青壮年PauwelsⅢ型股骨颈骨折3种内固定方案的生物力学分析  

Biomechanical analysis of three internal fixation schemes for Pauwels type III femoral neck fractures in young adults

作　　者：张子义 覃祺 阿里木江·玉苏甫 刘宇哲 玉素甫·热合曼 冉建 Zhang Ziyi;Qin Qi;Alimujiang·Yusufu;Liu Yuzhe;Yusufu·Reheman;Ran Jian(Xinjiang Medical University,Urumqi 830054,Xinjiang Uygur Autonomous region,China;Sixth Affiliated Hospital of Xinjiang Medical University,Urumqi 830092,Xinjiang Uygur Autonomous region,China)

机构地区：[1]新疆医科大学,新疆维吾尔自治区乌鲁木齐市830054 [2]新疆医科大学第六附属医院,新疆维吾尔自治区乌鲁木齐市830092

出　　处：《中国组织工程研究》2025年第33期7102-7108,共7页Chinese Journal of Tissue Engineering Research

基　　金：新疆维吾尔自治区研究生创新项目(XJ2023G186),项目负责人:阿里木江·玉素甫。

摘　　要：背景:青壮年PauwelsⅢ型股骨颈骨折的治疗极为棘手,内固定治疗PauwelsⅢ型股骨颈骨折时,不仅需保障内固定物的机械稳固性,更要确保其能够抵抗剪切、压缩和张力的冲击,防止在骨折愈合过程中内固定物因疲劳而断裂或松动。然而,现有的内固定方式还不能完全满足要求。目的:期望能够为临床治疗青壮年PauwelsⅢ型股骨颈骨折时,提供更为合理、有效的内固定方式选择,从而优化治疗效果,减少并发症的发生,提高患者的康复速度和生活质量。方法:利用志愿者股骨CT数据构建了Pauwels角为70°的股骨颈骨折模型,设置3种置入方式:①股骨颈动力交叉钉系统组:股骨颈动力交叉钉系统主钉位于股骨颈轴位中心;②联合组:股骨颈动力交叉钉系统主钉位于股骨颈轴位的偏下1/3,1枚空心钉位于股骨颈轴位的偏上1/3;③空心钉组:3枚空心钉的布置以经典的倒三角形状排列,确保固定效果的最大化。分析3种不同内固定方式下股骨近端骨折块和内固定装置的应力分布和位移;结果与结论:①3组股骨近端模型的应力均集中在骨折线附近,联合组(201.10 MPa)<股骨颈动力交叉钉系统组(222.25 MPa)<空心钉组(271.25 MPa);②股骨近端移位峰值均位于顶部,联合组(6.33 mm)<股骨颈动力交叉钉系统组(9.37 mm)<空心钉组(9.92 mm);③内固定应力均集中于骨折断端处的螺钉表面,并从该处向两侧逐渐延伸,空心钉组(136.67 MPa)<联合组(201.10 MPa)<股骨颈动力交叉钉系统组(222.25 MPa);④内固定装置模型位移最大处均位于内固定物的最顶端,3组均由顶部至远端逐渐减小,位移峰值分别为:联合组(6.21 mm)<股骨颈动力交叉钉系统组(9.19 mm)<空心钉组(9.51 mm);⑤3组模型的近端骨块应力主要集中在骨折断端,特别是在骨折端靠下方的区域,这表明这些区域在力学传递过程中承受了较大的应力和应变,联合组(24.96 MPa)<股骨颈动力交叉钉BACKGROUND:The treatment of Pauwels type III femoral neck fractures in young adults is extremely difficult.When treating Pauwels type III femoral neck fractures with internal fixation,it is not only necessary to ensure the mechanical stability of the internal fixation,but also to ensure that it can resist the impact of shear,compression and tension,so as to prevent the internal fixation from breaking or loosening due to fatigue during the fracture healing process.However,existing internal fixation methods do not fully meet our requirements for the treatment of this fracture.OBJECTIVE:To provide a more reasonable and effective choice of internal fixation mode for clinicians in the treatment of young adults with Pauwels type III femoral neck fracture,so as to optimize the treatment effect,reduce the occurrence of complications,and improve the recovery speed and quality of life of patients.METHODS:A femoral neck fracture model with Pauwels angle of 70°was constructed using CT data extracted from volunteers,and three placement modes were set up:(1)femoral neck system group:the main nail of femoral neck system was located in the center of the femoral neck axis.(2)Combination group:The main nail of femoral neck system was located in the lower third of the femoral neck axis,and a cannulated compression screw was located in the upper third of the femoral neck axis.(3)Cannulated compression screw group:The arrangement of three cannulated compression screws was arranged in the classic inverted triangle shape to ensure the maximum fixed effect.Stress distribution and displacement of proximal femoral fracture fragments and internal fixation devices were analyzed under three different internal fixation methods.RESULTS AND CONCLUSION:(1)The stress of the proximal femur models in the three groups was concentrated near the fracture line:combination group(201.10 MPa)<femoral neck system group(222.25 MPa)<cannulated compression screw group(271.25 MPa).(2)The peak value of proximal femur displacement was located at the top:combina

关 键 词：股骨颈骨折 股骨颈系统 空心钉 有限元分析 生物力学 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] R687