目的 使用三维有限元分析对股骨远端多维锁定型逆行髓内钉（新型髓内钉）、传统单平面锁定逆行髓内钉（传统髓内钉）和锁定钢板固定股骨远端AO/OTA 33A3型骨折的生物力学性能进行对比分析。 方法 使用Creo 5.0软件建立股骨远端AO/OTA 33A3型骨折模型与内固定3D模型。建立有限元模型，施加相同的边界条件与载荷并提交计算，分析不同模型受力后内固定应力分布情况、股骨整体与局部变形情况，评估了三种内固定治疗股骨远端骨折的稳定性。 结果 （1）垂直载荷工况下，锁定钢板的股骨和内固定最大应力值、股骨整体位移值、骨折端间隙、骨折端成角均远大于传统和新型髓内钉；新型髓内钉的内固定最大应力值大于传统髓内钉，但其股骨应力值、股骨整体位移值、骨折端间隙以及骨折端成角均小于传统髓内钉；（2）在载荷工况下，锁定钢板的内固定最大应力值与新型髓内钉相差不大，但其股骨最大应力值、股骨整体位移值、骨折端间隙以及骨折端成角均远大于传统和新型髓内钉；新型髓内钉的股骨最大应力值以及内固定最大应力值均大于传统髓内钉，但股骨整体位移值、骨折端间隙以及骨折端成角均小于传统髓内钉；（3）扭转载荷工况下，新型髓内钉除股骨最大应力值大于传统逆行髓内钉外，内固定最大应力值、股骨整体扭转位移值均远小于传统髓内钉和锁定钢板。 结论 相较于锁定钢板和传统髓内钉，新型髓内钉在治疗股骨远端AO/OTA 33A3型骨折时，无论在垂直、水平还是扭转载荷下均能够提供更好的稳定性，这为进一步的临床推广应用奠定了理论基础。
Abstract
Objective To compare the biomechanical properties of multi-dimensional locking retrograde intramedullary nail (new nail), traditional single plane locking retrograde intramedullary nail (traditional nail), and locking plate fixation for AO/OTA 33A3 distal femoral fractures using three-dimensional finite element method. Methods Models of AO/OTA 33A3 distal femoral fractures and 3D models of internal fixation devices were established using Creo 5.0 software. Then the finite element models were created and the same boundary conditions and three types of loads were applied for computation. The stress distribution of the internal fixation, as well as the overall and localized deformation of the femur, were analyzed under different loading conditions to evaluate the stability of the three fixation methods for treating distal femoral fractures. Results (1) Under vertical load conditions, the maximum stress values of femur internal fixation, as well as the overall displacement of the femur, interfragmental gap, and fracture angle, were significantly higher than those of traditional and new nails. Although the maximum stress value of the new nail was higher than that of the traditional nail, its femoral stress value, overall femoral displacement, interfragmental gap, and fracture angle were all smaller than those of the traditional nail. (2) Under load conditions, the maximum stress value of internal fixation of the locking plate was not significantly different from that of the new nail. However, its maximum stress value of the femur, overall displacement of the femur, interfragmental gap, and fracture angle were all much greater than those of traditional and new nails. The maximum stress values of the femur and internal fixation of the new nail were both greater than those of the traditional nail, but its overall displacement, interfragmental gap, and fracture angle were all smaller than those of the traditional intramedullary nail. (3) Under torsional load conditions, the new nail had significantly lower maximum stress values for internal fixation and overall torsional displacement of the femur compared with traditional nails and locking plate, except for the maximum stress value of the femur, which is greater than that of traditional nails. Conclusions Compared with the locking plate and traditional nail, the new nail provides better stability in the treatment of AO/OTA 33A3 distal femoral fractures under vertical, horizontal, or rotational loads. This demonstrates certain advantages and lays theoretical foundation for further clinical application and promotion.
关键词
股骨远端骨折 /
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锁定钢板 /
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股骨逆行髓内钉 /
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有限元分析 /
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生物力学
Key words
Distal femoral fracture /
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Locking plate /
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Retrograde femoral nail /
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Finite element analysis /
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Biomechanics
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基金
漳州市自然科学基金项目（ZZ2025JH52）
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