预防股骨颈骨折空心钉内固定术后股骨颈短缩空心螺纹钉优化选择的有限元分析  

Finite element analysis of optimal selection of cannulated threaded screw for the prevention of femoral neck shortening after internal fixation for femoral neck fracture

作　　者：陈泽铭 杨放 余盛 施泽文 余霄 陈先军 石林 王诚浩 庞清江 CHEN Ze-ming;YANG Fang;YU Sheng;SHI Ze-wen;YU Xiao;CHEN Xian-jun;SHI Lin;WANG Cheng-hao;PANG Qing-jiang(Hua Mei Hospital,University of Chinese Academy of Sciences,Ningbo 315010,Zhejiang,China)

机构地区：[1]中国科学院大学宁波华美医院,浙江宁波315010 [2]宁波大学医学院,浙江宁波315211

出　　处：《中国骨伤》2022年第11期1042-1048,共7页China Journal of Orthopaedics and Traumatology

基　　金：浙江省医药卫生科技项目(编号:22KY1129);浙江省公益技术研究计划(编号:LGF19H060003);宁波市自然科学基金(编号:2019A610242);浙江省中医药科技计划(编号:2020ZB227)。

摘　　要：目的:运用有限元分析法比较采用不同数量全螺纹空心钉在不同置钉位置内固定治疗PauwelsⅡ型股骨颈骨折,预防术后颈短缩的生物力学特性。方法:选取健康老年女性志愿者1名,年龄55岁,体重70 kg,身高165 cm。采用CT扫描,获取右侧股骨数据,在三维建模软件分别建立PauwelsⅡ型股骨颈骨折模型、全螺纹空心钉和半螺纹空心钉模型。按全螺纹空心钉数量和置入呈倒三角分布位置分为8组骨折内固定模型:3枚半螺纹钉组、1枚前上方全螺纹钉加2枚半螺纹钉组,1枚后上方全螺纹钉加2枚半螺纹钉组,1枚下方全螺纹钉加2枚半螺纹钉组,1枚前上方半螺纹钉加2枚全螺纹钉组,1枚后上方半螺纹钉加2枚全螺纹钉组,1枚下方半螺纹钉加2枚全螺纹钉组,3枚全螺纹钉组。在有限元分析软件中分别加载同样载荷,比较分析各组的内固定物的应力分布及应力峰值、股骨近端应力分布及应力峰值、骨折断端切面的应力分布及应力峰值、内固定物位移峰值,并比较术后股骨颈长度。结果:各组的内固定应力主要集中于骨折线处,且均位于下方螺钉的底部,应力峰值分别为239.71、213.44、199.37、230.82、201.63、215.72、185.65、192.64 MPa;各组股骨近端所受的应力主要集中于转子下内侧区域,应力峰值分别为269.48、241.62、249.43、269.69、271.60、346.64、236.97、439.62 MPa;骨折断端切面的应力主要集中于半螺纹钉道周围,全螺纹钉道周围应力相对较小,各组应力峰值分别为149.12、143.04、140.47、139.63、139.81、130.07、117.77、57.89 MPa;内固定物的位移基本沿股骨颈轴线方向,位移分布集中于螺钉尖端,各组螺钉位移峰值分别为5.52、5.43、5.32、5.17、5.05、5.13、5.28、5.04 mm;各组股骨颈长度分别为74.69、74.72、74.70、74.70、74.72、74.70、74.72、74.74 mm。结论:呈倒三角分布的前上方1枚半螺纹空心钉联合2枚全螺纹空心钉的置钉方案既�Objective:To propose the an optimal screw placement scheme to prevent femoral neck shortening,finite element analysis was used to evaluate the biomechanical outcome of different numbers formed by full threaded screws at different positions in the treatment of femoral neck fractures of Pauwels typeⅡ.Methods:Recruited for this study was a 55-year-old female volunteer with a weight of 70 kg and a height of 165 cm.CT scan data of her right femur was collected.The models of femoral of Pauwels typeⅡand fully threaded screw(FTS)and partially threaded screw(PTS)were constructed in three-dimensional modeling software.All these screw placement schemes were divided into eight groups simulated the inverted triangular configuration:three PTSs,an anterosuperior FTS and two PTSs,a posterosuperior FTS and two PTSs,an inferior FTS and two PTSs,an anterosuperior PTS and two FTSs,a posterosuperior PTS and two FTSs,an inferior PTS and two FTSs and three FTSs.All fracture internal fixation models were processed in finite element analysis software.Parameters of postoperative femoral neck length,displacement distribution and peak displacement of screws and VonMises stress distribution and peak stress of screws,the proximal femur and fracture section were collected.Results:The maximum VonMises stress of screws was 239.71,213.44,199.37,230.82,201.63,215.72,185.65 and 192.64 MPa,respectively,which was concentrated in the inferior screw near the fracture line.The maximum Von Mises stress of the proximal femur was 269.48,241.62,249.43,269.69,271.60,346.64,236.97 and 439.62 MPa,respectively,which was concentrated in the inferior medial area of subtrochanteric femur.The maximum Von Mises stress of fracture section was 149.12,143.04,140.47,139.63,139.81,130.07,117.77 and 57.89 MPa,respectively,which was concentrated around the partially threaded screw channel instead of the fully threaded screw channel.The maximum displacement of screws was 5.52,5.43,5.32,5.17,5.05,5.13,5.28 and 5.04 mm,respectively,which was along the axis of the femoral

关 键 词：股骨颈骨折 骨折固定术 内 有限元分析 

分 类 号：R683.42[医药卫生—骨科学]