端.dicom格式影像数据,导入mimics 15.0软件重建股骨近端三维图像,使用Solidworks 2017软件构建倒三角构型、“F”构型、偏轴构型固定PauwelsⅢ股骨颈骨折模型;加载应力,比较3组模型骨折断端在X、Y、Z轴上的最大移位、在内固定上的最大应力、股骨近端的总体位移以及股骨近端的最大应力分布。结果与结论:①倒三角构型、“F”构型、偏轴构型在螺钉上的最大应力分别为71.896,66.792,59.071 MPa;②倒三角构型、“F”构型、偏轴构型在股骨近端最大应力分别为12.791,11.886,11.949 MPa;③倒三角构型、“F”构型、偏轴构型在骨折断端X轴上的最大位移为0.844,0.587,0.538 mm;在Y轴上的最大位移为0.491,0.295,0.340 mm;在Z轴上的最大位移为0.832,0.752,0.741 mm;④倒三角构型、“F”构型、偏轴构型在股骨近端总体最大位移为1.707,1.396,1.325 mm;⑤偏轴构型和“F”构型的应力更为分散,骨折断端的位移较小,是治疗PauwelsⅢ股骨颈骨折较好的选择,其中偏轴构型在抗内翻应力和纵向剪切应力中略优于“F”构型。BACKGROUND:Cannulated screw is widely used in the clinical treatment of femoral neck fracture,while the traditional inverted triangle configuration has a high failure rate in the treatment of Pauwels Ⅲ femoral neck fracture.Some scholars have proposed to use“F”configuration and off-axis configuration to obtain better therapeutic effects.However,there are few reports on the comparative analysis of the above-mentioned three configurations from the perspective of biomechanics.OBJECTIVE:To compare the biomechanical properties of Pauwels type Ⅲ femoral neck fracture with three cannulated screw placement methods of inverted triangle configuration,“F"configuration,and off-axis configuration by three-dimensional finite element method.METHODS:A healthy male volunteer aged 35 years old with a body mass of 70 kg was recruited in this study.Image data(.dicom format)of his right proximal femur were obtained by computed tomography scanning.The three-dimensional images of the proximal femur was reconstructed using mimics 15.0 software.Solidworks 2017 software was used to construct the models of Pauwels type Ⅲ femoral neck fracture fixed with inverted triangle configuration,“F”configuration,and off-axis configuration.The maximum displacement of the broken end of the fracture in the X,Y,and Z axes,the maximum stress in internal fixation,the total displacement of the proximal femur and the maximum stress distribution of the proximal femur in the three groups were compared under loading stress.RESULTS AND CONCLUSION:The maximum stresses of inverted triangle configuration,“F”configuration,and off-axis configuration on the screw were 71.896,66.792,and 59.071 MPa,respectively.The maximum stresses of inverted triangle configuration,“F”configuration,and off-axis configuration in the proximal femur were 12.791,11.886,and 11.949 MPa,respectively.The maximum displacements of inverted triangle configuration,“F”configuration,and off-axis configuration at the fracture end were 0.844,0.587,0.538 mm on the X axis,0.4

关 键 词：内固定构型 股骨颈骨折 有限元 空心钉 生物力学 F构型 倒三角构型 偏轴构型 

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