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| 利用有限元探究内固定治疗股骨颈骨折的生物力学研究 |
| 王颖,刘志朋,殷涛,赵云龙,韩彪,郭超韡,滕延斌,范峥睿,杨宝成,马信龙 |
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| 中国医学科学院北京协和医学院生物医学工程研究所 （天津 300192）;天津市天津医院/天津大学天津医院骨科研究所数字骨科学研究室 （天津 300050 ） |
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| 摘要: |
| 利用有限元分析研究不同内固定治疗Pauwels III型股骨颈骨折的生物力学特点。方法：选取1名健康受试者的股骨CT数据进行三维重建，骨折造模，装配动力髋螺钉、锁定加压钢板、三枚空心钉、四枚空心钉和髓内钉，建立有限元模型，在股骨头顶端轴向加载1400 N应力。研究不同内固定的应力分布和位移分布、股骨的应力分布和位移分布，并比较内固定和股骨模型的应力峰值和位移峰值。结果：股骨和内固定应力较大区域均分布于股骨颈及股骨干部位，且在骨折线附近均出现应力增大的现象；内固定位移分布主要集中于股骨头内螺钉尖端位置，股骨位移集中于股骨头顶端，应力加载位置。四枚空心钉的应力最小，峰值为135.3 MPa；锁定加压钢板的应力最大，峰值为405.9 MPa，但锁定加压钢板的位移12.3 mm为最小峰值；三枚空心钉的位移18.8 mm为最大峰值；三枚空心钉固定时，股骨受力最小，应力峰值为36.8 MPa，但股骨位移最大，峰值为19.3 mm；锁定加压钢板固定时，股骨受力104.6 MPa为最大应力峰值而位移12.6 mm为最小位移峰值。结论：锁定加压钢板在固定股骨颈骨折时稳定性最高，但股骨和内固定承受更大的压力和剪切力；动力髋螺钉固定短期内促进骨折愈合较有优势，但长期固定时髓内钉固定更佳。 |
| 关键词: 股骨颈骨折 有限元分析 内固定 应力 位移 |
| DOI：10.3969/j.issn.1007-6948.2019.01.012 |
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| 基金项目:国家自然科学基金项目（81572154、11772226）；中国博士后科学基金面上资助(2017M621087)；吴阶平医学基金会临床科研专项资助项目（320.6750.15185）；天津市卫生局科技攻关项目（2014KY31）；天津市博士后创新项目择优资助项目（TJQYBSH2017017） |
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| Finite Element Study on Biomechanics of Internal Fixation for Femoral Neck Fracture |
| WANG Ying,LIU Zhi-peng,YIN Tao,ZHAO Yunlong,HAN Biao,GUO Chaowei,TENG Yanbin,FAN Zhengrui,YANG Baocheng,MA Xinlong |
| Institute of Biomedical Engineering, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin (300192), China;Department of Digital Bone Science, Tianjin Hospital, Tianjin University, Tianjin University, Tianjin 300050, China |
| Abstract: |
| Objective To explore the biomechanical properties of different internal fixation for Pauwels III femoral neck fracture and their clinical implications. Methods The three-dimensional digital model of the femur from a heathy male volunteer was reconstructed. The femur was modelled to Pauwels III femoral neck fracture and the models of different fixations were assembled. The 3D finite element models of the femur and five internal fixations were established, in which axial stresses of 1400 N were loaded. We measured and compared respectively the von Mises stress and displacement distributions in different fixations and on the femurs fixated by the five implants, as well as the stress and displacement peak values. Results The stress on the implant and femur were mainly located on the femoral neck and femoral shaft, and the stress increased near the fracture line. The displacement of the internal fixation mainly distributed on the screw tip inside the femoral head. The displacement of the femur is concentrated on the top of the femoral head, where the stress loaded. Among the five internal fixations, four cannulated screws had the minimum peak stress (135.3 MPa). Locking compression plate had the maximum peak stress (405.9 MPa) and the minimum peak displacement (12.3 mm). The maximum peak displacement (18.8 mm) was founded on the three cannulated screws. The minimum peak stress (36.8 MPa) of femur appeared when three cannulated screws fixed, as well as the maximum peak displacement (19.3 mm). Meanwhile the maximum peak stress (104.6 MPa) and the minimum peak displacement (12.6 mm) of femur appeared when locking compression plate fixed. Conclusion Locking compression plate has the most stability in five internal fixations, but at the same time the femur and internal fixation will bear greater pressures and shear forces. In addition, dynamic hip screw has an advantage in promoting fracture healing in the short term, however intramedullary nail is better for long-term fixation. |
| Key words: Femoral neck fracture finite element analysis internal fixation stress displacement |
