三种固定方式治疗内侧缺损型股骨转子间骨折术后失败的有限元分析  

Three fixation methods in the revision of medial defective intertrochanteric fractures with failed treatment:a finite element analysis

作　　者：祁麟 张伟 朱正国 聂少波 李嘉琦 陈华 唐佩福 Qi Lin;Zhang Wei;Zhu Zhengguo;Nie Shaobo;Li Jiaqi;Chen Hua;Tang Peifu(Chinese PLA Medical School,Beijing 100853,China;Department of Orthopaedics,the 4th Medical Center,Chinese PLA General Hospital,Beijing 100048,China;AI Sports Engineering Lab,School of Sports Engineering,Beijing Sport University,Beijing 100084,China)

机构地区：[1]中国人民解放军医学院,北京100853 [2]中国人民解放军总医院第四医学中心骨科医学部,北京100048 [3]北京体育大学体育工程学院人工智能体育工程实验室,北京100084

出　　处：《中华骨科杂志》2023年第5期308-315,共8页Chinese Journal of Orthopaedics

基　　金：骨科类医疗器械产品临床前相关研究(YQCH201601);三角稳定固定系统治疗股骨颈骨折骨不连的力学研究及其临床应用(XJS202107)。

摘　　要：目的通过有限元分析比较单纯动力髁螺钉(dynamic condylar screw,DCS)、锁定加压钢板(locking compression plate,LCP)联合DCS、股骨近端内侧解剖支撑钢板(medial anatomic buttress plate,MABP)联合DCS翻修治疗内侧缺损型股骨转子间骨折的生物力学差异。方法选取一名健康成年志愿者的股骨CT影像数据,通过Mimics 21.0软件及Geomagic Studio 12软件重建股骨实体化三维模型。使用Ansys Workbench 18.0软件建立股骨转子间Evans-JensenⅡB型骨折模型。在Solidworks 2015软件中重建股骨近端防旋髓内钉(proximal femoral nail antirotation,PFNA)、DCS、LCP、MABP的三维模型;将PFNA与骨折模型进行装配,随后取出PFNA,建立股骨转子间骨折术后失败模型,再模拟股骨转子间骨折术后失败保髋翻修手术进行装配固定,分别采用DCS(无内侧支撑重建)、DCS+LCP(间接内侧支撑重建)、DCS+MABP(股骨颈下部分直接内侧支撑重建)固定;在Abaqus 6.14软件中分别模拟70 kg正常人站立(700 N)、缓慢行走(1400 N)、快步行走(1750 N)和上下楼梯(2100 N)时的髋关节受力进行加载,记录不同模型中骨折断端的相对位移、应力峰值以及内固定的应力分布和应力峰值。结果加载700 N轴向载荷时,采用DCS、DCS+LCP及DCS+MABP固定的骨折断端相对位移分别为0.28、0.13、0.09 mm,骨折断端应力峰值分别为49.01、15.29、1.35 MPa,整体内固定应力峰值分别为230、220、174 MPa;加载1400 N轴向载荷时三种内固定方式的骨折断端相对位移分别为0.56、0.24、0.16 mm,骨折断端应力峰值分别为108.49、28.96、3.12 MPa,整体内固定应力峰值分别为469、352、324 MPa;加载1750 N轴向载荷时三种内固定方式的骨折断端相对位移分别为0.70、0.30、0.20 mm,骨折断端应力峰值分别为139.59、37.57、4.17 MPa,整体内固定应力峰值分别为594、421、393 MPa;加载2100 N轴向载荷时三种内固定的骨折断端相对位移分别为0.85、0.35、0.23 mm,骨�Objective To compare the biomechanical differences of dynamic condylar screw(DCS),locking compression plate(LCP)combined with DCS and medial anatomic buttress plate(MABP)combined with DCS in the revision of medial defective intertrochanteric fractures by finite element analysis.Methods The femoral CT imaging data provided by a healthy adult volunteer were used to reconstruct the solid three-dimensional model of femur by Mimics 21.0 and Geomagics Studio 12.Evans-Jensen II B intertrochanteric fracture was established by Ansys Workbench18.0.The three-dimensional models of proximal femoral nail antirotation(PFNA),DCS,LCP and MABP were reconstructed in Solidworks 2015.The PFNA was assembled with the fracture model,and then the PFNA was removed to establish the postoperative failure model of femoral intertrochanteric fracture and then simulated the fixation in the hip-preserving revision surgery of femoral intertrochanteric fractures:non-medial support reconstruction group(DCS);indirect medial support reconstruction group(DCS+LCP)and partial direct medial support reconstruction group(DCS+MABP).Finally,the forces on the hip joint of 70 kg normal people during standing(700 N),slow walking(1,400 N),brisk walking(1,750 N)and going up and down stairs(2,100 N)were simulated in Abaqus 6.14,the relative displacement and stress peak value of fracture end and stress distribution and stress peak value of internal fixation in different models were recorded.Results At 700 N axial load,the relative displacement of fracture end fixed by DCS,DCS+LCP and DCS+MABP was 0.28,0.13 and 0.09 mm;the peak stress of the fracture end was 49.01,15.29 and 1.35 MPa;the peak stress of internal fixation was 230,220 and 174 MPa,respectively.At 1,400 N axial load,the relative displacement of the fracture end of the three internal fixation methods was 0.56,0.24 and 0.16 mm;the peak stress of fracture end was 108.49,28.96 and 3.12 MPa;the peak stress of internal fixation was 469,352 and 324 MPa,respectively.At 1,750 N axial load,the relative displacement

关 键 词：股骨骨折 再手术 内固定器 有限元分析 

分 类 号：R687.3[医药卫生—骨科学]