摘要
背景:髓内钉治疗股骨干骨折取得了较好的临床疗效,但仍有部分患者并发无菌性骨不连,其原因为机械性不稳定。股骨作为人体最长最大的骨骼,不同部位骨折是否具有不同的生物力学特征,及不同进钉方式对于不同部位骨折端稳定性存在何种影响均研究甚少。目的:分析顺行和逆行髓内钉治疗不同部位股骨干骨折的生物力学特点,评估最佳进钉方式,减少骨不连发生率。方法:选取一名志愿者CT资料导入Mimics 19.0和Geomagic studio 2017软件中进行提取、优化得到右侧股骨三维模型;运用Solidworks 2017软件画出顺行和逆行髓内钉模型并与不同骨折部位股骨干骨折模型按照标准手术技术装配,以STEP格式导入Abaqus 2017软件中设置材料属性参数、边界条件、施加载荷、提交运算,于可视化模块中查看结果。其中上段股骨干骨折顺行和逆行髓内钉分别为A1、A2模型,中段为B1、B2模型,下段为C1、C2模型。结果与结论:(1)A1、B1、C2模型股骨整体应力分布更为均匀,位移、骨折端间隙与成角、股骨近折端骨块内翻均更小;(2)对于上段和中段股骨干骨折,顺行髓内钉具有更好的生物力学效果;对于下段股骨干骨折,逆行髓内钉效果更优。
BACKGROUND:Intramedullary nail has achieved a good clinical result in the treatment of femoral shaft fractures,but some patients still have aseptic nonunion due to mechanical instability.The femur is the longest and largest bone in the human body,but there are few studies on whether the fracture of the femur has different biomechanical results in different areas and the influence of different inserting methods on the stability of fracture fragments in different areas.OBJECTIVE:To analyze the biomechanical characteristics of anterograde and retrograde intramedullary nails in the treatment of different areas of femoral shaft fractures,and to evaluate the best way of insertion to reduce the incidence of nonunion.METHODS:CT data of a healthy volunteer were selected to import into the software of Mimics 19.0 and Geomagic studio 2017 to extract and optimize the three-dimensional model of the right femur.The anterograde and retrograde intramedullary nail models were built with Solidworks 2017 software and assembled with femoral shaft fracture models at different fracture areas according to standard surgical techniques.The models were imported into Abaqus 2017 software in STEP format to set material attribute parameters,boundary conditions,load and submit calculation,and the results were viewed in the visualization module.Among them,the antegrade and retrograde intramedullary nails of the upper femoral shaft fracture were A1 and A2 models,B1 and B2 models in the middle segment,and C1 and C2 models in the lower segment.RESULTS AND CONCLUSION:(1)In models A1,B1 and C2,the overall stress distribution of the femur was more uniform,and the placement,the displacement and angle of the fracture site,and inversion angle of the proximal femoral bone fragment were smaller.(2)For the upper and middle femoral shaft fractures,the anterograde intramedullary nail has a better biomechanical effect.For lower femoral shaft fractures,a retrograde intramedullary nail is preferable.
作者
黄培镇
董航
蔡群斌
林梓凌
黄枫
Huang Peizhen;Dong Hang;Cai Qunbin;Lin Ziling;Huang Feng(Department of Traumatic Orthopedics,First Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510405,Guangdong Province,China;Laboratory of Digital Orthopedics and Biomechanics,Lingnan Medical Research Center,Guangzhou University of Chinese Medicine,Guangzhou 510405,Guangdong Province,China)
出处
《中国组织工程研究》
CAS
北大核心
2024年第6期868-872,共5页
Chinese Journal of Tissue Engineering Research
基金
国家自然科学基金项目(82004390),项目负责人:董航。
关键词
顺行髓内钉
逆行髓内钉
股骨干骨折
有限元分析
生物力学
骨不连
anterograde intramedullary nail
retrograde intramedullary nail
femoral shaft fracture
finite element analysis
biomechanics
bone nonunion
