Delbet Ⅱ型儿童股骨颈骨折不同内固定方式的有限元分析  

Finite element analysis of different internal fixation methods for Delbet Ⅱ type femoral neck fracture in children

作　　者：尹伟[1] 欧阳振 周娟[1] 杨斌辉[1] 卫永鲲[1] Yin Wei;Ouyang Zhen;Zhou Juan;Yang Binhui;Wei Yongkun(Department of Orthopedics,3201 Hospital of Hanzhong City,Xi'an Jiaotong University,Hanzhong 723000,Shaanxi Province,China)

机构地区：[1]西安交通大学附属汉中三二〇一医院骨科,陕西省汉中市723000

出　　处：《中国组织工程研究》2023年第22期3476-3480,共5页Chinese Journal of Tissue Engineering Research

基　　金：陕西省医药卫生基金(S2018010122),项目负责人:杨斌辉。

摘　　要：背景:儿童DelbetⅡ型股骨颈骨折后股骨头坏死率较高,有限元法已广泛应用于研究成人股骨颈骨折内固定后的稳定性,但儿童股骨颈骨折的相关分析较少。目的:研究3种不同内固定方式治疗DelbetⅡ型儿童股骨颈骨折的生物力学性能。方法:选择1例8岁儿童健康志愿者为研究对象。CT扫描患儿股骨近端影像数据导入Mimics 17.0,在Geomagic 14.0,Cero 3.0,Hyper Works13.0中建立3种内固定方式治疗DelbetⅡ型儿童股骨颈骨折的有限元模型,分别为空心钉模型(CS模型)、空心钉联合克氏针模型(CS+K模型)、锁定钢板模型(LP模型),观察3种模型的内固定应力、骨骺应力及骨折断端相对位移。结果与结论:(1)CS+K模型骨折端和股骨头内的应力显著大于CS模型、LP模型(P <0.001);LP模型的股骨侧应力显著大于CS+K模型、CS模型(P<0.001);(2)CS模型的相对位移量显著大于CS+K模型和LP模型(P<0.001);(3)LP模型的骺板平均应力显著大于CS+K模型、CS模型(P<0.001);(4)结果表明,空心钉联合克氏针固定治疗DelbetⅡ型股骨颈骨折更有利于骨折的稳定,减少骨骺应力,有效降低股骨颈短缩和髋内翻的发生率。BACKGROUND:The rate of femoral head necrosis is high after Delbet type Ⅱ femoral neck fra ctures in children.Finite element method has been widely used to study the stability of femoral neck fra ctures in adults after internal fixation,but there are few related analyses of femoral neck fra ctures in children.OBJECTIVE:To study the biomechanical prope rties of three diffe rent internal fixation methods in the treatment of Delbet Ⅱ type femoral neck fracture in children.METHODS:A normal 8-year-old child volunteer was selected as the research subject.CT scanning of the proximal femur of children was performed,and the image data were imported into Mimics 17.0.Three kinds of finite element models,cannulated screw model(CS model),cannulated screw and Kirschner wire model(CS+K model) and locking plate model(LP model) we re established in Geomagic 14.0,Cero 3.0 and HyperWorks 13.0 to observe the internal fixation stress,epiphyseal stress and relative displacement of fra cture end in the three models.RESULTS AND CONCLUSION:(1) The stress in the fracture end and femoral head of CS+K model was significantly higher than that of CS model and LP model(P<0.001).The femoral stress of LP model was significantly higher than that of CS+K model and CS model(P<0.001).(2) The relative displacement of CS model was significantly greater than that of CS+K model and LP model(P <0.001).(3) The mean stress of epiphyseal plate in LP model was significantly higher than that in CS+K model and CS model(P <0.001).(4) It is concluded that cannulated screw combined with Kirschner wire fixation in the treatment of DelbetⅡ type femoral neck fracture is more conducive to the stability of fracture,can reduce epiphyseal stress,and effectively reduce the incidence of femoral neck shortening and hip varus.

关 键 词：股骨颈骨折 儿童 内固定 有限元 数字化骨科 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] R683.4