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
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。
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.
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
Subcapital femoral fracture / Nonanatomic reduction / Positive buttress / Negative buttress / Finite element analysis
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