股骨转子间骨折不同外侧壁分型髓内钉治疗的有限元分析  

Finite element analysis of femoral intertrochanteric fracture treated with intramedullary nail with different lateral wall classifications

作　　者：周龙 王亮 徐锐 鲍益东[2] 何双建 徐希斌 Zhou Long;Wang Liang;Xu Rui;Bao Yidong;He Shuangjian;Xu Xibin(Suzhou Science&Technology Town Hospital,Suzhou 215153,Jiangsu Province,China;College of Mechanical and Electrical Engineering,Nanjing University of Aeronautics and Astronautics,Nanjing 210016,Jiangsu Province,China)

机构地区：[1]苏州科技城医院,江苏省苏州市215153 [2]南京航空航天大学机电工程学院,江苏省南京市210016

出　　处：《中国组织工程研究》2023年第29期4652-4657,共6页Chinese Journal of Tissue Engineering Research

基　　金：苏州市临床重点病种诊疗技术专项基金(LCZX202135),项目负责人:何双建;院级博士专项基金(Szkjcyy2021015),项目负责人:何双建。

摘　　要：背景:目前针对外侧壁破损型股骨转子间骨折的手术内固定方式存在争议,以股骨近端防旋髓内钉固定为主流方案,不同外侧壁分型的股骨转子间骨折髓内固定的生物力学研究较少。目的:通过有限元分析比较股骨近端防旋髓内钉治疗不同外侧壁分型股骨转子间骨折的生物力学特点,探讨外侧壁对股骨转子间骨折内固定的影响。方法:选择1例健康老年女性患者,根据股骨近端CT扫描数据,应用Mimics 21.0,Geomagic Wrap,Creo 6.0,Abaqus 2020软件建立股骨近端和股骨近端防旋髓内钉的三维有限元模型,模拟外侧壁稳定型、危险型及破裂型股骨转子间骨折,建立股骨近端防旋髓内钉内固定装配模型。观察在静止及行走2种状况下赋予同等载荷时3种骨折内固定模型的等效应力及位移分布云图。结果与结论:①A3.3型股骨转子间骨折在动态载荷时最大等效应力及位移均最大,最大等效应力约为A2.3型的2倍,A1.3型的2.7倍,最大等效位移约为A2.3型的1.5倍,A1.3型的3倍,静态时各型差别不明显;②动静态载荷时股骨颈、骨折端及主钉处等效应力A3.3型较A1.3和A2.3型增大,以主钉处明显;③动态载荷时股骨头、股骨颈、骨折端、外侧壁、内侧壁、主钉及螺旋刀片各部位等效位移A3.3型均较A1.3和A2.3型增大,静态时变化不明显;④结果表明,外侧壁的完整性可减轻内固定应力,使应力及位移分布更为合理,有利于维持股骨转子间骨折内固定的稳定性。BACKGROUND:At present,there is a controversy on the internal fixation for the femoral intertrochanteric fracture with fracture of lateral wall.The main method is the proximal femoral nail antirotation.The biomechanical study of intramedullary fixation for femoral intertrochanteric fracture with different lateral wall classifications is less.OBJECTIVE:To compare the biomechanical characteristics of proximal femoral nail antirotation in the treatment of femoral intertrochanteric fracture with different lateral wall classifications by finite element analysis,and to explore the influence of lateral wall on the internal fixation of femoral intertrochanteric fracture.METHODS:A healthy elderly female patient was selected.A 3D finite element model of proximal femur and proximal femoral nail antirotation was established by using Mimics 21.0,Geomagic Wrap,Creo 6.0 and Abaqus 2020 software according to the CT scanning data of proximal femur.The proximal femoral nail antirotation assembly model was established by simulating lateral wall stable,dangerous and ruptured intertrochanteric fractures.The Von Mises stress and displacement distributions of three models of internal fixation were observed under the same load in static and walking conditions.RESULTS AND CONCLUSION:(1)The maximum Von Mises stress and displacement of A3.3 type intertrochanteric fracture were the largest under dynamic state;the maximum Von Mises stress was about twice of type A2.3,and 2.7 times of type A1.3;the maximum Von Mises displacement was about 1.5 times of type A2.3 and 3 times of type A1.3,and there was no significant difference among the various types under static state.(2)The Von Mises stress A3.3 at femoral neck,fracture end and main nail was larger than that of A1.3 and A2.3 under dynamic and static states,especially at main nail.(3)The Von Mises displacements of femoral head,femoral neck,fracture end,lateral wall,medial wall,main nail and spiral blade in A3.3 type were larger than that in A1.3 and A2.3 types;the change was not obvious under s

关 键 词：股骨转子间骨折 外侧壁分型 髓内钉 等效应力 有限元分析 动态载荷 

分 类 号：R459.9[医药卫生—治疗学] R319[医药卫生—临床医学] R311