空心钉联合同种异体腓骨内固定治疗中青年股骨颈骨折生物力学分析
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1.广州中医药大学第一临床医学院;2.广州中医药大学第一附属医院;3.广州中医药大学针灸康复临床医学院

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国家自然科学基金(81774339);广东省自然科学(2015A030310203);广州中医药大学第一附属医院青年科研人才培优项目(2015QN01)


Biomechanical Study of Young and Middle-aged Femoral Neck Fractures with Modified Operation Method of Intramedullary Fibular Allograft together with Cannulated Screw Fixation
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1.The First Clinical Medical College, Guangzhou University of Traditional Chinese Medicine;2.The first affiliated hospital of guangzhou university of Chinese medicine;3.Clinical Medical College of Acupuncture, Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine;4.The first clinical medical college of Guangzhou University of Chinese Medicine

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    摘要:

    目的:采用生物力学分析方法,比较空心钉联合同种异体腓骨内固定(以下称:改良术式)和单纯行空心钉内固定术(以下称:传统术式)在治疗中青年PauwelsⅠ、Ⅱ、Ⅲ型股骨颈骨折中力学稳定性的优劣。方法:运用Mimics10.01基于CT资料建立空心钉(3S)固定及改良术式(SFS)固定的PauwelsⅠ、Ⅱ、Ⅲ型股骨颈骨折模型,并对模型股骨头皮质骨壳负重区、植入体顶部、股骨近端冠状位、股骨颈骨折端进行应力分析;对股骨头皮质骨壳3个不同方向(S23、S13、S12)、股骨颈骨折面3个不同方向(S23、S13、S12)应力分布情况进行分析,并根据预测数据绘制股骨冠状位最大主应变云图、反作用力施加位置位移折线图进行分析。结果:根据皮质骨壳负重区应力分布情况,股骨颈骨内固定治疗后与正常情况分布差异不大。根据股骨近端冠状位应力分布模式图,PauwelsⅠ型SFS与3S时主应力模式基本上仍是从股骨头负重区传导到股骨矩处,而Ⅱ型SFS、 Ⅱ型3S、Ⅲ型SFS、Ⅲ型3S同时在植入体与骨折面交界出现应力集中现象。采用SFS内固定治疗的各骨折角度的股骨颈骨折,其股骨头皮质骨壳和股骨颈骨折面S12、S13、S23方向剪应力分布均显示采用SFS优于或相近于采用3S。Ⅲ型3S与Ⅱ型3S的反作用力施加位置大于采用SFS的股骨颈骨折,其中Ⅱ型3S的反作用力施加位置位移明显大于Ⅱ型SFS;而在Ⅰ型股骨颈骨折时,SFS反作用力施加位置位移显著大于3S。结论:改良术式(SFS)相对适用于大角度(Ⅱ、Ⅲ型)的中青年股骨颈骨折,而传统术式(3S)则适用于小角度(Ⅰ型)的中青年股骨颈骨折。

    Abstract:

    Objective: Basedon biomechanical characteristics, comparison of mechanical stability between Intramedullary Fibular Allograft together with Cannulated Screw Fixation(Modified Operation Method) and Cannulated Screw Fixation Alone(Conventional SurgeryMethod) in the treatment of young and middle-aged Pauwels Ⅰ, Ⅱ, Ⅲ type.Method:Construction of Pauwels Ⅰ, Ⅱ, Ⅲ femoral neck fracture model with treatment of conventional surgery method(3S) and modified operation method(SFS) by using Mimics10.01 based on CT data; Stress analysis among the weight-bearing area of the femoral cortical bone shell, the top of the implant, the proximal femoral crown, and the end of femoral neck fracture.Stress distribution of 3 different directions of the cortical bone shell of the femoral head and femoral neck fracture surface was analyzed, the maximum principal strain cloud map of the coronal position of femur and the line graph of displacement reaction forcing position were drawn according to predicted data. Result: The stress distributionin cortical bone-shell bearing region showed that internal fixation of femoral neck was not different from that of normal condition. According to stress distribution pattern of the femoral proximal coronary, Pauwels Ⅰ SFS and 3S principal stress pattern remains still basically transmits from the weight-bearing region of the femoral head to the femoral moment,while Ⅱ SFS, Ⅱ 3S, Ⅲ SFS, Ⅲ 3S appear stress concentration phenomenon at the border of implants and fracture surface. And the shear stress distribution in the three directions(S12,S13,S23)on the cortical bone shell of the femoral head and the fracture surface of the femoral neck showed that femoral neck fractures treated with SFS internal fixation was superior to or similar to 3S. The displacement of 3SⅢ and 3SⅡ were greater than femoral neck fracture with SFS, especially 3SⅡ. But Pauwels Ⅰshowed the opposite results on the displacement that reaction forces apply position.Conclusion: Modified operation method (SFS) is more suitable for large angle in femoral neck fracture (Ⅱ and Ⅲ);by contrast, Pauwels Ⅰ is more inclined to useconventional surgery.

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  • 收稿日期:2018-10-16
  • 最后修改日期:2019-02-18
  • 录用日期:2019-02-19
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