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用于髓内骨折固定的弹性自锁钉的力学行为:创新钉设计的数值分析

Mechanical Behavior of Elastic Self-Locking Nails for Intramedullary Fracture Fixation: A Numerical Analysis of Innovative Nail Designs.

作者信息

Putame Giovanni, Pascoletti Giulia, Terzini Mara, Zanetti Elisabetta M, Audenino Alberto L

机构信息

Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy.

PolitoBIOMed Lab, Politecnico di Torino, Turin, Italy.

出版信息

Front Bioeng Biotechnol. 2020 Jun 5;8:557. doi: 10.3389/fbioe.2020.00557. eCollection 2020.

Abstract

Intramedullary nails constitute a viable alternative to extramedullary fixation devices; their use is growing in recent years, especially with reference to self-locking nails. Different designs are available, and it is not trivial to foresee the respective performances and to provide clinical indications in relation to the type of bone and fracture. In this work a numerical methodology was set up and validated in order to compare the mechanical behavior of two new nailing device concepts with one already used in clinic. In detail, three different nails were studied: (1) the Marchetti-Vicenzi's nail (MV), (2) a revised concept of this device (MV), and (3) a new Terzini-Putame's nail (TP) concept. Firstly, the mechanical behavior of the MV device was assessed through experimental loading tests employing a 3D-printed component aimed at reproducing the bone geometry inside which the device is implanted. In the next step, the respective numerical model was created, based on a multibody approach including flexible parts, and this model was validated against the previously obtained experimental results. Finally, numerical models of the MV and TP concepts were implemented and compared with the MV nail, focusing the attention on the response of all devices to compression, tension, bending, and torsion. A stability index (SI) was defined to quantify the mechanical stability provided to the nail-bone assembly by the elastic self-locking mechanism for the various loading conditions. In addition, results in terms of nail-bone assembly stiffness, computed from force/moment vs. displacement/rotation curves, were presented and discussed. Findings revealed that numerical models were able to provide good estimates of load vs. displacement curves. The TP nail concept proved to be able to generate a significantly higher SI (27 N for MV vs. 380 N for TP) and a greater stiffening action (up to a stiffness difference for bending load that ranges from 370 Nmm/° for MV to 1,532 Nmm/° for TP) than the other two devices which showed similar performances. On the whole, a demonstration was given of information which can be obtained from numerical simulations of expandable fixation devices.

摘要

髓内钉是髓外固定装置的一种可行替代方案;近年来其使用越来越广泛,尤其是自锁钉。现有不同的设计,要预见其各自的性能并针对不同类型的骨骼和骨折提供临床指征并非易事。在这项工作中,建立并验证了一种数值方法,以比较两种新型钉装置概念与一种已在临床使用的钉装置的力学行为。具体而言,研究了三种不同的钉子:(1)马尔凯蒂 - 维琴齐钉(MV),(2)该装置的一种改进概念(MV),以及(3)一种新的特尔齐尼 - 普塔梅钉(TP)概念。首先,通过使用3D打印部件进行实验加载测试来评估MV装置的力学行为,该部件旨在再现植入该装置的骨骼几何形状。下一步,基于包含柔性部件的多体方法创建各自的数值模型,并根据先前获得的实验结果对该模型进行验证。最后,实现了MV和TP概念的数值模型,并与MV钉进行比较,重点关注所有装置在压缩、拉伸、弯曲和扭转时的响应。定义了一个稳定性指数(SI),以量化弹性自锁机制在各种加载条件下为钉 - 骨组件提供的力学稳定性。此外,还展示并讨论了根据力/力矩与位移/旋转曲线计算得出的钉 - 骨组件刚度方面的结果。研究结果表明,数值模型能够很好地估计载荷与位移曲线。结果证明,TP钉概念能够产生比其他两种性能相似的装置显著更高的SI(MV为27 N,TP为380 N)和更大的强化作用(弯曲载荷下的刚度差异范围从MV的370 Nmm/°到TP的1532 Nmm/°)。总体而言,展示了可从可扩展固定装置的数值模拟中获得的信息。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1ead/7289914/9564b43721dd/fbioe-08-00557-g0001.jpg

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