Finite element analysis to verify the rationality of bone
cement combined with plate internal fixation for benign proximal femoral
lesions

doi:10.3969/j.issn.2095-4344.2632

Abstract

Abstract:

BACKGROUND: For the patients with benign osteopathy, the patients usually get a good life cycle after surgical treatment. Through continuous improvement of the operation mode, the stress of the proximal femur after the operation of benign osteopathy is studied by using the finite element analysis. The risk of pathological fracture and secondary fracture is predicted and reduced. To explore the best operation and prognosis is of great significance for prolonging and improving the quality of life of patients.

OBJECTIVE: Three-dimensional finite element technique was used to analyze the different surgical models of benign proximal femoral lesions. The differences of different surgical models were compared and the rationality and effectiveness of internal fixation were verified. The reliability of the finite element model was verified in the follow-up of patients after operation.

METHODS: Preoperative CT examination was conducted in 10 patients with benign proximal femoral lesions who met the inclusion criteria. Three models of limbs scraping (group A), cavity internal nail re-infusion bone cement (group B) and intracavitary bone cement joint plate screw (group C) were established by MIMICS. The maximum stress values of the left and right side windows of the cortical model of group A, B and C were measured under simulated conditions, and the stress values of the three groups were compared. All patients signed the informed consent. This study was approved by the Hospital Ethics Committee.

RESULTS AND CONCLUSION: (1) The comparison of the maximum stress values of the anterior and posterior sides of the cortical fenestration in the three groups of models was group A > group B > group C (P < 0.05). The risk of fracture was high in group A, and the risk of fracture in group B was large. The stress in group C was controlled within a reasonable range, and the risk of fracture was low. (2) Therefore, 10 subjects underwent the treatment in group C. The prognosis was good and there were no secondary fractures. The Musculoskeletal Tumor Society score was 27-30 points 1 year after surgery. (3) The model stress is prone to increase the local stress after opening the window. After adding bone cement and steel plate, the stress value of the model window is significantly reduced. After the benign lesions of the proximal femur are scraped, the stress of the fenestration can be effectively reduced by placing the bone cement and the steel plate, and the fracture probability at the surgical site is significantly reduced. Steel plate placement is reasonable.

Key words: proximal femur, benign lesion, finite element, tumor, internal fixation, steel plate, bone defect

CLC Number:

Yang Zhaoxin, Niu Mengye, Lü Jiaxing, Cao Haiying, Kong Lingwei, Zhao Jingxin, Jin Yu. Finite element analysis to verify the rationality of bone cement combined with plate internal fixation for benign proximal femoral lesions[J]. Chinese Journal of Tissue Engineering Research, 2020, 24(15): 2368-2373.

Figures/Tables 8

References

[1] TAKEUCHI A, SUWANPRAMOTE P, YAMAMOTO N, et al. Mid- to long-term clinical outcome of giant cell tumor of bone treated with calcium phosphate cement following thorough curettage and phenolization. J Surg Oncol. 2018;117: 1232-1238.
[2] 郭卫,李建民,沈靖南,等.骨巨细胞瘤临床循证诊疗指南[J].中华骨与关节外科杂志,2018,11(4):276-287.
[3] 付鑫,马信龙,马剑雄,等.应用三维有限元分析正常站立位股骨近端结构生物力学特性[J].中国组织工程研究与临床康复,2009, 13(52):10241-10246.
[4] CANALE ST, BEATY JH, 原著.坎贝尔骨科手术学[M] 11版. 北京:人民军医出版社,2009:937.
[5] DUCHEMIN L, BOUSSON V, RAOSSANALY C, et al. Prediction of mechanical properties of cortical bone by quantitative computed tomography. Med Eng Phys. 2008; 30(3):321-328.
[6] ANDERSON DD, GOLDSWORTHY JK, SHIVANNA K, et al. Intra-articular contact stress distributions at the ankle throughout stance phase-patient-specific finite element analysis as a metric of degeneration propensity. Biomech Model Mechanobiol. 2006;5(2-3):82-89.
[7] CORAZZA F, O’CONNOR JJ, LEARDINI A, et al. Ligament fibre recruitment and forces for the anterior drawer test at the human ankle joint. J Biomech. 2003;36(3):363-372.
[8] REILLY DT, BURSTEIN AH. The elastic and ultimate properties of compact bone tissue. J Biomech. 1975;8:393.
[9] ENNEKING WF, DUNHAM W, GEBHARDT MC, et al. A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res.1993;286: 241-246.
[10] NAWATHE S, NGUYEN BP, BARZANIAN N, et al. Cortical and trabecular load sharing in the human femoral neck. J Biomech. 2015;48(5): 816-822.
[11] 杨正明,陶惠民,杨迪生,等.邻膝关节骨巨细胞瘤外科治疗的选择[J].中华外科杂志,2006,44(24):1693-1698.
[12] 杨迪生,严世贵.病损内处置与整块切除治疗邻膝关节骨巨细胞瘤的比较观察[J].中国矫形外科杂志,1999,6(8):5-7.
[13] 童小鹏,何洪波,刘擎,等.扩大刮除并骨水泥填充治疗骨巨细胞瘤的临床诊疗分析[J].实用骨科杂志,2019,25(2):123-126+130.
[14] Riidei TP, Burkley RE, Moran CG. 骨折治疗的AO原则[M].上海:上海科学技术出版社,2010:176-188.
[15] FRAQUET N, FAIZON G, ROSSET P, et al. Long bones giant cells tumors: treatment by curretage and cavity filling cementation. Orthop Traumatol Surg Res.2009;95:402-406.
[16] PAUWELS F. Biomechanics of the Locomotor Apparatus.1st ed. Berlin Heidelberg New York: SpringerVerlag,1980.
[17] HAIDER IT, GOLDAK J, FREI H. Femoral fracture load and fracture pattern is accurately predicted using a gradient-enhanced quasi-brittle finite element model. Med Eng Phys. 2018;55:1-8.
[18] 张海波.股骨近段骨缺损的三维有限元模型的建立及相关生物力学研究[D].成都:四川大学,2007.