两种非解剖复位内固定Pauwels Ⅲ型头下型股骨颈骨折的有限元分析

doi:10.13418/j.issn.1001-165x.2017.06.015

中国临床解剖学杂志 ›› 2017, Vol. 35 ›› Issue (6): 665-670.doi: 10.13418/j.issn.1001-165x.2017.06.015

两种非解剖复位内固定Pauwels Ⅲ型头下型股骨颈骨折的有限元分析

郑翔¹，　许锦煌¹，　黄建荣²

1.广州市增城区人民医院骨科，广州 510300； 2.中山大学孙逸仙纪念医院，广州 510120

收稿日期:2017-06-19 出版日期:2017-11-25 发布日期:2017-12-30
通讯作者: 黄建荣，副主任医师，硕士生导师，E-mail：guke16@163.com
作者简介:郑翔（1989-），男，陕西安康人，骨科医师，研究方向：创伤骨科、数字骨科，E-mail:zhengxiangup@126.com

Finite element analysis of two nonanatomic reductions of Pauwels Ⅲ subcapital femoral fractures fixation

ZHENG Xiang¹, XU Jin-huang¹, HUANG jian-rong²

1. Department of Orthopedic , Zengcheng District People’s Hospital of Guangzhou , Guangzhou 510010, China；2. Department of orthopedic , Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, China

Received:2017-06-19 Online:2017-11-25 Published:2017-12-30

摘要/Abstract

摘要：

目的　通过三维有限元法对“阳性支撑”和“阴性支撑”两种非解剖复位内固定Pauwels Ⅲ型头下型股骨颈骨折进行生物力学比较，并为临床应用提供理论参考。方法　将25岁男性青年健康股骨CT数据及PH螺钉数据导入相关软件，分别建立Pauwels Ⅲ型头下型股骨颈骨折的“阳性支撑”和“阴性支撑”两种非解剖复位三维模型，再通过PH螺钉系统行内固定。应用有限元分析法在相同加载和约束条件下模拟“单腿站立”、“行走”两种工况。评价和比较“阳性支撑”组和“阴性支撑”组骨折端最大位移、股骨最大应变、内固定最大应力等指标。结果　在两种工况下，骨折端最大位移“阳性支撑”组和“阴性支撑”组在“单腿站立”、“行走”两种工况下分别为0.87 mm和1.38 mm, 股骨最大应变分别为1.27 mm和1.98 mm, 1.77e-2 和 2.47e-2, 1.89e-2 和 2.12e-2, 内固定最大应力分别为304.47 Mpa和359.03 Mpa, 362.24 Mpa和391.52 Mpa。结论　本研究通过有限元分析方法证实了Yechiel Gotfried复位理论适用于Pauwels Ⅲ型头下型股骨颈骨折该型骨折，“阳性支撑”复位较“阴性支撑”复位具有生物力学优势。

关键词: 头下型股骨颈骨折, 　非解剖复位, 　阳性支撑, 　阴性支撑, 　有限元分析

Abstract:

Objective　To explore and compare the biomechanical properties of two nonanatomic reductions of Pauwels Ⅲ subcapital femoral fractures fixation using finite element analysis, therefore to provide theoretic reference for clinic application.　Methods　Using a CT scan from a 25-year-old healthy male femur and the measuring data of a PH Nail (Physiological Hip Nail) and screws, positive buttress reduction and negative buttress reduction models of Pauwels Ⅲ subcapital femoral fracture fixation were developed using finite element soft wares. The maximum displacement of the fracture sites, the maximum Von Mises strain on femur, the maximum von Mises stress on implants were compared under two loading conditions simulating “stance” and “walking” respectively. 　Results　The maximum displacement of the fracture sites of two models under “stance” and “walking” conditions were 0.87 mm and 1.38 mm, 1.27 mm and 1.98 mm, respectively. The maximum Von Mises strains on femur were 1.77e-2 and 2.47e-2, 1.89e-2 and 2.12e-2, respectively. The maximum von Mises stresses on implants were 304.47 Mpa and 359.03 Mpa, 362.24 Mpa and 391.52 Mpa, respectively. Conclusions The reduction of positive buttress has better biomechanical properties than negative buttress under the same loading conditions for Pauwels Ⅲ subcapital femoral fracture fixation. Results of this study support the Yechiel Gotfried theory for Pauwels Ⅲ subcapital femoral fracture fixation from a biomechanical perspective.

Key words: Subcapital femoral fracture, 　Nonanatomic reduction, 　Positive buttress, 　Negative buttress, 　Finite element analysis

郑翔,许锦煌,黄建荣. 两种非解剖复位内固定Pauwels Ⅲ型头下型股骨颈骨折的有限元分析[J]. 中国临床解剖学杂志, 2017, 35(6): 665-670.

ZHENG Xiang, XU Jin-huang, HUANG jian-rong. Finite element analysis of two nonanatomic reductions of Pauwels Ⅲ subcapital femoral fractures fixation[J]. Chinese Journal Of Clinical Anatomy, 2017, 35(6): 665-670.

参考文献

[1] Hawks MA, Kim H, Strauss J, et al. Does a trochanteric lag screw improve fixation of vertically oriented femoral neck fractures A biomechanical analysis in cadaveric bone [J]. Clin Biomech, 2013, 28(8): 886-891.
[2] Mittal R, Banerjee S. Proximal femoral fractures: Principles of management and review of literature[J]. J Clin Orthop Trauma, 2012, 3 (1):15-23.
[3] van Vust AB. Femoral neck non-unions: How do l do it [J] ? Injury, 2007, 38 (Suppl 2): S51-54.
[4] Stacey SC, Renninger CH, Hak D, et al. Tips and tricks for ORIF of displaced femoral neck fractures in the young adult patient[J]. Eur J Orthop Surg Traumatol, 2016, 26(4):355-363.
[5] Nagi ON，Dhillon MS. Management of neglected/uninvited fractures of the femoral neck in young adults[J]. Current Orthopedics, 2003,17(5):394-402.
[6] Ehlinger M, Moser T, Adam P, et al. Early prediction of femoral head avascular necrosis following neck fracture[J]. Orthop Traumatol Surg Res, 2011,97(1):79-88.
[7] Gotfried Y. The Gotfried (Nonanatomic, Closed) Reduction of Unstable Subcapital Femoral Fractures[J]. Techniques in Orthopaedics, 2014, 29(4):194-96
[8] Gotfried Y, Kovalenko S, Fuchs D. Nonanatomical reduction of displaced subcapital femoral fractures (Gotfried reduction) [J]. J Orthop Trauma, 2013, 27(11): e254-e259.
[9] 樊黎霞, 丁光兴, 费王华, 等. 基于CT图像的长管骨有限元材料属性研究及实验验证[J]. 医用生物力学, 2012, 28(1):102-108.
[10]Tupis TM, Altman GT, Altman DT, et al. Femoral bone strains during antegrade nailing: A comparison of two entry points with identical nails using finite element analysis[J]. Clin Biomech, 2012, 27(4): 354-359.
[11]Saqib N, Cerianne P, Tim F, et al. Finite element analysis modelling of proximal femoral fractures, including post-fixation periprosthetic fractures[J]. Injury, 2013, 44 (6):791-795.
[12] Mahaisavariya B, Sitthiseripratip K, Suwanprateeb J. Finite element study of the proximal femur with retained trochanteric gamma nail and after removal of nail. [J]. Injury, 2006, 37 (8):778-785.
[13]Mei J, Liu S, Jia G, et al. Finite element analysis of the effect of cannulated screw placement and drilling frequency on femoral neck fracture fixation[J]. Injury, 2014, 45(12):342-348.
[14]Chen DW, Lin C, Hu C, et al. Finite element analysis of different repair methods of Vancouver B1 periprosthetic fractures after total hip arthroplasty[J]. Injury, 2012, 43(7): 1061-65.
[15]Sim E, Freimuller W, Reiter TJ. Finite element analysis of the stress distributions in the proximal end of the femur after stabilization of a pertrochanteric model fracture: a comparison of two implants[J]. Injury, 1995, 26(7): 445-449.
[16]Sabalic S, Kodvanj J, Pavic A. Comparative study of three models of extra-articular distal humerus fracture osteosynthesis using the finite element method on an osteoporotic computational model[J]. Injury, 2013, 44 (Suppl 3): S56-S61.
[17]Hambli R, Lespessailles E, Benhamou C. Integrated remodeling-to-fracture finite element model of human proximal femur behavior[J]. J Mech Behav Biomed Mater, 2013, 17(1): 89-106.
[18]Disegi JA, Eschbach L. Strainless steel in bone surgery[J]. Injury, 2004, 31(Suppl 4): D2-6.

两种非解剖复位内固定Pauwels Ⅲ型头下型股骨颈骨折的有限元分析

Finite element analysis of two nonanatomic reductions of Pauwels Ⅲ subcapital femoral fractures fixation

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

Metrics

本文评价

推荐阅读 0

[1]	张悦, 蔡兴博, 张必欢, 王斌, 徐永清. 全腕关节置换术后腕关节生物力学研究进展[J]. 中国临床解剖学杂志, 2024, 42(1): 112-114.
[2]	李笑予, 张磊, 付磊, 李东波, 汪国友. 三步接骨法治疗Sanders Ⅱ型跟骨骨折的有限元研究[J]. 中国临床解剖学杂志, 2024, 42(1): 65-70.
[3]	洪丽婷, 孟庆国, 吴建辉, 徐凌雁, 高润泽, 翟丽东. 突入膀胱不同形态的前列腺增生的有限元分析[J]. 中国临床解剖学杂志, 2023, 41(4): 459-464.
[4]	林文杰, 孙欣, 黄文华, 魏波, 林涛, 梁振明, 钟环, 张欣, 欧阳汉斌. 踝关节融合术后后足关节生物力学分析[J]. 中国临床解剖学杂志, 2023, 41(2): 212-217.
[5]	蔡昊, 周海波, 虞嘉欢, 胡凯, 孟洪明, 寿泽榆, 陈春, 白植标, . 空心螺钉联合“8”、“0”张力带钢丝内固定治疗髌骨横行骨折模型的有限元分析与比较[J]. 中国临床解剖学杂志, 2022, 40(4): 454-459.
[6]	仝铃, 许阳阳, 王一丹, 马渊, 王海燕, 李筱贺. 颈椎前路微型记忆加压合金板的有限元分析[J]. 中国临床解剖学杂志, 2022, 40(3): 320-326.
[7]	魏明杰, 许育健, 吴一芃, 王腾, 吴欢, 袁礼波, 唐文宝, 郭孝菊, 徐永清. 手腕部不同载荷状态下舟月骨间韧带应力分布分析[J]. 中国临床解剖学杂志, 2021, 39(5): 586-592.
[8]	吴晓薇, 李鉴轶, 杜冰冉, 杨巧华, 范天成, 李路韬. 轻度青少年特发性脊柱侧凸有限元模型构建及分析[J]. 中国临床解剖学杂志, 2021, 39(4): 443-448.
[9]	张旭林, 徐永清, 何晓清, 毛羽驰, 杨龄坚, 袁礼波. 手舟骨腰部骨折3种内固定方式的有限元分析[J]. 中国临床解剖学杂志, 2019, 37(5): 553-558.
[10]	张宝成, 蔡贤华, 刘海波, 王志华, 徐峰, 康辉, 丁然. 两种改良Goel技术治疗颅底凹陷症稳定性的有限元分析[J]. 中国临床解剖学杂志, 2019, 37(3): 304-310.
[11]	康永强, 　芮永军 . 2~5掌指关节屈伸活动中关节面应力分布的有限元分析[J]. 中国临床解剖学杂志, 2019, 37(3): 299-303.
[12]	吴耿,张振伟,张美超,李征. 钢板骨折区增加螺钉帽对胫骨骨折内固定影响的有限元分析[J]. 中国临床解剖学杂志, 2019, 37(2): 185-189.
[13]	凌钦杰,林晖,谢普生,邓羽平,黄文华. 全腰椎非线性有限元模型的建立与有效性验证[J]. 中国临床解剖学杂志, 2018, 36(6): 662-667.
[14]	邱卫华,李鉴轶,林荔军 . 全髋关节置换术中臼杯水平位移对股骨侧非骨水泥型假体-骨界面应力影响的有限元分析[J]. 中国临床解剖学杂志, 2018, 36(5): 557-564.
[15]	张永强,章莹,夏远军,谢会斌,代元元,陈泽鹏. 髋臼部T形骨折四种不同内固定方式的生物力学有限元分析[J]. 中国临床解剖学杂志, 2017, 35(3): 312-317.