摘要
目的:建立外固定与髓内钉联合外固定骨搬移治疗股骨和胫骨骨缺损的术前有限元模型,评估其稳定性及生物力学性能。方法:2022年5月至2022年8月,新疆医科大学第一附属医院骨科中心显微修复外科选取1名男性志愿者,29岁,身高175 cm,体重65 kg,采用64排CT扫描右下肢,数据导入Mimics 21.0软件建立正常的股骨及胫骨几何模型。以此为基础,根据股骨、胫骨行不同固定方式骨搬移,分为股骨外固定架组、股骨髓内钉联合外固定架组、胫骨外固定架组及胫骨髓内钉联合外固定架组等4组。采用Hypermesh 10.0软件进行网格划分,在Ansys v.11软件中进行有限元分析,分别测量2种治疗方式中搬移骨段、胫骨近端及远端和固定装置的等效应力分布及特点。结果:股骨与胫骨髓内钉联合外固定架组中皮质骨与外固定架及螺钉的Von Mises等效应力峰值高于外固定架组,其皮质骨应力降幅分别约为76.9%和77.8%,外固定结构应力降幅分别为81.4%和76.3%。股骨与胫骨髓内钉联合外固定架组中结构位移峰值低于外固定架组,其位移降幅分别约为78.4%和60.1%。结论:股骨、胫骨缺损后行髓内钉联合外固定架骨搬移手术治疗可能具有更佳的生物力学优势,有利于牵张期和矿化期新骨形成和骨盐沉积。
Objective To establish a finite element model for bone transport before surgery in the treatment of femoral and tibial bone defects with external fixation and combined intramedullary nails with external fixations,and evaluate the stability and properties of biomechanics.Methods Between May 2022 and August 2022,a male volunteer in the Department of Trauma and Microreconstructive Surgery,the First Affiliated Hospital of Xinjiang Medical University was selected.The right lower limb was scanned using 64-slice CT.Data were imported into Mimics 21.0 to establish normal geometric models of femur and tibia.The models were arranged in 4 groups:a femoral external fixator group,a femoral external fixator combined with intramedullary nail group,a tibial external fixator group and a tibial external fixator combined with intramedullary nail group.Hypermesh 10.0 was used for meshing.Finite element analysis was performed by Ansys v.11 to measure the distribution and characteristics of equivalent stress in the transported bone segment,proximal and distal tibia,and fixtures in the 2 treatment modalities,respectively.Results Peak Von Mises equivalent stress of cortical bone and external fixation was found higher in both of the femoral and tibial external fixator combined with intramedullary nail groups than that in the external fixator group,with stress reduction on cortical bone at approximately 76.9%and 77.8%,respectively.The stress reduction on external fixator was about 81.4%and 76.3%,respectively.Peak displacement of the structure in both of the femoral and tibial external fixator combined with intramedullary nail groups was lower than that in the external fixator group,with 78.4%and 60.1%reduction in displacement,respectively.Conclusion Bone transport with intramedullary nailing combined with external fixator in treatment of femoral and tibial defects would offer better biomechanical advantages.It can facilitates bone regeneration and bone mineralisation during distraction phase and consolidation phase.
作者
夏依买尔旦·买买提
谢增如
刘凯
陈辉
艾合买提江·玉素甫
XIAYIMAIERDAN Maimaiti;XIE Zengru;LIU Kai;CHEN Hui;AIHEMAITIJIANG Yusufu(Department of Trauma and Microreconstructive Surgery,Orthopaedic Center,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China;Department of Trauma Orthopaedics,Orthopaedic Center,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China)
出处
《中华显微外科杂志》
CSCD
北大核心
2023年第4期436-441,共6页
Chinese Journal of Microsurgery
基金
新疆维吾尔自治区自然科学基金(2020D01C264)
中央引导地方科技发展资金资助项目(ZYYD2022A03)。
关键词
骨缺损
下肢
骨搬移
外固定
有限元
生物力学
Bone defect
Lower limb
Bone transport
External fixation
Finite element
Biomechanics
