五种内固定方式治疗SeinsheimerⅤ型股骨转子下骨折的生物力学特性比较  

Comparison of biomechanical characteristics of five internal fixation methods for the treatment of Seinsheimer type Ⅴ subtrochanteric fractures of the femur

作　　者：徐志 李豫皖 刘子铭 杨民[4] Xu Zhi;Li Yuwan;Liu Ziming;Yang Min(Department of Orthopaedics,Zhangjiagang Fifth People's Hospital,Zhangjiagang 215600,China;Department of Orthopaedics,the First Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310009,China;Department of Sports Medicine,Peking University Third Hospital,Beijing 100191,China;Department of Orthopaedics,the First Affiliated Hospital of Wannan Medical College,Wuhu 241000,China)

机构地区：[1]张家港市第五人民医院骨科,张家港215600 [2]浙江大学医学院附属第一医院骨科,杭州310009 [3]北京大学第三医院运动医学科,北京100191 [4]皖南医学院弋矶山医院创伤骨科,芜湖241000

出　　处：《中华骨科杂志》2024年第9期616-625,共10页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金青年科学基金项目(82302853)。

摘　　要：目的通过有限元分析比较股骨近端锁定钢板、头干髓内钉+钢板、头干髓内钉+钛缆、重建髓内钉+钢板、重建髓内钉+钛缆固定SeinsheimerⅤ型股骨转子下骨折的生物力学特性。方法采集1名健康成年志愿者左侧股骨CT数据,通过软件构建SeinsheimerⅤ型股骨转子下骨折有限元模型及股骨近端锁定钢板、头干髓内钉、重建髓内钉、钢板和钛缆内固定器械模型,完成骨折和内固定装配后比较股骨近端锁定钢板、头干髓内钉+钢板、头干髓内钉+钛缆、重建髓内钉+钢板和重建髓内钉+钛缆模型在生理载荷下骨折块和内固定系统各部件最大位移、最大应力以及对内外侧壁骨折断端应力激发效果的差异。结果股骨近端锁定钢板、头干髓内钉+钢板、头干髓内钉+钛缆、重建髓内钉+钢板和重建髓内钉+钛缆的最大位移分别为7.9、5.7、4.3、4.3和4.9 mm,内固定系统最大位移分别为7.4、5.8、4.3、4.3和4.9 mm,内固定系统最大扭转角度分别为1.8°、1.5°、1.4°、1.3°、1.5°,最大应力分别为172.0、114.1、115.4、93.5和118.5 MPa,内固定最大应力分别为4530.0、993.6、1179.0、890.4和847.2 MPa。股骨近端锁定钢板在内侧壁远端和近端骨折接触面、外侧壁远端和近端骨折接触面的最大接触应力在五种固定方式中最大,分别为48.9、37.9、4.4、18.7 MPa;头干髓内钉+钛缆在上述4个接触面上的最大接触应力分别为16.1、18.1、6.9、11.7 MPa超过了头干髓内钉+钢板的0.0、0.0、5.5、7.5 MPa;重建髓内钉+钛缆在上述4个接触面上的最大接触应力分别为13.7、13.4、6.9、14.1 MPa超过了重建髓内钉+钢板的0.0、0.0、5.6、11.0 MPa。结论采用重建髓内钉+钛缆的固定方式治疗SeinsheimerⅤ型股骨转子下骨折在结构稳定性、耐久性和对骨皮质的应力激发作用方面具有更好的表现。Objective To conduct a comparative analysis of the biomechanical properties of Seinsheimer type Ⅴ subtrochanteric femoral fractures treated with different fixation methods,including proximal femoral locking plate,Cephalomedullary nail+plate,Cephalomedullary nail+titanium cable,reconstructive intramedullary nail+plate,and reconstructive intramedullary nail+titanium cable,using finite element analysis.Methods CT scan data of the left femur from a healthy adult volunteer was obtained and utilized to create a finite element model of Seinsheimer Ⅴ subtrochanteric femoral fracture through software simulation.The construction of femoral proximal locking plates,cephalomedullary nails,reconstructive intramedullary nails,steel plates,and titanium cable internal fixation devices was based on manufacturer-provided product manuals.Following the assembly of fracture and internal fixation components,comparisons were made under physiological loads regarding the maximum displacement,maximum stress,and stress excitation effects on fracture fragments and internal fixation components across the various fixation models.Results The maximum displacements of the femoral proximal locking plate,cephalomedullary nail+plate,cephalomedullary nail+titanium cable,reconstructive intramedullary nail+plate,and reconstructive intramedullary nail+titanium cable were 7.9,5.7,4.3,4.3,and 4.9 mm,respectively.The maximum displacements of the internal fixation systems were 7.4,5.8,4.3,4.3,and 4.9 mm,respectively.The maximum torsion angles of the internal fixation systems were 1.8°,1.5°,1.4°,1.3°,and 1.5°,respectively.The maximum stresses on the fracture fragments of the femoral proximal locking plate were 172.0,114.1,115.4,93.5,and 118.5 MPa,respectively.The maximum stresses on the internal fixation systems were 4,530.0,993.6,1,179.0,890.4,and 847.2 MPa,respectively.The maximum contact stress on the contact surfaces of the distal and proximal fracture contact surface of the medial wall,and the distal and proximal fracture contact surface of the

关 键 词：股骨骨折 内固定器 有限元分析 生物力学现象 

分 类 号：R687.3[医药卫生—骨科学]