| 动力髋联合空心钉与动力髋联合内侧板治疗Pauwels Ⅲ型股骨颈骨折的有限元分析比较 |
| Finite element analysis and comparison between dynamic hip combined with cannulated screw and dynamic hip combined with medial femoral plate for Pauwels type Ⅲ femoral neck fracture |
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| DOI： |
| 中文关键词: 力髋螺钉 髋关节 有限元 Pauwels Ⅲ型 股骨颈骨折 |
| 英文关键词:Dynamic hip screw Hip joint Finite element Pauwels type Ⅲ Femoral neck fracture |
| 基金项目: |
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| 通讯作者:何嘉尧1 舒涛1 马季1 黄喆2 刘有玉1* |
| 摘要点击次数: 289 |
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| 中文摘要: |
| 目的 探究动力髋螺钉（DHS）的两种手术方式（DHS 联合空心钉和DHS 联合股骨颈内侧板）治疗Pauwels Ⅲ型股骨颈骨折的生物力学优缺点。方法 建立采用3 种内固定方法治疗Pauwels Ⅲ型股骨颈骨折的有限元模型。分别为单独使用DHS内固定、DHS联合空心钉固定、DHS联合股骨颈内侧板固定，并建立正常股骨模型用于与前3 个模型对比分析。在相同边界及载荷条件下比较以下结果：4 个模型的股骨颈内侧（股骨头下缘至股骨距到小转子的位置）的等效应力分布；3个内固定模型的内固定物的最大等效应力值；4个模型股骨头断端最大位移。结果 股骨颈内侧等效应力分布最接近正常股骨的模型是DHS联合股骨颈内侧板，单纯DHS固定的模型和DHS联合空心钉固定的模型在股骨颈内侧的等效应力集中值大于正常股骨模型，分别为53.57 MPa和26.72 MPa。股骨头骨折断端总位移：单纯DHS固定模型的位移是4.01 mm，DHS联合空心钉固定模型的位移是1.73 mm，DHS联合股骨颈内侧板固定模型的位移是1.68 mm。DHS内固定物最大等效应力由大到小分别是：单独DHS固定为101.07 MPa，DHS联合空心钉固定为38.19 MPa，DHS联合股骨颈内侧板固定为22.69 MPa。结论 DHS联合空心钉与DHS联合内侧板手术方式都优于单独DHS固定的手术方式。DHS联合空心钉固定能在股骨头位移相对较小的情况下维持较高的股骨颈应力，适合于股骨颈内侧相对完整及未出现粉碎骨折的患者；DHS联合内侧板可以更好地重建股骨力线，更适合于股骨颈内侧皮质处有粉碎骨折的患者。 |
| 英文摘要: |
| Objective To explore the biomechanical advantages and disadvantages of two surgical methods for dynamic hip screw(DHS), DHS combined with cannulated screw and DHS combined with medial femoral plate for the treatment of Pauwels type Ⅲ femoral neck fracture. Methods The present study established three finite element models for Pauwels type Ⅲ femoral neck fractures. They were models using DHS internal fixation alone, DHS combined with cannulated screw internal fixation model, and DHS combined with femoral neck medial plate fixation model, and normal femoral model was established for comparative analysis with these three models. Compared the following results under the same boundary and loading conditions: The equivalent stress distribution of the medial femoral neck (inferior border of the femoral head to the calcar femoral to the lesser trochanter) of the four models, the maximum equivalent stress values of the three internal fixation models, maximum displacements of the broken end of the femoral head in four models. Results The model in which the equivalent stress distribution of the femoral neck was closest to that of the normal femur was DHS combined with the femoral neck medial plate. The equivalent stress concentration value in the medial neck of femur of DHS fixation model and DHS combined with cannulated screw fixation model was larger than that of normal femoral neck model, which was 53.57 MPa and 26.72 MPa respectively. The total displacement of the broken end of femoral head fracture was 4.01 mm in the model of DHS fixation alone, 1.73 mm in the model of DHS combined with cannulated screw, and 1.68 mm in the model of DHS combined with internal plate fixation. The maximum equivalent stress of DHS in the three models was 101.07 MPa in the single DHS fixation model, 38.19 MPa in the DHS combined with cannulated screw fixation model, and 22.69 MPa in the DHS combined with plate internal fixation model. Conclusion Both DHS combined with cannulated screw and DHS combined with medial femoral plate surgical methods are superior to that of DHS fixation alone. DHS combined with cannulated screw fixation can maintain high femoral neck stress with relatively little femoral head displacement, and it is suitable for patients with relatively intact medial femoral neck and no comminuted fracture. DHS combined with medial femoral plate can better reconstruct the femoral force line, so it is suitable for patients with comminuted fractures at the medial cortex of the femoral neck. |
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