中国组织工程研究

中国组织工程研究 ›› 2024, Vol. 28 ›› Issue (3): 336-340.doi: 10.12307/2023.978

• 组织工程骨材料 tissue-engineered bone • 上一篇    下一篇

骨水泥分布位置与含量对股骨反转子间骨折应力、位移影响的有限元分析

张乾龙1，2，买合木提•亚库甫1，2，宋晨辉1，2，刘修信1，2，任  政1，2，刘宇哲1，2，木牙沙尔•阿布都沙拉木1，2，萨吉旦•艾克拜尔1，2，冉  建1，2   

  1. 1新疆医科大学，新疆维吾尔自治区乌鲁木齐市  830054；2新疆医科大学第六附属医院，新疆维吾尔自治区乌鲁木齐市  830002
  • 收稿日期:2022-11-10 接受日期:2023-01-29 出版日期:2024-01-28 发布日期:2023-07-08
  • 通讯作者: 冉建，主任医师，硕士生导师，新疆医科大学，新疆维吾尔自治区乌鲁木齐市 830054；新疆医科大学第六附属医院，新疆维吾尔自治区乌鲁木齐市 830002
  • 作者简介:张乾龙，男，1994年生，河南省周口市人，汉族，新疆医科大学第六附属医院在读硕士，主要从事创伤骨科力学研究与分析方面的研究。
  • 基金资助:
    新疆维吾尔自治区自然科学基金资助项目(2021D01C454)，项目负责人：刘修信

Finite element analysis of the effect of the distribution position and content of bone cement on the stress and displacement of reverse femoral intertrochanteric fracture

Zhang Qianlong1, 2, Maihemuti•Yakufu1, 2, Song Chenhui1, 2, Liu Xiuxin1, 2, Ren Zheng1, 2, Liu Yuzhe1, 2, Muyashaer•Abudushalamu1, 2, Sajidan•Aikebaier1, 2, Ran Jian1, 2   

  1. 1Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China; 2Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi 830002, Xinjiang Uygur Autonomous Region, China 
  • Received:2022-11-10 Accepted:2023-01-29 Online:2024-01-28 Published:2023-07-08
  • Contact: Ran Jian, Chief physician, Master’s supervisor, Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China; Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi 830002, Xinjiang Uygur Autonomous Region, China
  • About author:Zhang Qianlong, Master candidate, Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China; Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi 830002, Xinjiang Uygur Autonomous Region, China
  • Supported by:
    Natural Science Foundation of Xinjiang Uygur Autonomous Region, No. 2021D01C454 (to LXX)

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摘要：


文题释义：

增强型股骨近端防旋髓内钉：是治疗不稳定型股骨转子间骨折较为理想的内固定之一，增强即注入聚甲基丙烯酸甲酯(骨水泥)包裹螺旋刀片近端，增加螺旋刀片的把持力和锚固力，降低内固定失败风险。
有限元分析：是一种用于求解微分方程组或积分方程组数值解的数值技术，具有操作简便、仿真度高、可重复利用等优势，是用于评估股骨骨折植入物效果的有效工具。


背景：股骨近端防旋髓内钉是治疗骨质疏松性反转子间骨折的首选治疗方案，其中骨水泥增强可减少股骨近端防旋髓内钉切出与切穿的概率，但目前没有相关生物力学研究证明骨水泥的含量及位置对骨折端应力及位移的影响。

目的：通过有限元方法分析骨水泥增强型股骨近端防旋髓内钉中骨水泥含量及位置对老年骨质疏松性股骨反转子间骨折应力、应变及位移的影响。
方法：采用Mimics软件建立健康成年女性右侧股骨模型，并在Geometric软件中进行光滑处理，利用Solidworks软件分别建立股骨近端防旋髓内钉(无骨水泥、头端球形1 mL骨水泥、头端球形2 mL骨水泥、头端球形3.4 mL骨水泥、螺旋刀片周围圆柱形5 mL骨水泥)5种类型内固定方式及股骨反转子间骨折(AO分型31-A3.1型)模型，装配后，在Ansys软件中比较5种模型内植物的总应力分布、应力峰值及位移。 

结果与结论：①无骨水泥与头端球形1 mL、头端球形2 mL、头端球形3.4 mL、螺旋刀片周围圆柱形5 mL骨水泥增强型股骨近端防旋髓内钉组内植物的应力峰值分别为571.07 MPa(位于螺旋刀片与主钉交界处)，495.45 MPa(位于螺旋刀片与主钉交界处)、467.20 MPa(位于主钉与远端螺钉连接处)、642.70 MPa(位于主钉与远端螺钉连接处)、458.58 MPa(位于远端与主钉交界处)；②无骨水泥与头端球形1 mL、头端球形2 mL、头端球形3.4 mL、螺旋刀片周围圆柱形5 mL骨水泥增强型股骨近端防旋髓内钉组内植物的最大位移量分别为9.260 5，7.589 1，7.316 8，6.790 7，6.615 7 mm，均位于股骨头近端；③结果显示，采用股骨近端防旋髓内钉内固定股骨反转子间骨折时，骨水泥增强较未增强有明显的力学稳定性，并且螺旋刀片周围5 mL骨水泥的增强效果最好，对于老年不稳定型股骨转子间骨折是优先选择。

https://orcid.org/0000-0003-3030-8631(张乾龙)

中国组织工程研究杂志出版内容重点：生物材料；骨生物材料；口腔生物材料；纳米材料；缓释材料；材料相容性；组织工程

关键词: 内植物, 股骨近端防旋髓内钉, 股骨反转子骨折, 有限元分析, 骨水泥, 增强型股骨近端防旋髓内钉

Abstract: BACKGROUND: The proximal femoral nail antirotation is the preferred treatment for reverse osteoporotic intertrochanteric fractures. Bone cement enhancement can reduce the probability of proximal femoral nail antirotation cut-out and cut-through, but there are no relevant biomechanical studies demonstrating the effect of bone cement content and location on the stress and displacement of the fracture end.
OBJECTIVE: To investigate the effects of different contents and locations of bone cement in cement-reinforced proximal femoral nail antirotation on stress, strain, and displacement of reverse osteoporotic femoral intertrochanteric fractures in the elderly by finite element analysis.  
METHODS: A healthy adult female right femur model was extracted by Mimics software and smoothed in Geometric software. Five types of internal fixation methods of proximal femoral nail antirotation (cementless, cephalic spherical 1 mL, cephalic spherical 2 mL, cephalic spherical 3.4 mL, and cylindrical 5 mL around spiral blade) and femoral intertrochanteric fracture (AO subtype 31-A3.1 type) model were established in Solidworks software. After assembly, the total stress distribution, peak stress and displacement of the five models of implants with the femur were compared in Ansys software.
RESULTS AND CONCLUSION: (1) The peak stresses of proximal femoral nail antirotation with head-end spherical 1 mL, head-end spherical 2 mL, head-end spherical 3.4 mL, and cylindrical 5 mL enhanced proximal femoral nail antirotation around the spiral blade respectively were 571.07 MPa (located at the junction of the spiral blade and the main nail), 495.45 MPa (located at the junction of the spiral blade and the main nail), 467.20 MPa (located at the junction of the main nail and the distal screw connection), 642.70 MPa (located at the junction of the main nail and distal screw connection), and 458.58 MPa (located at the junction of the spiral blade and the main nail). (2) The maximum displacements of proximal femoral nail antirotation with head end sphere 1 mL, head end sphere 2 mL, head end sphere 3.4 mL, and with cylindrical 5 mL enhancement around the spiral blade were 9.260 5, 7.589 1, 7.316 8, 6.790 7, and 6.615 7 mm, respectively, all of which were located at the proximal end of the femoral head. (3) These findings revealed that for reverse femoral intertrochanteric fractures treated with proximal femoral nail antirotation, the bone cement enhancement had significant mechanical stability compared with no enhancement, and the enhancement of the spiral blade 5 mL around the perimeter was the best, which is more preferable for aged unstable intertrochanteric fractures.

Key words: implant, proximal femoral nail antirotation, reverse femoral intertrochanteric fracture, finite element analysis, bone cement, enhanced proximal femoral nail antirotation

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