Department of Orthopedics, Songjiang District Central Hospital, Shanghai 201600, China.
Department of Orthopedics, Tongji Hospital, Tongji University School of Medicine, Shanghai 200092, China.
Math Biosci Eng. 2019 Aug 27;16(6):7808-7828. doi: 10.3934/mbe.2019392.
To evaluate the influence of drilling sites for benign lesions in femoral head and neck with curettage, bone-grafting and internal fixation. Twelve paired formalin-fixed human cadaveric femora were grouped randomly into 2 groups of 6 pairs each, which were group 1 and group 2, and one of each pair of femora was grouped randomly to drill an oval-shaped hole in the anterior femoral neck, and the contralateral femur was assigned to drill an oval-shaped hole in the lateral of the proximal femur. Group 1 femora were simulated the operation of curettage, bone-grafting and internal fixation, and group 2 femora were simulated the operation of curettage. Besides, finite element models corresponding to mechanical testing were simulated according to one of the twelve femora, then finite element analysis were done. Wilcoxon signed-rank test was used for statistical analysis, with a p value < 0.05 indicating statistical significance. The simulated operation of curettage decreased the axial stiffness and torsional stiffness of the intact proximal femur significantly, while there was no statistical difference on the degree of the decline between different drilling sites. Although the simulated operation of bone-grafting and internal fixation in different drilling sites increased the axial stiffness and torsional stiffness, only in the case of implanting bones and internal fixation for the lateral cortical drilled hole increased the axial stiffness greatly and made a statistical difference, even more stiff than the intact proximal femur model. Compared with drilling in the anterior femoral neck, a bigger stability could be obtained after drilling in the lateral proximal femur for benign lesions in femoral head and neck with curettage, bone-grafting and internal fixation.
为了评估经股骨头颈钻孔刮除、植骨和内固定治疗良性病变对骨力学性能的影响。将 12 对福尔马林固定的人尸体股骨随机分为 2 组，每组 6 对，分别为第 1 组和第 2 组。每组中的一对股骨随机在股骨头颈前侧钻椭圆形孔，对侧股骨在股骨近端外侧钻椭圆形孔。第 1 组股骨模拟刮除、植骨和内固定手术，第 2 组股骨模拟刮除手术。此外，根据其中 12 对股骨中的一对模拟机械测试的有限元模型，进行有限元分析。Wilcoxon 符号秩检验用于统计分析，p 值<0.05 表示具有统计学意义。刮除手术模拟操作显著降低了完整近端股骨的轴向刚度和扭转刚度，而不同钻孔部位对刚度降低的程度没有统计学差异。虽然不同钻孔部位的植骨和内固定模拟操作增加了轴向刚度和扭转刚度，但只有在外侧皮质钻孔中植入骨骼和内固定的情况下，轴向刚度才会显著增加并具有统计学差异，甚至比完整的近端股骨模型更硬。与在股骨头颈前侧钻孔相比，经股骨头颈钻孔刮除、植骨和内固定治疗良性病变时，在股骨近端外侧钻孔可获得更大的稳定性。
