北京生物醫(yī)學(xué)工程

股骨近端骨缺損在內(nèi)固定術(shù)后的生物力學(xué)特征分析

Analysis of biomechanical characteristics of proximal femoral bone defects after internal fixation

作者：邱俊駿顧延慶王強

單位：南京醫(yī)科大學(xué)附屬南京醫(yī)院（南京市第一醫(yī)院）骨科（南京 210006） 通信作者：邱俊駿。E-mail：[email protected]

關(guān)鍵詞：股骨近端；內(nèi)固定術(shù)后；生物力學(xué)；有限元

分類號：R318.01

出版年·卷·期（頁碼）：2021·40·5（526-529）

摘要：

目的探討股骨頭近端骨缺損在內(nèi)固定術(shù)后的生物力學(xué)情況。方法選擇正常志愿者1例以及股骨近端骨缺損內(nèi)固定術(shù)后患者1例進行股骨近端有限元模型的建構(gòu)。在MIMICS這一軟件中輸入DICOM數(shù)據(jù)進行截骨模擬，建立70°PAUWELLS角且骨缺損體積不等的股骨頸骨折模型。在模型與空心釘完成裝配之后，于ABAQUS軟件中進行導(dǎo)入，執(zhí)行約束與加載操作。結(jié)果股骨頸外上方和下方的最大應(yīng)力是18.9 MPa和24.2 MPa，應(yīng)力集中分布在股骨頸中段。股骨頭的應(yīng)力峰值最大，股骨頸上方次之，而下方空心釘所受到的應(yīng)力峰值最低。隨著股骨頸下后方骨缺損體積的増大，股骨頸上方兩枚空心螺釘所承受的最大拉伸應(yīng)力值變大，該最大拉伸應(yīng)力出現(xiàn)于骨折斷端位置，且股骨頭最大應(yīng)力范圍向外移動，非主要負(fù)重區(qū)出現(xiàn)高壓強區(qū)。結(jié)論股骨頸近端骨缺損固定術(shù)中，在股骨頸下方置釘?shù)墓潭ǚ绞铰葆斪冃螖嗔迅怕首钚。瑢晒穷i下后方骨缺損體積患者來說倒三角置釘固定方式可為骨折處能提供良好的力學(xué)環(huán)境。

Objective To analyze the biomechanical situation of the proximal femoral head bone defect after internal fixation,. Methods The finite element model of proximal femur was constructed in one normal volunteer and one patient after internal fixation of proximal femur bone defect. Dicom data were input into the Mimics software for osteotomy simulation to establish a femoral neck fracture model with 70° Pauwells angle and different bone defect volumes. After the assembly of the model and the hollow nail was completed, import it into the software ABAQUS to perform constraint and loading operations. Results The maximum stresses above and below the bone neck were 18.9 MPa and 24.2 MPa, and the stress was concentrated in the middle of the femoral neck. The peak stress of the femoral head was the largest, followed by the lower part of the femoral neck, and the lower hollow nail had the lowest peak stress.. With the femoral neck rear bone defect under the rights of large volume, the femoral neck above two hollow screw on the maximum tensile stress, the maximum tensile should appear in the position of fracture end, with the increase of femoral neck under the rear defects of bone volume, femoral head move outward at the maximum stress range, the main load-bearing section appears strong high pressure area. Conclusions In the fixation of bone defect at the proximal femoral neck, screw deformation and fracture rate are the least when screws are inserted at the lower part of the femoral neck. For patients with bone defect volume at the lower part of the femoral neck, the inverted triangle nail fixation method can provide a good mechanical environment for the fracture site.

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