空心螺钉联合同种异体腓骨治疗股骨颈骨折的三维有限元力学研究

Three-dimensional finite element mechanical study of the treatment of femoral neck fracture with cannulated screw combined with fibular allograft

摘要:

目的 探讨空心螺钉联合同种异体腓骨术式治疗股骨颈骨折的生物力学稳定性，为股骨颈骨折临床治疗新方法提供理论依据。方法 采用三维有限元分析方法对空心螺钉联合同种异体腓骨术式治疗股骨颈骨折进行力学分析。基于1位45岁骨盆及股骨正常解剖的男性志愿者的CT数据，应用三维重建、逆向工程、有限元力学分析等技术，建立空心螺钉联合同种异体腓骨和多枚空心螺钉两种术式三维有限元模型，进行力学分析，评估两种术式内固定构型的生物力学稳定性。结果 空心螺钉联合同种异体腓骨术式与多枚空心螺钉术式的股骨头颈部皮质的最大应力和位移及骨组织内部和内固定的最大应力分布位置无明显差异，但空心螺钉联合同种异体腓骨术式的股骨头颈部皮质的最大应力和位移及骨组织内部和内固定的最大应力值均比多枚空心螺钉术式小。结论 空心螺钉联合同种异体腓骨术式固定股骨颈骨折的力学稳定性优于多枚空心螺钉术式，能够为股骨颈骨折愈合提供良好的力学稳定性，在股骨头发生坏死后腓骨亦可以提供力学支撑，预防股骨头塌陷，为较理想的股骨颈骨折治疗术式。

Abstract:

Objective To investigate the biomechanical stability of cannulated screws combined with fibula allograft in the treatment of femoral neck fractures, and to provide theoretical basis for a new clinical treatment method of femoral neck fractures.Methods Three-dimensional finite element analysis was used to analyze the mechanical properties of cannulated screws combined with fibula allograft in the treatment of femoral neck fractures. Based on the CT data of a 45-year-old male volunteer with normal anatomy of the pelvis and femur, three-dimensional reconstruction, reverse engineering, finite element mechanical analysis and other techniques were used to establish three-dimensional finite element models of the surgical methods of cannulated screws combined with fibula allograft and multiple cannulated screws for mechanical analysis, and the biomechanical stability of the two internal fixation configurations was evaluated.Results There was no significant difference in the distribution in the maximum stress and displacement of the femoral head and neck cortex and the maximum stress within the bone tissue and internal fixation between the cannulated screws combined with fibular allograft and multiple cannulated screws operation. However, the maximum stress and displacement of the femoral head neck cortex and the maximum stress of the bone and internal fixation in the cannulated screw combined with fibular allograft group were significantly lower than those in the multiple cannulated screw group.Conclusion The mechanical stability of cannulated screws combined with fibular allograft is better than that of multiple cannulated screws, which can provide good mechanical stability for the healing of femoral neck fracture, and provide mechanical support after the femoral head necrosis, to prevent the collapse of the femoral head. It is an ideal surgical method for the treatment of femoral neck fractures.