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

doi:10.3877/cma.j.issn.2096-0263.2021.06.003

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. 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 Li^,²

^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

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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。

关键词: 股骨颈骨折, 生物力学, 青壮年, 有限元分析

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.

Key words: Femoral neck fractures, Biomechanics, Youth, Finite element analysis

表1 有限元模型的节点数及单元数

有限元模型	节点数	单元数
a组	410174	310754
b组	467235	358821

表1 有限元模型的节点数及单元数

有限元模型	节点数	单元数
a组	410174	310754
b组	467235	358821

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

材料名称	弹性模量（MPa）	泊松比
皮质骨	16 800	0.30
松质骨	840	0.30
股骨头	900	0.29
股骨颈	620	0.29
钛合金	110 000	0.30

表2 模型材料参数

材料名称	弹性模量（MPa）	泊松比
皮质骨	16 800	0.30
松质骨	840	0.30
股骨头	900	0.29
股骨颈	620	0.29
钛合金	110 000	0.30

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

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