摘要
目的基于有限元方法,对Vancouver B1型股骨假体周围骨折内固定后的稳定性及生物力学状态进行分析研究。方法收集30名中老年健康志愿者左侧股骨CT图像数据以及股骨假体、锁定钛板的外形数据并进行三维重建。模拟人工髋关节置换术后假体周围骨折锁定板内固定手术,近端分别采用钛缆捆扎、锁定螺钉单层皮质固定及两者组合,施加模拟完全负重及部分负重的载荷,观察最大位移及峰值应力情况。结果对于近端钛缆捆扎与锁定螺钉单层皮质固定两种方式,在模拟完全负重及部分负重压力载荷作用下的骨折位移,锁定板、假体及股骨上的应力峰值差异均无统计学意义,也即钛缆捆扎和锁定螺钉单层皮质固定后生物力学状态无明显区别。但若将两者组合使用,则可增加内固定稳定性,并且降低锁定板应力峰值,与单独使用两种内固定方式的结果差异均有统计学意义(P<0.05或P<0.01)。结论对于Vancouver B1型股骨假体周围骨折切开复位锁定板内固定手术,钛缆捆扎结合锁定螺钉单层皮质固定是首选的内固定方式。
Objective To apply finite element method for analyzing the biomechanics status and stability of internal fixation for Vancouver type B1 periprosthetic femoral fractures. Methods CT image data of the left femur from 30 healthy middle-aged or elderly volunteers and the profile data of femur prosthesis and locking compression plate were collected and used for 3D reconstruction. Three different types of internal fixation methods for Vancouver type B1 periprosthetic femoral fracture were simulated. The proximal part of the prosthesis was fixed with cable cerclage, single cortical locking screw and a combination of both, and the load simulating full load or partial load was applied. Then the maximum displacement and Von Mises stress were observed. Results There was no significant difference in the maximum displacement or Von Mises stress between cahle cerclage fixation and single-cortical locking screw fixation under full and partial loads. The maximum displacement and Von Mises stress were decreased and the internal fixation was more stable when the two fixations combined together, with significant difference found between cable eerelage fixation and single-cortical locking screw fixation （P〈0. 05, P〈0. 01）. Conclusion Combination of cable cerclage and single-cortical locking screw is the first choice for internal fixation in the treatment of Vancouver type B1 periprosthetic femoral fracture.
出处
《第二军医大学学报》
CAS
CSCD
北大核心
2017年第2期253-257,共5页
Academic Journal of Second Military Medical University
