Department of Mechanical Engineering, École de Technologie Supérieure, 1100, rue Notre-Dame Ouest, Montreal, QC H3C 1K3, Canada.
Med Biol Eng Comput. 2012 Apr;50(4):411-7. doi: 10.1007/s11517-012-0892-x. Epub 2012 Mar 9.
Greater trochanter (GT) stabilization techniques following a fracture or an osteotomy are still showing high levels of postoperative complications. Understanding the effect of femoral neck cut placement, cable tension and muscles forces on GT fragment displacements could help surgeons optimize their techniques. A 3D finite element model has been developed to evaluate, through a statistical experimental design, the impact of the above variables on the GT fragment gap and sliding displacements. Muscles forces were simulating typical daily activities. Stresses were also investigated. The femoral neck cut placement had the most significant effect on the fragment displacement. Lowering it by 5 mm increased the gap and sliding fragment displacements by 288 and 128 %, respectively. Excessive cable tightening provided no significant reduction in fragment displacement. Muscle activities increased the gap and the sliding displacements for all muscle configurations. The maximum total displacement of 0.41 mm was present with a 10 mm femoral neck cut, a cable tension of 178 N, and stair climbing. Caution must be used not to over tighten the cables as the potential damage caused by the increased stress is more significant than any reduction in fragment displacement. Furthermore, preservation of the contact area is important for GT stabilization.
大转子 (GT) 骨折或截骨术后的稳定技术仍存在较高的术后并发症。了解股骨颈截骨位置、钢缆张力和肌肉力量对 GT 骨折块移位的影响，有助于外科医生优化其技术。通过统计实验设计，建立了一个 3D 有限元模型来评估上述变量对 GT 骨折块间隙和滑动位移的影响。模拟了典型的日常活动中的肌肉力量。还研究了应力。股骨颈截骨位置对骨折块位移的影响最大。降低 5mm 会使间隙和滑动骨折块位移分别增加 288%和 128%。过度收紧钢缆并不能显著减少骨折块位移。对于所有肌肉配置，肌肉活动都会增加间隙和滑动位移。当股骨颈截骨 10mm、钢缆张力 178N 和爬楼梯时，总位移最大可达 0.41mm。必须小心不要过度收紧钢缆，因为增加的应力造成的潜在损伤比任何减少骨折块位移的效果都更显著。此外，GT 稳定术时保持接触面积也很重要。
