空心螺钉联合同种异体腓骨治疗股骨颈骨折的三维有限元力学研究  

Three-dimensional finite element mechanical study of the treatment of femoral neck fracture with cannulated screw combined with fibular allograft

作　　者：葛辉 苏丽霞 陈鹏[2] 汤永南 罗东斌 焦锋 何伟 GE Hui;SU Lixia;CHEN Peng;TANG Yongnan;LUO Dongbin;JIAO Feng;HE Wei(Department of Orthopedics,Guangzhou Hospital of Integrated Traditional Chinese and Western Medicine,Guangzhou,Guangdong 510800,China;Department of Orthopedics,the First Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou,Guangdong 510405,China;Department of Orthopedics,the Third Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou,Guangdong 510378,China)

机构地区：[1]广州市中西医结合医院骨科,广东广州510800 [2]广州中医药大学第一附属医院骨科,广东广州510405 [3]广州中医药大学第三附属医院骨科,广东广州510378

出　　处：《中国医学工程》2024年第4期1-7,共7页China Medical Engineering

基　　金：广东省中医药局科研项目(20222175);广州市花都区科技计划项目(21-HDWS-068)。

摘　　要：目的探讨空心螺钉联合同种异体腓骨术式治疗股骨颈骨折的生物力学稳定性,为股骨颈骨折临床治疗新方法提供理论依据。方法采用三维有限元分析方法对空心螺钉联合同种异体腓骨术式治疗股骨颈骨折进行力学分析。基于1位45岁骨盆及股骨正常解剖的男性志愿者的CT数据,应用三维重建、逆向工程、有限元力学分析等技术,建立空心螺钉联合同种异体腓骨和多枚空心螺钉两种术式三维有限元模型,进行力学分析,评估两种术式内固定构型的生物力学稳定性。结果空心螺钉联合同种异体腓骨术式与多枚空心螺钉术式的股骨头颈部皮质的最大应力和位移及骨组织内部和内固定的最大应力分布位置无明显差异,但空心螺钉联合同种异体腓骨术式的股骨头颈部皮质的最大应力和位移及骨组织内部和内固定的最大应力值均比多枚空心螺钉术式小。结论空心螺钉联合同种异体腓骨术式固定股骨颈骨折的力学稳定性优于多枚空心螺钉术式,能够为股骨颈骨折愈合提供良好的力学稳定性,在股骨头发生坏死后腓骨亦可以提供力学支撑,预防股骨头塌陷,为较理想的股骨颈骨折治疗术式。【Objective】To investigate the biomechanical stability of cannulated screws combined with fibula allograft in the treatment of femoral neck fractures,and to provide theoretical basis for a new clinical treatment method of femoral neck fractures.【Methods】Three-dimensional finite element analysis was used to analyze the mechanical properties of cannulated screws combined with fibula allograft in the treatment of femoral neck fractures.Based on the CT data of a 45-year-old male volunteer with normal anatomy of the pelvis and femur,three-dimensional reconstruction,reverse engineering,finite element mechanical analysis and other techniques were used to establish three-dimensional finite element models of the surgical methods of cannulated screws combined with fibula allograft and multiple cannulated screws for mechanical analysis,and the biomechanical stability of the two internal fixation configurations was evaluated.【Results】There was no significant difference in the distribution in the maximum stress and displacement of the femoral head and neck cortex and the maximum stress within the bone tissue and internal fixation between the cannulated screws combined with fibular allograft and multiple cannulated screws operation.However,the maximum stress and displacement of the femoral head neck cortex and the maximum stress of the bone and internal fixation in the cannulated screw combined with fibular allograft group were significantly lower than those in the multiple cannulated screw group.【Conclusion】The mechanical stability of cannulated screws combined with fibular allograft is better than that of multiple cannulated screws,which can provide good mechanical stability for the healing of femoral neck fracture,and provide mechanical support after the femoral head necrosis,to prevent the collapse of the femoral head.It is an ideal surgical method for the treatment of femoral neck fractures.

关 键 词：股骨颈骨折 股骨头坏死 生物力学 三维有限元 空心螺钉 同种异体腓骨 

分 类 号：R687.3[医药卫生—骨科学]