可吸收螺钉应用于伯尔尼髋臼周围截骨术的有限元分析  

Finite element analysis of absorbable screws in Bernese periacetabular osteotomy

作　　者：程徽 马晓颖 任宁涛 张振东 贾海港 李勇 张建立 罗殿中 张洪 柴伟 Cheng Hui;Ma Xiaoying;Ren Ningtao;Zhang Zhendong;Jia Haigang;Li Yong;Zhang Jianli;Luo Dianzhong;Zhang Hong;Chai Wei(Senior Department of Orthopaedics,the Fourth Medical Center of PLA General Hospital(National Clinical Research Center for Orthopaedics,Sports Medical and Rehabilitation),Beijing 100048,China)

机构地区：[1]中国人民解放军总医院第四医学中心骨科医学部关节外科(国家骨科与运动康复临床医学研究中心),北京100048

出　　处：《中华骨科杂志》2024年第6期419-426,共8页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金(U22A20355)。

摘　　要：目的探讨在伯尔尼髋臼周围截骨术中使用可吸收螺钉的稳定性和可行性。方法采集1例发育性髋关节发育不良并已接受伯尔尼髋臼周围截骨术的36岁女性患者(体重55 kg)的影像学资料,使用有限元分析方法模拟髋臼在承受患者体重10%、20%、50%和100%的载荷下的稳定程度。观察髋臼骨块与髂骨是否接触、使用3枚还是4枚螺钉、及是否使用垫块(包括腓骨皮质骨垫块和PEEK垫块)共14种不同条件下骨盆的结构刚度及可吸收螺钉上的最大等效应力的变化。结果使用4枚螺钉固定的骨盆结构刚度较3枚螺钉提高了67%~94%;使用垫块后骨盆结构刚度较不使用垫块提升了50%~83%。承受患者体重10%、20%、50%和100%时,随着载荷增加螺钉上的最大等效应力相应增加。当髋臼骨块与髂骨无接触、不使用垫块、仅使用3枚螺钉固定时,最大等效应力可达518.9 MPa,而使用4枚螺钉时降至318.7 MPa(61%)。当髋臼骨块与髂骨有接触时,无论使用多少螺钉,最大等效应力均约为无接触时的12%。当置入皮质骨垫块或PEEK垫块时,最大等效应力可降至不使用垫块时的21%~26%。当螺钉强度为130 MPa时,施加20%体重载荷,只使用3枚螺钉并且不使用垫块时,等效应力可超过螺钉的强度;如果使用4枚螺钉,在施加50%体重载荷时,等效应力略高于螺钉的强度。而在使用垫块的情况下(无论皮质骨垫块或PEEK垫块),即使在施加100%体重载荷时,等效应力也略低于螺钉的强度。结论可吸收螺钉可以为伯尔尼髋臼周围截骨术提供足够的稳定性;髋臼骨块与髂骨的接触、螺钉数量的增加以及使用垫块(皮质骨垫块和PEEK垫块)均可进一步提高稳定性。ObjectiveTo investigate the stability and feasibility of using absorbable screws during Bernese periacetabular osteotomy.MethodsA retrospective analysis was conducted on a 36 year-old woman diagnosed with developmental dysplasia of the hip,who had undergone Bernese periacetabular osteotomy.Finite element analysis was used to simulate the stability of the acetabulum under loads of 10%,20%,50%,and 100%of the patient's weight.The structural stiffness of the pelvis and the maximum equivalent stress on the absorbable screws were observed under different conditions,including whether the acetabular bone block and the ilium were in contact,whether 3 or 4 screws were used,and whether a graft(including fibular cortical bone and PEEK grafts)was used.ResultsThe structural stiffness of the pelvis fixed with four screws increased by 67%-94%compared to that with three screws.After using a graft,the structural stiffness of the pelvis increased by 50%-83%.As the load increased,the maximum equivalent stress on the screws also increased.When the acetabular bone block and the ilium had no contact,no graft was used,and only three screws were used for fixation,the maximum equivalent stress could reach 518.9 MPa,while this value dropped to 61%when four screws were used(318.7 MPa).When the acetabular bone block and the ilium were in contact,the maximum equivalent stress was about 12%of that when there was no contact,regardless of the number of screws used.When a cortical bone graft or a PEEK graft was used,the maximum equivalent stress could drop to 21%-26%of that without a graft.When the screw strength was 130 MPa,a load of 20%of body weight was applied,and only three screws were used without a graft,the equivalent stress could exceed the strength of the screw;if four screws were used,the equivalent stress was slightly higher than the strength of the screw when a load of 50%of body weight was applied.However,when a graft was used(either cortical bone or PEEK),even when a load of 100%of body weight was applied,the equivalent stress was

关 键 词：截骨术 可吸收性植入物 有限元分析 应力 物理 

分 类 号：R687.3[医药卫生—骨科学]