不同载荷条件下三种内固定方式治疗PauwelsⅢ型股骨颈骨折的有限元分析  

Finite element analysis of three internal fixation modalities for treatment of Pauwels type III femoral neck fractures under different loading conditions

作　　者：李正刚 尚学红 吴张 李红 孙朝军 陈华东 孙哲 杨毅[4] Li Zhenggang;Shang Xuehong;Wu Zhang;Li Hong;Sun Chaojun;Chen Huadong;Sun Zhe;Yang Yi(Department of Trauma and Orthopedics,First Affiliated Hospital of Dali University,Dali 671000,Yunnan Province,China;Department of Orthopedics,First People’s Hospital of Dali,Dali 671000,Yunnan Province,China;Department of Joint Surgery,First Affiliated Hospital of Dali University,Dali 671000,Yunnan Province,China;Department of Orthopedics,First Affiliated Hospital of Kunming Medical University,Kunming 650032,Yunnan Province,China Li Zhenggang,Master,Master’s supervisor,Department of Trauma and Orthopedics,First Affiliated Hospital of Dali University,Dali 671000,Yunnan Province,China)

机构地区：[1]大理大学第一附属医院创伤骨科,云南省大理市671000 [2]大理市第一人民医院骨科,云南省大理市671000 [3]大理大学第一附属医院关节外科,云南省大理市671000 [4]昆明医科大学第一附属医院骨科,云南省昆明市650032

出　　处：《中国组织工程研究》2025年第3期455-463,共9页Chinese Journal of Tissue Engineering Research

基　　金：云南省骨关节疾病临床医学中心分中心建设项目(DFYGK005),项目负责人:李正刚;大理大学第一附属医院学科建设骨干项目(DFYGG2022-21),项目负责人:李正刚。

摘　　要：背景:治疗PauwelsⅢ型股骨颈骨折的最佳内固定方式仍未达成共识,既往相关有限元分析大多采用单一简化载荷条件,对于常用内固定装置的生物力学特性还需进一步探究。目的:通过有限元方法分析空心加压螺钉、动力髋螺钉和股骨颈系统治疗PauwelsⅢ型股骨颈骨折在单腿站立载荷及侧方跌倒载荷条件下的生物力学特性。方法:通过CT扫描获取健康成人股骨DICOM数据,导入Mimics 15.0软件,得到骨组织的粗糙模型,再通过Geomagics软件对Mimics导出的数据进行优化处理,然后根据空心加压螺钉、动力髋螺钉和股骨颈系统的临床应用参数采用Pro/E软件建立3种内固定模型并与股骨模型组装,最后导入Ansys软件进行加载、计算,分析3种内固定模型在单腿站立载荷及侧方跌倒载荷的不同工况下股骨和内固定的应力分布和位移情况,以及股骨距和Ward三角区的应力特点。结果与结论:(1)单腿站立载荷及侧方跌倒载荷下,3种内固定模型的股骨近端应力均主要分布在股骨颈骨折端内上方,3种内固定模型的股骨近端、骨折端、Ward三角以及股骨距的应力峰值均为股骨颈系统内固定模型最小,空心加压螺钉内固定模型最大;(2)单腿站立载荷及侧方跌倒载荷下,3种内固定模型的股骨近端位移峰值均位于股骨头顶端,且位移峰值均为股骨颈系统内固定模型最小,空心加压螺钉内固定模型最大;(3)3种内固定模型在单腿站立及侧方跌倒载荷条件下内固定的位移峰值均位于内固定装置上方顶端,且位移峰值均为股骨颈系统内固定模型最小,空心加压螺钉内固定模型最大;(4)3种内固定模型在单腿站立及侧方跌倒载荷条件下内固定的应力均主要集中在内固定装置的骨折端附近区域,且内固定应力峰值均为股骨颈系统内固定模型最小,空心加压螺钉内固定模型最大;(5)结果表明,股骨颈系统的机械稳定性最佳,但BACKGROUND:There is still no consensus on the optimal internal fixation for the treatment of Pauwels III femoral neck fracture,and most of the related finite element analyses have been performed using a single simplified loading condition,and the biomechanical properties of commonly used internal fixation devices need to be further investigated.OBJECTIVE:To analyze the biomechanical characteristics of Pauwels III femoral neck fractures treated with cannulated compression screw,dynamic hip screw,and femoral neck system by finite element method under different loading conditions of single-leg standing loads and sideways fall loads.METHODS:The DICOM data of healthy adult femur were obtained by CT scanning,imported into Mimics 15.0 software to obtain the rough model of bone tissue.The data exported from Mimics were optimized by Geomagics software,and then three internal fixation models were built and assembled with the femur model according to the parameters of the clinical application of the cannulated compression screw,dynamic hip screw,and femoral neck system by using Pro/E software.Finally,the three internal fixation models were imported into Ansys software for loading and calculation to analyze the stress distribution and displacement of the femur and the internal fixation under different working conditions of single-leg standing loads and sideways fall loads,as well as the stress characteristics of the calcar femorale and Ward’s triangle.RESULTS AND CONCLUSION:(1)Under the single-leg standing load and the sideways fall load,the proximal femoral stress of the three internal fixation models was mainly distributed above the fracture end of the femoral neck.The peak stress of the proximal femoral end,fracture end,Ward triangle,and calcar femorale of the three internal fixation models were the smallest in the femoral neck system model and the largest in the cannulated compression screw model.(2)Under the single-leg standing load and the sideways fall load,the peak displacement of the proximal femur of the three in

关 键 词：股骨颈骨折 内固定 有限元分析 生物力学 单腿站立 侧方跌倒 股骨距 Ward三角 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] R683.4