PauwelsⅢ型股骨颈骨折骨缺损不同内固定方案的生物力学分析  

Biomechanical analysis of four internal fixations for PauwelsⅢfemoral neck fractures with defects

作　　者：苏志豪 谭宏莉 徐子环 李鹏飞[1,2] 王永钦 李双 倪明 SU Zhi-hao;TAN Hong-li;XU Zi-huan;LI Peng-fei;WANG Yong-qin;LI Shuang;NI Ming(School of Health Science and Engineering,Shanghai University of Technology,Shanghai 200093,China;Department of Orthopaedics,Shanghai Pudong New Area People's Hospital,Shanghai201299,China;Department of Rehabilitation,Haian Hospital of Traditional Chinese Medicine in Jiangsu Province,Haian 226600,Jiangsu,China;Department of Orthopaedics,Ruijin Hospital,Shanghai Jiaotong University School of Medicine,Shanghai200025,China)

机构地区：[1]上海理工大学健康科学与工程学院,上海200093 [2]上海市浦东新区人民医院骨科,上海201299 [3]海安市中医院康复科,江苏海安226600 [4]上海交通大学医学院附属瑞金医院骨科,上海200025

出　　处：《中国骨伤》2023年第3期255-261,共7页China Journal of Orthopaedics and Traumatology

基　　金：上海市浦东新区新兴交叉学科-数字骨科项目(编号:PWXx2020-08);上海市科委港澳合作项目(编号:21410760200)。

摘　　要：目的:探究不同内固定治疗PauwelsⅢ型股骨颈骨折骨缺损的生物力学特征,为骨折治疗提供参考。方法:基于CT图像建立PauwelsⅢ型股骨颈骨折模型,包括单纯骨折和骨折骨缺损两种特征,模拟4种内固定,即倒置空心螺钉(inverted cannulated screw,ICS)、ICS+内侧板、股骨颈系统(femoral neck system,FNS)和FNS+内侧板。测量并比较不同骨折模型在2100 N轴向载荷下的应力分布、模型刚度和位移情况。结果:ICS和FNS固定时,峰值应力集中于螺钉与骨折端接触位置,FNS的峰值应力高于ICS;与内侧板联用后,峰值应力转移至内侧板,且应力增大,ICS的增加幅度大于FNS。在骨折类型相同的情况下,FNS固定的刚度高于ICS。与骨缺损模型相比,骨折模型在相同内固定时刚度更高。内侧支撑板的使用可增加模型的刚度,但ICS模型的增加幅度超过FNS模型。ICS固定模型的骨折端位移超过FNS模型。结论:对于PauwelsⅢ型股骨颈骨折骨缺损模型,FNS较ICS具有更好的生物力学性能。ICS+内侧板有助于增强治疗的稳定性,但建议采用非锁定板;FNS具有抗剪切功能,无须与内侧板联用。Objective To investigate the biomechanical characteristics of different internal fixations for Pauwels typeⅢfemoral neck fracture with defect,and provide reference for the treatment of femoral neck fracture.Methods Three-dimensional(3D)finite element models of femoral neck fractures were established based on CT images,including fracture and fracture with defects.Four internal fixations were simulated,namely,inverted cannulated screw(ICS),ICS combined with medial buttress plate,the femoral neck system(FNS)and FNS combined with medial buttress plate.The von Mises stress,model stiffness and fracture displacements of fracture models under 2100 N axial loads were measured and compared.Results When femoral neck fracture was fixed by ICS and FNS,the peak stress was mainly concentrated on the surface of the screw near the fracture line,and the peak stress of FNS is higher than that of ICS;When the medial buttress plate was combined,the peak stress was increased and transferred to medial buttress plate,with more obvious of ICS fixation.For the same fracture model,the stiffness of FNS was higher than that of ICS.Compared with femoral neck fracture with defects,fracture model showed higher stiffness in the same internal fixation.The use of medial buttress plate increased model stiffness,but ICS increased more than FNS.The fracture displacement of ICS model exceeded that of FNS.Conclusion For Pauwels typeⅢfemoral neck fracture with defects,FNS had better biomechanical properties than ICS.ICS combined with medial buttress plate can better enhance fixation stability and non-locking plate is recommended.FNS had the capability of shear resistance and needn't combine with medial buttress plate.

关 键 词：股骨颈骨折 骨缺损 有限元分析 内侧板 股骨颈系统 

分 类 号：R687.3[医药卫生—骨科学] R318.01[医药卫生—外科学]