摘要
背景:股骨转子间骨折后如何重建外侧壁目前尚无统一方法,在股骨转子前外侧放置重建钢板是目前较为常用的方式,但其生物力学、临床适用如何目前鲜有研究。目的:探讨股骨近端防旋髓内钉联合前外侧重建钢板用于不同类型不稳定型股骨转子间骨折的生物力学参数变化。方法:CT扫描1名男性志愿者下肢骨,通过有限元建立股骨三维模型,根据骨折线涉及内侧壁、外侧壁与内外侧壁以及其在侧壁上是否获得稳定支撑,对模型进行分割,建立对应的骨折模型:外侧壁不稳定、内侧壁稳定模型;外侧壁稳定、内侧壁不稳定模型;内外侧壁均不稳定模型,同时进行装配股骨近端防旋髓内钉、前外侧重建钢板,应用普通钉或锁定钉固定,由abaqus进行计算,比较多组模型骨折块、内固定的应力及位移等变化。结果与结论:(1)在3种不稳定型股骨转子模型中,前外侧重建钢板可以提升股骨近端的稳定性,并且在一定程度上恢复股骨近端失衡杠杆。在外侧壁不稳定型、内侧壁不稳定型中,锁定钉优于普通钉;在内外侧壁均不稳定型中,锁定钉与普通钉差异性未能探知。(2)结果说明,前外侧重建钢板的放置可以显著提升不稳定股骨转子间骨折的稳定性,减少退钉以及内固定物的失效可能,并且对恢复股骨近端失衡的杠杆起到一定的作用,锁定钉比普通钉在力学上更佳。
BACKGROUND:At present,there is no unified method to reconstruct the lateral wall after intertrochanteric fractures of femur.It is a common way to place reconstruction plates on the anterolateral side of the femoral intertrochanteric fracture,but there is little research on its biomechanics and clinical application.OBJECTIVE:To investigate the changes in biomechanical parameters of proximal femoral nail anti-rotation combined with anterolateral reconstruction plate for different types of unstable intertrochanteric fractures.METHODS:CT scanning was used to scan the lower limb bone of a male volunteer.A three-dimensional model of the femur was established through the finite element method.According to whether the fracture line involved the medial wall,the lateral wall,the internal and external walls,and whether it was stably supported on the lateral wall,the model was divided to establish the corresponding fracture model:The lateral wall was unstable,and the medial wall was stable.The lateral wall was stable,and the medial wall was unstable.Both the internal and external walls of the model were unstable.Proximal femoral nail anti-rotation and anterolateral reconstruction plates were assembled at the same time.Ordinary nails or locking nails were used for fixation.The stress and displacement of fracture fragments and internal fixation of multiple models were compared and calculated by Abaqus.RESULTS AND CONCLUSION:(1)In the three types of unstable femoral trochanter models,the anterolateral reconstruction plate could improve the stability of the proximal femur,and restore the imbalance lever of the proximal femur to a certain extent.In the unstable type of lateral wall and the unstable type of medial wall,the locking nail is superior to the ordinary nail.In the type of unstable internal and external sidewalls,the difference between the locking nail and the ordinary nail could not be detected.(2)It is concluded that the placement of anterolateral reconstruction plate can significantly improve the stability of unstable
作者
李光晟
林伟民
张申申
林旺
林成寿
Li Guangsheng;Lin Weimin;Zhang Shenshen;Lin Wang;Lin Chengshou(Mindong Hospital Affiliated to Fujian Medical University,Fuan 355000,Fujian Province,China)
出处
《中国组织工程研究》
CAS
北大核心
2023年第36期5753-5759,共7页
Chinese Journal of Tissue Engineering Research
关键词
外侧壁
内侧壁
骨折固定术
有限元分析
前外侧重建钢板
不稳定股骨转子间骨折
股骨近端防旋髓内钉
杠杆-支点平衡
lateral wall
medial wall
fracture fixation
finite element analysis
anterolateral reconstruction plate
unstable intertrochanteric fracture of femur
proximal femoral nail anti-rotation
lever fulcrum balance
