中国组织工程研究

中国组织工程研究 ›› 2024, Vol. 28 ›› Issue (21): 3319-3325.doi: 10.12307/2024.081

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

非解剖复位下股骨颈系统内固定治疗股骨颈骨折的有限元分析

贾继斋1，殷贵鲲2，谢  辉1，傅维民1，韩  顺1，马英杰1，温  准2，王本杰1   

  1. 1大连大学附属中山医院骨科，辽宁省大连市   116001；2庄河市中心医院骨科，辽宁省大连市   116400
  • 收稿日期:2023-04-18 接受日期:2023-06-10 出版日期:2024-07-28 发布日期:2023-09-27
  • 通讯作者: 温准，硕士，主任医师，庄河市中心医院骨科，辽宁省大连市 116400 王本杰，博士，主任医师，大连大学附属中山医院骨科，辽宁省大连市 116001
  • 作者简介:贾继斋，男，1996年生，河南省濮阳市人，汉族，大连大学附属中山医院在读硕士，主要从事关节外科方面的研究。
  • 基金资助:
    大连市科技创新基金项目(2019J13SN95)，项目负责人：王本杰

Finite element analysis of femoral neck fracture treated by internal fixation of femoral neck system under nonanatomical reduction

Jia Jizhai1, Yin Guikun2, Xie Hui1, Fu Weimin1, Han Shun1, Ma Yingjie1, Wen Zhun2, Wang Benjie1   

  1. 1Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian 116001, Liaoning Province, China; 2Department of Orthopedics, Zhuanghe Central Hospital, Dalian 116400, Liaoning Province, China
  • Received:2023-04-18 Accepted:2023-06-10 Online:2024-07-28 Published:2023-09-27
  • Contact: Wen Zhun, Master, Chief physician, Department of Orthopedics, Zhuanghe Central Hospital, Dalian 116400, Liaoning Province, China Wang Benjie, MD, Chief physician, Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian 116001, Liaoning Province, China
  • About author:Jia Jizhai, Master candidate, Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian 116001, Liaoning Province, China
  • Supported by:
    Science and Technology Innovation Fund Project of Dalian, No. 2019J13SN95 (to WBJ)

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摘要：


文题释义：

非解剖复位：骨折断端未完全对位对线。股骨颈远端骨折块位于近端骨折块下内侧缘的内下方，即骨折近端较解剖复位稍上移，称之为阳性支撑；相反，股骨颈骨折近端较解剖复位稍下移为阴性支撑。
Pauwels分型：股骨颈骨折线与经过股骨头上方水平线的夹角为Pauwels角。根据该角度将股骨颈骨折分为3种类型：Ⅰ型< 30°，Ⅱ型30°-50°，Ⅲ型> 50°。Pauwels角越大，骨折线就越接近垂直方向，骨折越不稳定。


背景：难复性股骨颈骨折很难获得解剖复位，作为一种新型内固定装置，目前关于股骨颈系统内固定治疗非解剖复位的股骨颈骨折尚是空白。

目的：运用有限元分析方法，探讨股骨颈系统内固定治疗未能获得解剖复位的股骨颈骨折的生物力学稳定性。
方法：收集一名健康女性成年人的髋关节CT数据，利用Mimics 21.0、Geomagic Wrap 2021和SolidWorks 2020制作Pauwels角分别为30°，50°和70°的解剖复位股骨颈骨折模型，将以上3个解剖复位模型的骨折近端沿骨折线向上移位2 mm，得到3个不同Pauwels角的阳性支撑模型；相反，得到3个阴性支撑模型。使用SolidWorks 2020制作股骨颈系统内固定，并与以上9个模型装配。使用Ansys 19.0软件进行有限元分析，记录2 100 N应力下股骨和股骨颈系统的位移分布和最大位移、应力分布和最大应力。

结果与结论：①Pauwels角为30°，50°，70°时，股骨颈系统最大应力均集中在螺栓与抗旋螺钉交界处，股骨最大应力集中在股骨内侧皮质，最大位移均分布于股骨头上部和股骨颈系统顶端；②Pauwels角为30°，50°时，股骨颈系统和股骨的最大位移和最大应力情况均为阴性支撑>解剖复位>阳性支撑；③Pauwels角为70°时，股骨颈系统的最大位移和最大应力情况为阴性支撑>解剖复位>阳性支撑；股骨的最大位移和最大应力情况为阴性支撑>阳性支撑>解剖复位；④随着Pauwels角的增大，阳性支撑的生物力学优势在减弱，但均优于阴性支撑；当Pauwels角为30°时，阳性支撑比解剖复位更稳定；当Pauwels角为50°时，阳性支撑与解剖复位的生物力学差异变得更小；当Pauwels角为70°时，解剖复位的稳定性略优于阳性支撑；⑤提示股骨颈骨折在术中若难以达到解剖复位，但已实现移位2 mm以内的阳性支撑，应用股骨颈系统内固定可以得到稳定的力学固定，但是需要避免阴性支撑复位。

https://orcid.org/0000-0006-2204-6503 (贾继斋) 

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: 股骨颈骨折, 股骨颈系统, 内固定, 非解剖复位, 阳性支撑, 有限元分析

Abstract: BACKGROUND: Irreducible femoral neck fracture was difficult to obtain anatomic reduction. As a new type of internal fixation, the femoral neck system is still blank for the treatment of non-anatomical reduced femoral neck fractures.
OBJECTIVE: To explore the biomechanical stability of femoral neck system internal fixation under nonanatomical reduction in the treatment of femoral neck fractures based on finite element analysis.
METHODS: CT data of the hip joint of a healthy female adult were obtained. Anatomical reduction of femoral neck fracture models with Pauwels angles of 30°, 50°, and 70° were established using Mimics 21.0, Geomagic Wrap 2021, and SolidWorks 2020. The fracture proximal ends of the three anatomical reduction models were shifted upward by 2 mm along the fracture line, and three positive buttress models with different Pauwels angles were obtained. In the same way, three negative buttress models were acquired by shifting downward by 2 mm. SolidWorks 2020 was used to make the femoral neck system internal fixation, and the nine femoral neck fracture models were assembled with the femoral neck system. Then Ansys 19.0 was used for finite element analysis. The displacement distribution and maximum displacement, stress distribution and maximum stress of the femur and femoral neck system were recorded under 2 100 N stress. 
RESULTS AND CONCLUSION: (1) When Pauwels angles were 30°, 50°, and 70°, the maximum stresses of the femoral neck system appeared to be concentrated at the junction of the sliding hip screw and anti-rotation screw. The maximum femur stresses appeared to be concentrated in the medial cortex of the femur. The maximum displacement was concentrated at the upper of the femoral head and femoral neck system. (2) When Pauwels angles were 30° and 50°, the maximum displacement and maximum stress of the femoral neck system and femur were: negative buttress > anatomical reduction > positive buttress. (3) When Pauwels angle was 70°, the maximum displacement and maximum stress of the femoral neck system were: negative buttress > anatomical reduction > positive buttress; the maximum displacement and maximum stress of the femur were: negative buttress > positive buttress > anatomical reduction. (4) With the increase of Pauwels angle, the biomechanical advantage of the positive buttress was weakening. However, it was better than a negative buttress. When Pauwels angle was 30°, positive buttress was more stable than anatomical reduction. When Pauwels angle was 50°, the biomechanical difference between positive buttress and anatomical reduction became smaller. When Pauwels angle was 70°, the stability of anatomical reduction was slightly better than positive buttress. (5) If it was difficult to achieve anatomical reduction of femoral neck fracture during operation, but the positive buttress had been displaced within 2 mm, the femoral neck system could be used to offer stable mechanical fixation. It is necessary to avoid negative buttress reduction. 

Key words: femoral neck fracture, femoral neck system, internal fixation, nonanatomical reduction, positive buttress, finite element analysis

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