摘要
背景:传统锁定螺钉存在刚度过高、钢板近侧应力较集中等问题,为克服上述不足而设计的对侧皮质锁定螺钉已逐步应用于临床,但其在骨质疏松骨折治疗中应用的生物力学特性尚不明确。目的:通过有限元分析的方法,探讨在骨质疏松股骨骨折中应用传统锁定螺钉及对侧皮质锁定螺钉的生物力学差异,为对侧皮质锁定螺钉的临床应用提供参考。方法:选择1例老年男性骨质疏松志愿者的股骨二维CT数据,通过Mimics和Geomagic软件构建骨质疏松股骨骨折模型,并利用UG软件建立股骨骨折内固定模型;根据使用螺钉类型分为传统锁定螺钉组(股骨骨折两端使用传统锁定螺钉内固定)和对侧皮质锁定螺钉组(股骨骨折近端使用对侧皮质锁定螺钉内固定,远端使用传统锁定螺钉内固定);在Abaqus软件中,采用三维有限元分析方法分析模拟轴向加载,扭转加载,前后4点弯曲加载3种模式下模型的生物力学特性。结果与结论:①对侧皮质锁定螺钉组股骨承受较小应力,降低了骨干再骨折的风险;②对侧皮质锁定螺钉组钢板应力较传统锁定螺钉组钢板应力较小且分散,对侧皮质锁定螺钉组螺钉的应力均匀分布在所有对侧皮质锁定螺钉上,并且对侧皮质锁定螺钉的应力均匀地分布在整个螺杆,从而避免因钢板、螺钉局部承受较大应力发生断裂;③对侧皮质锁定螺钉组骨折断端间微动接近于平行微动,为骨折Ⅱ期愈合提供更有利条件;④上述结果表明,应用对侧皮质锁定螺钉较传统锁定螺钉治疗骨质疏松股骨骨折能减少股骨干的应力,且能分散内固定物上应力,降低因再骨折或内固定断裂导致再次手术的风险;对侧皮质锁定螺钉能够提供骨质疏松股骨骨折间平行微动,促进骨痂对称性生长。
BACKGROUND:To overcome the shortcomings of high stress at the near side of the plate and high stiffness of standard locking screw,a new far cortical locking screw has been developed.The biomechanical character of osteoporotic femoral fracture with far cortical locking screw is still unclear.OBJECTIVE:To investigate the biomechanical difference of osteoporotic femoral fracture with standard locking screw and far cortical locking screw by finite element analysis so as to provide reference for the clinical application of far cortical locking screw.METHODS:One male old volunteer with osteoporosis was selected,and the two-dimensional CT data of osteoporotic femur were obtained.The finite element model of osteoporotic femoral fracture was established using the software of Mimics,Geomagic,and the finite element models of internal fixators were established using the software of UG.With three-dimensional finite element analysis,biomechanical characteristics of established model under axial compression,torsion and four point bending loading were analyzed using Abaqus software.RESULTS AND CONCLUSION:(1)The stress of femur in far cortical locking group was smaller than those of in locking screw group,which decreased the risk of refracture.(2)The plate stress of far cortical locking group was less than that of locking screw group,and dispersed.The stress distribution on the screw in far cortical locking group was evenly distributed on all the far cortical locking screws,and the stress of the locking screws was evenly distributed throughout the screw,to avoid the breakage of internal fixation due to large local stress of plate and screw.(3)Far cortical locking group provided nearly parallel interfragmentary motion,and this motion promoted secondary fracture healing by callus formation.(4)The results imply that treatment of osteoporotic femoral fracture with far cortical locking screw can decrease the stress of femur and distribution of the stress on the internal fixation,and reduce the risk of reoperation due to refracture or internal fixation fracture.Far cortical locking screw can provide nearly parallel interfragmentary motion to promote callus formation.
作者
朱云
陈渝
邱皓
刘盾
靳国荣
陈诗谋
翁政
Zhu Yun;Chen Yu;Qiu Hao;Liu Dun;Jin Guorong;Chen Shimou;Weng Zheng(Center for Traumatology(Orthopedic Ward),Ninth People’s Hospital of Chongqing,Chongqing 400700,China)
出处
《中国组织工程研究》
CAS
北大核心
2021年第24期3832-3837,共6页
Chinese Journal of Tissue Engineering Research
基金
重庆市北碚区科学技术委员会科研项目(2019-7),项目负责人:朱云。
关键词
骨
股骨
骨质疏松
内固定
螺钉
骨不连
有限元分析
生物力学
bone
femur
osteoporosis
internal fixation
screw
nonunion
finite element analysis
biomechanics
