Pauwels III型股骨颈骨折的新型固定方法：滑动髋螺钉、L形及带内侧钢板L形的有限元分析
New fixation method for Pauwels type III femoral neck fracture: a finite element analysis of sliding hip screw, L-shaped, and L-shaped with medial plate.
作者信息
Freitas Anderson, Bontempo Ricardo Lourenço, Azevedo Frank Anderson Ramos, Battaglion Leonardo Rigobello, Giordano Marcos Noberto, Barin Fabrício Reichert, Giordano Vincenzo
机构信息
Regional Hospital of the City of Gama, Brasilia, Distrito Federal, Brazil.
Research and Education Institute of the Orthopedics and Specialized Medicine Hospital (IPE - H O M E) , SGAS Quadra 613- Conjunto C , Brasília, Distrito Federal, 70200-730, Brazil.
出版信息
Eur J Orthop Surg Traumatol. 2021 Aug;31(6):1069-1075. doi: 10.1007/s00590-020-02824-x. Epub 2021 Jan 3.
OBJECTIVE
In this study, we aimed to evaluate the biomechanical behavior of three fixations for Pauwels type III fractures (sliding hip screw (SHS), L-shaped, and L-shaped with medial plate), by finite element analysis (FEM).
METHODS
Three internal fixators were developed to treat Pauwels type III fracture by finite elements: SHS; L-shaped; and L-shaped with medial plate. Under the same conditions, localized and total vertical fracture displacement, maximum and minimum principal and von Mises stresses were evaluated.
RESULTS
The localized and total vertical displacement evaluated for the SHS, L-shaped, and L-shaped with medial plate were 0.15 mm, 0.17 mm, and 0.07 mm (localized), and 4.52 mm, 6.97 mm, and 6.83 mm (total), respectively. The maximum values obtained in the upper region of the femoral neck for the internal fixations were 1.43 MPa, 1.29 MPa, and 1.24 MPa, and the minimum values obtained in the lower region of the femoral neck were - 0.73 MPa, - 1.09 MPa, and - 1.03 MPa, respectively. The maximum Von Mises peak stress values were 6.35 MPa, 10.7 MPa, and 16.2 MPa for the fixation models using the SHS, L-shaped, and L-shaped with medial plate, respectively.
CONCLUSION
The present FEM analysis showed that SHS yields better results in terms of total vertical displacements, maximum distribution, and Von Mises peak stresses reduction. On the other hand, the L-shaped construction plus a medial plate decreases localized vertical displacements and maximum principal distribution when compared to the SHS and L-shaped constructions. These results demonstrate that both constructions, SHS and L-shaped plus a medial plate, are biomechanically efficient for the fixation of Pauwels type III femoral neck fractures.
目的
在本研究中，我们旨在通过有限元分析（FEM）评估三种用于 Pauwels III 型骨折固定方式（滑动髋螺钉（SHS）、L 形以及带内侧钢板的 L 形）的生物力学行为。
方法
通过有限元方法开发了三种用于治疗 Pauwels III 型骨折的内固定器：SHS；L 形；以及带内侧钢板的 L 形。在相同条件下，评估局部和整体垂直骨折位移、最大和最小主应力以及 von Mises 应力。
结果
SHS、L 形以及带内侧钢板的 L 形的局部和整体垂直位移分别为 0.15 毫米、0.17 毫米和 0.07 毫米（局部），以及 4.52 毫米、6.97 毫米和 6.83 毫米（整体）。内固定在股骨颈上部区域获得的最大值分别为 1.43 兆帕、1.29 兆帕和 1.24 兆帕，在股骨颈下部区域获得的最小值分别为 -0.73 兆帕、-1.09 兆帕和 -1.03 兆帕。使用 SHS、L 形以及带内侧钢板的 L 形固定模型的最大 von Mises 峰值应力值分别为 6.35 兆帕、10.7 兆帕和 16.2 兆帕。
结论
目前的有限元分析表明，在整体垂直位移、最大应力分布以及 von Mises 峰值应力降低方面，SHS 产生更好的结果。另一方面，与 SHS 和 L 形结构相比，L 形结构加上内侧钢板可减少局部垂直位移和最大主应力分布。这些结果表明，SHS 和 L 形加上内侧钢板这两种结构在生物力学上对于 Pauwels III 型股骨颈骨折的固定都是有效的。
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