中国组织工程研究

中国组织工程研究 ›› 2024, Vol. 28 ›› Issue (6): 868-872.doi: 10.12307/2023.786

• 骨与关节生物力学 bone and joint biomechanics • 上一篇    下一篇

顺行和逆行髓内钉治疗不同部位股骨干骨折的有限元分析

黄培镇1，董  航1，蔡群斌1，林梓凌1，黄  枫1，2   

  1. 1广州中医药大学第一附属医院创伤骨科，广东省广州市   510405；2广州中医药大学岭南医学研究中心数字骨科与生物力学实验室，广东省广州市   510405
  • 收稿日期:2022-11-15 接受日期:2022-12-26 出版日期:2024-02-28 发布日期:2023-07-11
  • 通讯作者: 黄枫，主任中医师，教授，博士生导师，广州中医药大学第一附属医院创伤骨科，广东省广州市 510405；广州中医药大学岭南医学研究中心数字骨科与生物力学实验室，广东省广州市 510405
  • 作者简介:黄培镇，男，1984年生，广东省普宁市人，汉族，2011年广州中医药大学毕业，硕士，副主任中医师，主要从事运用中西医结合技术治疗骨折不愈合、畸形愈合、骨感染及骨与关节损伤的有限元研究。
  • 基金资助:
    国家自然科学基金项目(82004390)，项目负责人：董航

Finite element analysis of anterograde and retrograde intramedullary nail for different areas of femoral shaft fractures

Huang Peizhen1, Dong Hang1, Cai Qunbin1, Lin Ziling1, Huang Feng1,  2   

  1. 1Department of Traumatic Orthopedics, First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China; 2Laboratory of Digital Orthopedics and Biomechanics, Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China
  • Received:2022-11-15 Accepted:2022-12-26 Online:2024-02-28 Published:2023-07-11
  • Contact: Huang Feng, Chief TCM physician, Professor, Doctoral supervisor, 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
  • About author:Huang Peizhen, Master, Associate chief TCM physician, Department of Traumatic Orthopedics, First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China
  • Supported by:
    the National Natural Science Foundation of China, No. 82004390 (to DH)

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摘要：


文题释义：

顺行和逆行髓内钉：髓内钉是治疗股骨干骨折的金标准，其中心性固定，生物力学效果好，临床存在两种不同进钉方式——顺行髓内钉和逆行髓内钉。
股骨干骨折：股骨干骨折在临床中整体治疗效果满意，但仍有并发症发生，无菌性骨不连最为常见，其原因主要是机械性不稳定。


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：①A1、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。

https://orcid.org/0000-0002-4097-2790(黄培镇) 

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

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

Abstract: 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.

Key words: anterograde intramedullary nail, retrograde intramedullary nail, femoral shaft fracture, finite element analysis, biomechanics, bone nonunion

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