北京生物医学工程

股骨近端骨缺损在内固定术后的生物力学特征分析

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

作者：邱俊骏顾延庆王强

单位：南京医科大学附属南京医院（南京市第一医院）骨科（南京 210006） 通信作者：邱俊骏。E-mail：arrg516@163.com

分类号：R318.01

出版年·卷·期（页码）：2021·40·5（526-529）

摘要：

目的探讨股骨头近端骨缺损在内固定术后的生物力学情况。方法选择正常志愿者1例以及股骨近端骨缺损内固定术后患者1例进行股骨近端有限元模型的建构。在MIMICS这一软件中输入DICOM数据进行截骨模拟，建立70°PAUWELLS角且骨缺损体积不等的股骨颈骨折模型。在模型与空心钉完成装配之后，于ABAQUS软件中进行导入，执行约束与加载操作。结果股骨颈外上方和下方的最大应力是18.9 MPa和24.2 MPa，应力集中分布在股骨颈中段。股骨头的应力峰值最大，股骨颈上方次之，而下方空心钉所受到的应力峰值最低。随着股骨颈下后方骨缺损体积的増大，股骨颈上方两枚空心螺钉所承受的最大拉伸应力值变大，该最大拉伸应力出现于骨折断端位置，且股骨头最大应力范围向外移动，非主要负重区出现高压强区。结论股骨颈近端骨缺损固定术中，在股骨颈下方置钉的固定方式螺钉变形断裂概率最小，对股骨颈下后方骨缺损体积患者来说倒三角置钉固定方式可为骨折处能提供良好的力学环境。

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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