摘要
目的 通过有限元分析比较股骨近端锁定钢板、头干髓内钉+钢板、头干髓内钉+钛缆、重建髓内钉+钢板、重建髓内钉+钛缆固定Seinsheimer Ⅴ型股骨转子下骨折的生物力学特性.方法 采集1名健康成年志愿者左侧股骨CT数据,通过软件构建Seinsheimer Ⅴ型股骨转子下骨折有限元模型及股骨近端锁定钢板、头干髓内钉、重建髓内钉、钢板和钛缆内固定器械模型,完成骨折和内固定装配后比较股骨近端锁定钢板、头干髓内钉+钢板、头干髓内钉+钛缆、重建髓内钉+钢板和重建髓内钉+钛缆模型在生理载荷下骨折块和内固定系统各部件最大位移、最大应力以及对内外侧壁骨折断端应力激发效果的差异.结果 股骨近端锁定钢板、头干髓内钉+钢板、头干髓内钉+钛缆、重建髓内钉+钢板和重建髓内钉+钛缆的最大位移分别为7.9、5.7、4.3、4.3和4.9 mm,内固定系统最大位移分别为7.4、5.8、4.3、4.3和4.9 mm,内固定系统最大扭转角度分别为1.8°、1.5°、1.4°、1.3°、1.5°,最大应力分别为172.0、114.1、115.4、93.5和118.5 MPa,内固定最大应力分别为4 530.0、993.6、1 179.0、890.4和847.2 MPa.股骨近端锁定钢板在内侧壁远端和近端骨折接触面、外侧壁远端和近端骨折接触面的最大接触应力在五种固定方式中最大,分别为48.9、37.9、4.4、18.7 MPa;头干髓内钉+钛缆在上述4个接触面上的最大接触应力分别为16.1、18.1、6.9、11.7 MPa超过了头干髓内钉+钢板的0.0、0.0、5.5、7.5 MPa;重建髓内钉+钛缆在上述4个接触面上的最大接触应力分别为13.7、13.4、6.9、14.1 MPa超过了重建髓内钉+钢板的0.0、0.0、5.6、11.0 MPa.结论 采用重建髓内钉+钛缆的固定方式治疗Seinsheimer Ⅴ型股骨转子下骨折在结构稳定性、耐久性和对骨皮质的应力激发作用方面具有更好的表现.
Abstract
Objective To conduct a comparative analysis of the biomechanical properties of Seinsheimer type Ⅴ subtro-chanteric femoral fractures treated with different fixation methods,including proximal femoral locking plate,Cephalomedullary nail+plate,Cephalomedullary nail+titanium cable,reconstructive intramedullary nail+plate,and reconstructive intramedullary nail+titanium cable,using finite element analysis.Methods CT scan data of the left femur from a healthy adult volunteer was ob-tained and utilized to create a finite element model of Seinsheimer Ⅴ subtrochanteric femoral fracture through software simulation.The construction of femoral proximal locking plates,cephalomedullary nails,reconstructive intramedullary nails,steel plates,and titanium cable internal fixation devices was based on manufacturer-provided product manuals.Following the assembly of fracture and internal fixation components,comparisons were made under physiological loads regarding the maximum displacement,maxi-mum stress,and stress excitation effects on fracture fragments and internal fixation components across the various fixation models.Results The maximum displacements of the femoral proximal locking plate,cephalomedullary nail+plate,cephalomedullary nail+titanium cable,reconstructive intramedullary nail+plate,and reconstructive intramedullary nail+titanium cable were 7.9,5.7,4.3,4.3,and 4.9 mm,respectively.The maximum displacements of the internal fixation systems were 7.4,5.8,4.3,4.3,and 4.9 mm,respectively.The maximum torsion angles of the internal fixation systems were 1.8°,1.5°,1.4°,1.3°,and 1.5°,respectively.The maximum stresses on the fracture fragments of the femoral proximal locking plate were 172.0,114.1,115.4,93.5,and 118.5 MPa,respectively.The maximum stresses on the internal fixation systems were 4,530.0,993.6,1,179.0,890.4,and 847.2 MPa,re-spectively.The maximum contact stress on the contact surfaces of the distal and proximal fracture contact surface of the medial wall,and the distal.and proximal fracture contact surface of the lateral wall of the proximal femoral locking plate was 48.9,37.9,4.4,18.7 MPa,which was the highest among the five fixation methods,respectively.The contact stress of the cephalomedullary nail+titanium cable on contact surfaces mentioned above was 16.1,18.1,6.9,11.7 MPa,exceeding the.0.0,0.0,5.5,7.5 MPa of the cephalomedullary nail+plate.The contact stress of the reconstructive intramedullary nail+titanium cable on contact surfaces mentioned above was 13.7,13.4,6.9,14.1 MPa,exceeding the 0.0,0.0,5.6,11.0 MPa of the reconstructive intramedullary nail+plate as well.Conclusion The utilization of the reconstructive intramedullary nail+titanium cable fixation method for treating Seinsheimer type Ⅴ subtrochanteric femoral fractures demonstrates superior performance in terms of structural stability,durability,and stress stimulation on the bone cortex.
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