髓内增强固定治疗骨质疏松性肱骨近端骨折的有限元分析  

Biomechanical stability of endosteal augmentation for osteoporotic proximal humerus fracture:a finite element analysis

作　　者：朱正国 曹文豪[2] 常祖豪 张伟 郭浩 于洋 刘娜 李嘉琦 梁永辉 陈华 唐佩福[2] Zhu Zhengguo;Cao Wenhao;Chang Zuhao;Zhang Wei;Guo Hao;Yu Yang;Liu Na;Li Jiaqi;Liang Yonghui;Chen Hua;Tang Peifu(Department of Orthopaedics,Aerospace Center Hospital,Beijing 100049,China;Department of Orthopaedic Surgery,Chinese PLA General Hospital,Beijing 100853,China;Department of Orthopedic Surgery,Beijing Chaoyang Hospital,Capital Medical University,Gongren Tiyuchang Nanlu,Beijing 100020,China;AI Sports Engineering Lab,School of Sports Engineering,Beijing Sports University,Beijing 1000843,China;The Second Surgical Department,Hospital of Beijing Municipal Corps of Chinese People's Armed Police Force,Beijing 100027,China;Newton Laboratory,Tianjin Walkman Biomaterials Co.,Ltd,Tianjin 301609,China)

机构地区：[1]航天中心医院骨科,北京100049 [2]解放军总医院第四医学中心骨科医学部,北京100853 [3]首都医科大学附属北京朝阳医院骨科,北京100020 [4]北京体育大学体育工程学院人工智能体育工程实验室,北京1000843 [5]武警北京市总队医院外二科,北京100027 [6]天津威曼生物材料有限公司牛顿力学实验室,天津301609

出　　处：《中华创伤骨科杂志》2023年第11期993-998,共6页Chinese Journal of Orthopaedic Trauma

基　　金：国家自然科学基金面上项目(81772336,82272455);航天医科科研基金资助项目(2021YK17)。

摘　　要：目的通过有限元分析,探究何种肱骨近端锁定内固定系统(PHILOS)的髓内增强固定方式能够为治疗骨质疏松性肱骨近端骨折提供最有效的生物力学稳定性。方法在1名老年女性(年龄78岁,骨密度T值为-3.0)志愿者肱骨CT数据基础上,通过Mimics 19.0、Geomagic Studio 12、Creo 2.0 ANSYS Workbench2019等数字医学软件建立肱骨三维有限元模型,建立不稳定性肱骨近端骨折模型,分别行单纯PHILOS固定(PHILOS组)、PHILOS结合6 cm腓骨固定(PHILOS-F-C-6组)、PHILOS结合6 cm腓骨无calcar螺钉固定(PHILOS-F-6组)、PHILOS结合9 cm腓骨固定(PHILOS-F-C-9组)、PHILOS结合9 cm腓骨无calcar螺钉固定(PHILOS-F-9组)5种方式固定。模拟肩关节外展25°的受力方式,加载200 N的压缩载荷,研究不同固定方式的内固定应力分布及骨折断端位移等数据,比较不同内固定的力学稳定性。结果在肩关节外展25°、200 N载荷作用下,PHILOS-F-C-9组模型的内固定的最大应力、断端两点位移(38.678 Mpa、0.012 mm)较PHILOS-F-C-6组(55.321 Mpa、0.022 mm)分别下降30.08%、45.45%,PHILOS-F-9组模型的(77.012 Mpa、0.033 mm)较PHILOS-F-6组(88.106 Mpa、0.039 mm)分别下降12.48%、15.38%。PHILOS-F-C-6组模型的内固定的最大应力、断端两点位移较PHILOS-F-6组分别下降37.21%、43.59%,PHILOS-F-C-9组模型的较PHILOS-F-9组分别下降49.83%、63.63%。结论更长的腓骨髓内支撑及calcar螺钉的放置能够降低内固定的应力,减少骨折断端的位移。Objective To explore which configuration schemes of proximal humerus internal locking system(PHILOS)fixation with endosteal augmentation can provide the optimal biomechanical stability for treatment of osteoporotic proximal humeral fractures by means of finite element analysis.Methods Based on the CT data of the humerus of an old female volunteer(78 years old,with a bone density T-value of-3.0),a three-dimensional finite element model of the humerus was established by digital medical software such as Mimics 19.0,Geomagic Studio 12,and Creo 2.0 ANSYS Workbench2019.Next,a model of unstable proximal humerus fracture was established and subjected respectively to 5 different fixations:simple PHILOS fixation(PHILOS group),PHILOS plus 6-cm fibula fixation with calcar screws(PHILOS-F-C-6 group),PHILOS plus 6-cm fibula fixation without calcar screws(PHILOS-F-6 group),PHILOS plus 9-cm fibula fixation with calcar screws(PHILOS-F-C-9),and PHILOS plus 9-cm fibula fixation without calcar screws(PHILOS-F-9 group).After a stress mode of shoulder joint abduction at 25°was simulated,a compressive load of 200N was applied to the 5 fixation models.The stress distribution and displacement of fracture ends in different fixation models were tested,and the biomechanical stability was compared among the 5 different internal fixations.Results Under a shoulder joint abduction at 25°and a load of 200 N,the maximum stress and the displacement of the fracture ends in PHILOS-F-C-9 group(38.678 Mpa and 0.012 mm)decreased by 30.08%and 45.45%,respectively,compared with PHILOS-F-C-6 group(55.321 Mpa and 0.022 mm),and decreased by 12.48%and 15.38%,respectively,in PHILOS-F-9 group(77.012 Mpa and 0.033 mm)compared with PHILOS-F-6 group(88.106 Mpa and 0.039 mm).The maximum stress and the displacement of the fracture ends in PHILOS-F-C-6 group decreased by 37.21%and 43.59%,respectively,compared with PHILOS-F-6 group while decreased by 49.83%and 63.63%in PHILOS-F-C-9 group compared with PHILOS-F-9 group,respectively.Conclusion For treatment of osteopo

关 键 词：肱骨骨折 骨质疏松 骨折固定术 腓骨 生物力学 有限元分析 

分 类 号：R687.3[医药卫生—骨科学]