股骨转子间骨折内固定术后初始负重稳定性的研究  

Study on initial weight-bearing stability after internal fixation of femoral intertrochanteric fracture

作　　者：张晓萌[1] 王艳华[1] 姬云 张一翀[1] 丁镇涛 陈小锋 熊晨 王依林[1] 唐缪田 张殿英[1] Zhang Xiaomeng;Wang Yanhua;Ji Yun;Zhang Yichong;Ding Zhentao;Chen Xiaofeng;Xiong Chen;Wang Yilin;Tang Miaotian;Zhang Dianying(Department of Orthopaedics and Traumatology,Key Laboratory of Ministry of Education for Trauma Treatment and Nerve Regeneration,Peking University People's Hospital,Beijing 100044,China)

机构地区：[1]北京大学人民医院创伤骨科,创伤救治与神经再生教育部重点实验室,北京100044

出　　处：《中华骨科杂志》2024年第7期492-498,共7页Chinese Journal of Orthopaedics

摘　　要：目的探讨股骨转子间骨折重建内侧支撑和外侧壁的内固定方式对术后初始负重稳定性的影响。方法基于Sawbones股骨数字模型构建不同内侧支撑与外侧壁状态的股骨转子间骨折模型,结合多种髓内、髓外固定方式对固定后力学模型进行简化,获得七种力学简化模型。分别在股骨头末端节点施加集中力(700N)模拟单倍体重载荷(70kg)下的受力特点。通过StrucMaster软件内对各模型进行分析计算,获得各力学模型内各杆件的轴力、剪力、弯矩、位移形变和支座反力,并导人配套的SMConsole输出结果。结果昊模型1的弯矩中位数及四分位数为11.55(5.57,18.00)N·m,位移为2.89(2.81,2.94)rad;模型2的弯矩中位数及四分位数为13.72(9.30,20.05)N·m,位移为2.93(2.77,3.05)rad;模型3的弯矩中位数及四分位数为19.65(10.23,26.11)N·m,位移为2.93(2.77,3.05)rad;模型4的弯矩中位数及四分位数为25.95(25.14,36.70)N·m,位移为4.38(3.16,5.15)rad;模型5的弯矩中位数及四分位数为13.66(7.99,25.62)N·m,位移为3.50(3.32,3.56)rad;模型6的弯矩中位数及四分位数为24.60(9.33,29.37)N·m,位移为3.90(3.69,4.10)rad;模型7的弯矩中位数及四分位数为41.14(0.16,41.30)N·m,位移为5.50(5.50,7.05)rad。模型1的力学性能优于其他六种模型。结论基于杠杆平衡重建理论构建的力学简化模型及其力学计算分析可用于初步揭示股骨转子间骨折内固定后的力学特性,股骨转子间骨折重建内侧支撑和外侧壁的内固定方式可提高股骨转子间骨折内固定后负重的初始稳定性,对术后早期负重的功能康复研究具有指导意义。Objective To investigate the effect of internal fixation of medial support and lateral wall on initial weight-bearing stability of femoral intertrochanteric fracture after reconstruction of intertrochanteric fracture.Methods Based on the digital model of Sawbones femur,intertrochanteric fracture models with different medial support and lateral wall states were con-structed.Combined with various intramedullary and extramedullary fixation methods,the mechanical models after fixation were simplified,and seven mechanical simplified models were obtained.The individual body weight load(70 kg)was simulated by ap-plying concentrated force(700 N)to the end nodes of the femoral head.Through the analysis and calculation of each model in StrucMaster software,the axial force,shear force,bending moment,displacement deformation,and support reaction force of each bar in each mechanical model were obtained,and the results were output through the supporting SMConsole.ResultsThe medi-an bending moment of model 1 was 11.55(5.57,18.00)N·m,and the median bending moment was 2.89(2.81,2.94)rad.The medi-an bending moment of model 2 was 13.72(9.30,20.05)N·m,and the median bending moment was 2.93(2.77,3.05)rad.The medi-an bending moment of model 3 was 19.65(10.23,26.11)N·m,and the median bending moment was 2.93(2.77,3.05)rad.The me-dian bending moment of model 4 was 25.95(25.14,36.70)N·m,and the median bending moment was 4.38(3.16,5.15)rad.The me-dian bending moment of model 5 was 13.66(7.99,25.62)N·m,and the median bending moment was 3.50(3.32,3.56)rad.The me-dian bending moment of model 6 was 24.60(9.33,29.37)N•m,and the median bending moment was 3.90(3.69,4.10)rad.The me-dian bending moment of model 7 was 41.14(0.16,41.30)N·m,and the median bending moment was 5.50(5.50,7.05)rad.The me-chanical properties of model 1 were better than those of the other six models.Conclusion The simplified mechanical model and its mechanical calculation analysis based on the lever reconstruction balance theory can be used to preliminarily reveal th

关 键 词：髋骨折 骨折固定术 内固定器 术后并发症 生物力学现象 

分 类 号：R687.3[医药卫生—骨科学]