切换至 "中华医学电子期刊资源库"

中华老年骨科与康复电子杂志 ›› 2021, Vol. 07 ›› Issue (06) : 333 -338. doi: 10.3877/cma.j.issn.2096-0263.2021.06.003

股骨骨折

新型股骨颈内固定系统与3枚空心钉加内侧钢板固定青壮年Pauwels Ⅲ型股骨颈骨折的有限元分析
杜兵1, 马腾2, 路遥2, 张聪明2, 许毅博2, 黄强1, 姬帅2, 李明2, 任程2, 王谦2, 张堃2(), 李忠2,()   
  1. 1. 716000 延安大学医学院;710054 西安交通大学医学院附属红会医院
    2. 710054 西安交通大学医学院附属红会医院
  • 收稿日期:2021-07-29 出版日期:2021-12-05
  • 通信作者: 张堃, 李忠

Finite Element Analysis of the new femoral neck internal fixationsystem and three hollow screws plus medial plate fixation for Pauwels III femoral neck fractures in young adults

Bing Du1, Teng Ma2, Yao Lu2, Congming Zhang2, Qiang Huang2, Shuai Ji1, Ming Li2, Cheng Ren2, Qian Wang2, Kun Zhang2, Zhong Li2,()   

  1. 1. Medical College of Yan'an University, Yan'an 716000, China; Honghui Hospital Affiliated to Medicine College of Xi'an Jiaotong University, Xi'an 710054, China
    2. Honghui Hospital Affiliated to Medicine College of Xi'an Jiaotong University, Xi'an 710054, China
  • Received:2021-07-29 Published:2021-12-05
  • Corresponding author: Zhong Li
引用本文:

杜兵, 马腾, 路遥, 张聪明, 许毅博, 黄强, 姬帅, 李明, 任程, 王谦, 张堃, 李忠. 新型股骨颈内固定系统与3枚空心钉加内侧钢板固定青壮年Pauwels Ⅲ型股骨颈骨折的有限元分析[J/OL]. 中华老年骨科与康复电子杂志, 2021, 07(06): 333-338.

Bing Du, Teng Ma, Yao Lu, Congming Zhang, Qiang Huang, Shuai Ji, Ming Li, Cheng Ren, Qian Wang, Kun Zhang, Zhong Li. Finite Element Analysis of the new femoral neck internal fixationsystem and three hollow screws plus medial plate fixation for Pauwels III femoral neck fractures in young adults[J/OL]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2021, 07(06): 333-338.

目的

采用有限元分析方法比较新型股骨颈内固定系统(FNS)与3枚空心螺钉加内侧钢板固定青壮年Pauwels Ⅲ型股骨颈骨折的生物力学特性。

方法

收集一例Pauwels Ⅲ型股骨颈骨折住院患者(男,35岁)的健侧股骨CT扫描数据,将该股骨CT数据通过数字医学软件建立股骨的三维模型。按照60°骨折线角度对股骨颈进行简化分割,模拟出Pauwels Ⅲ型股骨颈骨折,在Solidworks2017软件中按照临床上相应的内固定尺寸和手术方案置入模拟的内固定模型于股骨模型中,分为FNS置入和3枚空心钉加内侧钢板置入两种模型,最后使用ANSYS软件进行划分网格、材料赋值和数据计算等步骤,FNS与3枚空心钉加内侧钢板固定后的生物力学稳定性有何差异。

结果

实验分为2组:a.FNS组,b.空心钉加内侧钢板组。股骨头侧应力峰值分别为:a:126.74Mpa,b:180.11Mpa。内固定应力峰值分别为:a:143.17Mpa,b:214.68MPa。股骨头处位移峰值分别为:a:10.726mm,b:11.278mm。内固定位移峰值分别为:a:10.164mm,b:11.004mm。

结论

FNS对骨折端固定的力学稳定性优于3枚空心钉加内侧钢板,是青壮年不稳定型股骨颈骨折值得优先考虑的手术固定方式。

Objective

In this study, finite element analysis method was used to compare the biomechanical characteristics of femoral neck system (FNS) and three hollow screws combined with medial plate fixation of Pauwels type Ⅲfemoral neck fracture, so as to provide reference for the selection of clinical surgical options.

Methods

The CT scanning data of the healthy femur of a hospitalized patient with Pauwels III femoral neck fracture (male, 35 years old) were collected, and the CT data of the femur were used to establish the three-dimensional model of the femur by digital medical software. The femoral neck was simplified and segmented according to the angle of 60° fracture line, and the Pauwels III femoral neck fracture was simulated. In Solidworks 2017 software, the simulated internal fixation model was placed in the femoral model according to the corresponding clinical internal fixation size and surgical scheme, and it was divided into two models, FNS placement and three hollow nails plus medial plate placement. Finally, ANSYS software was used meshing, material assignment and data calculation. What was the difference in biomechanical stability between FNS and three hollow nails plus medial plate fixation.

Results

The peak stress of femoral head were, a: 126.74 Mpa, b: 180.11 Mpa. The peak stress of internal fixation were, a: 143.17 MPa, b: 214.68 MPa. The peak displacement of femoral head were, a: 10.726 mm, b: 11.278 mm. The peak displacement of internal fixation were, a: 10.164 mm, b: 11.004 mm.

Conclusions

FNS for the fixation of the fracture end is better than that of the hollow nail and the medial plate, and the femoral neck system has the advantages of small incision and short timeconsuming in the operation process, which is a preferred surgical fixation method for femoral neck fractures.

表1 有限元模型的节点数及单元数
图1 模型分组:股骨颈系统组(a);3枚空心钉加内侧钢板组(b)
表2 模型材料参数
图2~3 两组模型股骨头侧应力分布云图
图8~9 两组模型内固定位移分布云图
1
Okcu G, Özkayın N, Erkan S, et al. Should full threaded compression screws be used in adult femoral neck fractures? [J]. Injury, 2015, 46 Suppl 2: S24-S28.
2
Windolf M, Braunstein V, Dutoit C, et al. Is a helical shaped implant a superior alternative to the Dynamic Hip Screw for unstable femoral neck fractures? A biomechanical investigation [J]. Clin Biomech(Bristol, Avon), 2009, 24(1): 59-64.
3
Knobe M, Altgassen S, Maier KJ, et al. Screw-blade fixation systems in Pauwels three femoral neck fractures: a biomechanical evaluation[J]. Int Orthop, 2018, 42(2): 409-418.
4
Shen M, Wang C, Chen H, et al. An update on the Pauwels classification [J]. J Orthop Surg Res, 2016, 11(1): 161.
5
Ye Y, Chen K, Tian K, et al. Medial buttress plate augmentation of cannulated screw fixation in vertically unstable femoral neck fractures: Surgical technique and preliminary results [J]. Injury, 2017, 48(10): 2189-2193.
6
Lichstein PM, Kleimeyer JP, Githens M, et al. Does the Watson-Jones or modified Smith-Petersen approach provide superior exposure for femoral neck fracture fixation? [J]. Clin Orthop Relat Res, 2018, 476(7): 1468-1476.
7
Sitthiseripratip K, Van OH, Vander Sloten J, et al. Finite element study of trochanteric gamma nail for trochanteric fracture [J]. Med Eng Phys, 2003, 25(2): 99-106.
8
Sowmianarayanan S, Chandrasekaran A, Kumar RK. Finite element analysis of a subtrochanteric fractured femur with dynamic hip screw, dynamic condylar screw, and proximal femur nail implants--a comparative study [J]. Proc Inst Mech Eng H, 2008, 222(1): 117-127.
9
Li J, Wang M, Zhou J, et al. Finite element analysis of different screw constructs in the treatment of unstable femoral neck fractures[J]. Injury, 2020, 51(4): 995-1003.
10
Freitas A, Bontempo R L, Azevedo F, et al. New fixation method for Pauwels type III femoral neck fracture: a finite element analysis of sliding hip screw, L-shaped, and L-shaped with medial plate[J]. Eur J Orthop Surg Traumatol,2021,31(6):1069-1075..
11
Roerdink WH, Aalsma AM, Nijenbanning G, et al. The dynamic locking blade plate,a new implant for intracapsular hip fractures: biomechanical comparison with the sliding hip screw and Twin Hook[J]. Injury, 2008, 40(3): 283-287.
12
Samsami S, Saberi S, Sadighi S, et al. Comparison of three fixation methods for femoral neck fracture in young adults: experimental and numerical investigations [J]. J Med Biol Eng, 2015, 35(5): 566-579.
13
Li J, Wang M, Li L, et al. Finite element analysis of different configurations of fully threaded cannulated screw in the treatment of unstable femoral neck fractures [J]. J Orthop Surg Res, 2018, 13(1): 272.
14
Li J, Yin P, Zhang L, et al. Medial anatomical buttress plate in treating displaced femoral neck fracture a finite element analysis [J]. Injury, 2019, 50(11): 1895-1900.
15
Siavashi B, Aalirezaei A, Moosavi M, et al. A comparative study between multiple cannulated screws and dynamic hip screw for fixation of femoral neck fracture in adults [J]. Int Orthop, 2015, 39(10): 2069-2071.
16
Damany DS, Parker MJ, Chojnowski A. Complications after intracapsular hip fractures in young adults. A meta-analysis of 18 published studies involving 564 fractures [J]. Injury, 2005, 36(1): 131-141.
17
Slobogean GP, Sprague SA, Scott T, et al. Complications following young femoral neck fractures [J]. Injury, 2015, 46(3): 484-491.
18
Liporace F, Gaines R, Collinge C, et al. Results of internal fixation of Pauwels type- 3 vertical femoral neck fractures [J]. J Bone Joint Surg Am Vol, 2008, 90A(8): 1654-1659.
19
Tianye L, Peng Y, Jingli X, et al. Finite element analysis of different internal fixation methods for the treatment of Pauwels type III femoral neck fracture [J]. Biomed Pharmacother, 2019, 112: 108658.
20
Mir H, Collinge C. Application of a medial buttress plate May prevent many treatment failures seen after fixation of vertical femoral neck fractures in young adults [J]. Med Hypotheses, 2015, 84(5): 429-433.
21
Samsami S, Augat P, Rouhi G. Stability of femoral neck fracture fixation: A finite element analysis [J]. Proc Inst Mech Eng H, 2019, 233(9): 892-900.
22
Stoffel K, Zderic I, Gras F, et al. Biomechanical Evaluation of the Femoral Neck System in Unstable Pauwels III Femoral Neck Fractures: A Comparison with the Dynamic Hip Screw and Cannulated Screws [J]. J Orthop Trauma, 2017, 31(3): 131-137.
[1] 高小康, 张净宇, 刘金伟, 田东牧, 胡永成, 徐卫国. 连接型人工膝关节假体运动和负重模式的演变和进展[J/OL]. 中华关节外科杂志(电子版), 2024, 18(04): 505-516.
[2] 刘正宇, 刘春风, 王振. 改良后外侧入路半髋置换治疗股骨颈骨折的早期疗效[J/OL]. 中华关节外科杂志(电子版), 2024, 18(03): 409-413.
[3] 蒋政, 郑楠, 毛彦杰, 何阿祥, 林蔚铭, 郭瀚, 刘语嫣, 臧慧, 王聪, 刘万军. 关于胫骨高位截骨术后髌股关节变化的研究进展[J/OL]. 中华关节外科杂志(电子版), 2024, 18(03): 398-404.
[4] 卢国良, 潘耀成. 比较不同类型假体用于骨质疏松症的老年股骨颈骨折[J/OL]. 中华关节外科杂志(电子版), 2024, 18(02): 277-279.
[5] 欧梁, 齐麒, 胡伟伟, 卢敏, 黄彦昌, 黄维琛, 匡建军. 股骨颈动力交叉钉系统与其它内固定治疗股骨颈骨折对比[J/OL]. 中华关节外科杂志(电子版), 2024, 18(01): 92-105.
[6] 张起尧, 刘子文. 复杂腹壁疝的解剖和生物力学基础[J/OL]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 674-676.
[7] 秦家麟, 吴炯, 王振宜, 金磊. 有限元法在肛肠良性疾病中的研究进展及前景展望[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(04): 341-346.
[8] 张琛朋, 王靖, 曾塬杰, 高鹏, 陈昕彤. 反式全肩关节置换术的研究进展[J/OL]. 中华肩肘外科电子杂志, 2024, 12(04): 373-376.
[9] 王曦, 关鹏飞. 双钢板内固定治疗肱骨远1/3骨折的有限元分析及基于肘关节功能和肘关节活动度评估疗效[J/OL]. 中华肩肘外科电子杂志, 2024, 12(03): 230-237.
[10] 张于, 程亮亮, 王峰, 赵德伟. 2枚与3枚空心钉治疗无移位股骨颈骨折的疗效对比[J/OL]. 中华老年骨科与康复电子杂志, 2024, 10(05): 281-286.
[11] 茹江英, 廖启宇, 温国洪, 潘思华, 刘栋, 张皓琛, 牛云飞. 直接前方入路和后外侧入路半髋关节置换治疗老年痴呆股骨颈骨折的疗效比较[J/OL]. 中华老年骨科与康复电子杂志, 2024, 10(05): 287-293.
[12] 单良, 刘怡, 于涛, 徐丽. 老年股骨颈骨折术后患者心理弹性现状及影响因素分析[J/OL]. 中华老年骨科与康复电子杂志, 2024, 10(05): 294-300.
[13] 李彦霖, 王海程, 权元元, 张一凡, 陈伟. 腰椎骨小梁生物力学特性及其在骨质疏松骨折治疗中的应用[J/OL]. 中华老年骨科与康复电子杂志, 2024, 10(04): 243-250.
[14] 权元元, 丁凯, 王海程, 李彦霖, 张一凡, 张建志, 陈伟. 骨小梁的形态结构和生物力学性能研究进展[J/OL]. 中华老年骨科与康复电子杂志, 2024, 10(02): 123-128.
[15] 孙阳, 杨帅, 贾晋瑄, 杜震, 周凌峰, 魏贤振. 电针联合等速训练对THA术后髋关节生物力学的影响[J/OL]. 中华老年骨科与康复电子杂志, 2024, 10(02): 103-110.
阅读次数
全文


摘要