摘要
目的比较股骨近端抗旋髓内钉螺旋刀片静态锁定与滑动加压固定治疗不稳定股骨粗隆间骨折的生物力学性能,为临床手术选择内固定提供科学依据。方法基于健康成年男性CT三维原始图像建立股骨有限元模型,利用Solidworks软件建立内固定模型。模拟20个不同骨折线位置和移位程度的不稳定(Evans-Jensen Ⅳ/Ⅴ)股骨粗隆间骨折内固定有限元模型,将螺旋刀片两种模型(静态锁定和滑动加压)导入到Abaqus分析软件中,并模拟单足站立时股骨受力情况,予施加相同的约束和载荷,观察受力分布和位移大小。结果从有限元模型图中可以看出,应力主要分布在股骨颈及大、小粗隆部、中下段,小粗隆处的应力相对集中。在站立和行走两种状态下,两种不同分型(Ⅳ/Ⅴ型)股骨粗隆间骨折PFNA内固定模型螺旋刀片静态锁定固定应力和位移均低于滑动加压固定,差异均有统计学意义(P<0.05)。结论股骨近端抗旋髓内钉治疗不稳定股骨粗隆间骨折时,螺旋刀片静态锁定比滑动加压锁定力学上应力更小且分布更合理,具有对骨折愈合更佳的生物力学优势。
Objective To compare the biomechanical properties of the proximal femoral anti-rotation intramedullary nail helical blade static locking and sliding compression fixation in the treatment of unstable femoral intertrochanter fracture,and to provide a scientific basis for the selection of internal fixation in clinical surgery.Methods The finite element model of the femur was established based on the three-dimensional original CT images of healthy adult males.The internal fixation model was established using Solidworks software.Twenty finite element models of unstable(Evans-Jensen Ⅳ/Ⅴ)femoral intertrochanter fracture internal fixation with different fracture line positions and degrees of displacement were simulated.Two models of the helical blade(static locking and sliding compression)were imported into Abaqus analysis software,and the femoral stress when the single foot was standing was simulated.The same constraint and load were applied.The force distribution and displacement magnitude were observed.Results It was seen from the finite element model diagram that the stress was mainly distributed in the femoral neck,large and small trochanter,middle and lower segment,and the stress at the small site was relatively concentrated.In the two states of standing and walking,the stress and displacement of the helical blade static locking fixation in the PFNA internal fixation model of two different types(type Ⅳ/Ⅴ)of femoral intertrochanter fractures were lower than those of sliding compression fixation,and the differences were statistically significant(P<0.05).Conclusion Compared with sliding compression locking,helical blade static locking has less mechanical stress and more reasonable distribution in the treatment of unstable femoral fracture with femoral antirotation intramedullary nail,which has better biomechanical advantages for fracture healing.
作者
林臻
陈少坚
高连云
阮康明
刘清平
LIN Zhen;CHEN Shaojian;GAO Lianyun;RUAN Kangming;LIU Qingping(Department of Orthopaedic Trauma,Mindong Hospital Affiliated to Fujian Medical University,Ningde 355000,China)
出处
《中国现代医生》
2021年第21期58-61,F0003,共5页
China Modern Doctor
基金
福建省宁德市医技提升科研项目(宁财社指〔2017〕35号)
福建省宁德市科技计划项目(20170145)。
关键词
股骨粗隆间骨折
PFNA固定
静态锁定
滑动加压
有限元分析
Femoral intertrochanter fracture
PFNA fixation
Static locking
Sliding compression
Finite element analysis
