三角形支撑髓内钉：治疗股骨转子间骨折的一种新的内固定创新及其有限元分析。
Triangular support intramedullary nail: A new internal fixation innovation for treating intertrochanteric fracture and its finite element analysis.
机构信息
Trauma Emergency Center, The Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Shijiazhuang, Hebei 050051, PR China; Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei 050051, PR China.
Trauma Emergency Center, The Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Shijiazhuang, Hebei 050051, PR China; Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei 050051, PR China; NHC Key Laboratory of Intelligent Orthopeadic Equipment (The Third Hospital of Hebei Medical University), PR China; Chinese Academy of Engineering, Beijing, PR China.
出版信息
Injury. 2022 Jun;53(6):1796-1804. doi: 10.1016/j.injury.2022.03.032. Epub 2022 Mar 20.
BACKGROUND
Proximal femoral nail anti-rotation (PFNA) and Gamma nail were recommended for intertrochanteric fracture, however, with high rate of post-operation complications. The triangular support intramedullary nail (TSIN) was designed to reduce the risk of postoperative complications related to Gamma nail and PFNA, and the aim is to compare the biomechanical characters of Gamma nail, PFNA and TSIN for fixation of intertrochanteric fracture and prove the rationality of the concept of triangle fixation in the treatment of intertrochanteric fractures.
METHODS
The finite element model of proximal femur was constructed according to the CT data of femur. Intertrochanteric fracture models with Evans type Ⅰ and Ⅳ were established and fixed with Gamma nail, PFNA and TSIN by UG-NX 12.0. The finite element analysis software was used to compare the stress distribution and displacement of three implants fixation models.
RESULTS
Under axial loading of 600 N, the peak stress and maximum displacement of intact proximal femur was 13.78 MPa and 1.33 mm, respectively. The maximum stress of TSIN for fixation of Evans type Ⅰ and Ⅳ intertrochanteric fractures was 86.23 MPa and 160.63 MPa which was significantly lower than that of Gamma nail and PFNA. The maximum relative displacement of fracture section in Gamma nail and PFNA fixation models was 0.18 mm and 0.19 mm which has 135% and 148% higher than in TSIN fixation models for fixing Evans type Ⅰ intertrochanteric fracture, and 0.47 mm and 0.59 mm which has 91% and 140% higher than in TSIN fixation models for stabilization of Evans type Ⅳ intertrochanteric fracture.
CONCLUSION
Compared with Gamma nail and PFNA fixation, TSIN has superior advantages in stress distribution and construct stability. We believe that triangle fixation concept help to reduce the risk of post-operative complications associated with PFNA and Gamma nail and improve the clinical effect of intertrochanteric fracture.
背景
股骨近端防旋髓内钉（PFNA）和Gamma 钉被推荐用于治疗股骨转子间骨折，但术后并发症发生率较高。三角支撑髓内钉（TSIN）的设计旨在降低与 Gamma 钉和 PFNA 相关的术后并发症风险，其目的是比较 Gamma 钉、PFNA 和 TSIN 固定股骨转子间骨折的生物力学特性，并证明三角形固定治疗转子间骨折的概念的合理性。
方法
根据股骨 CT 数据构建股骨近端有限元模型。建立 Evans Ⅰ型和Ⅳ型转子间骨折模型，并分别采用 UG-NX12.0 对 Gamma 钉、PFNA 和 TSIN 进行固定。采用有限元分析软件比较三种内固定模型的应力分布和位移。
结果
在轴向加载 600N 下，完整股骨近端的峰值应力和最大位移分别为 13.78MPa 和 1.33mm。TSIN 固定 Evans Ⅰ型和Ⅳ型转子间骨折的最大应力分别为 86.23MPa 和 160.63MPa，明显低于 Gamma 钉和 PFNA。Gamma 钉和 PFNA 固定模型骨折端的最大相对位移分别为 0.18mm 和 0.19mm，分别比 TSIN 固定模型固定 Evans Ⅰ型转子间骨折高 135%和 148%，比 TSIN 固定模型固定 Evans Ⅳ型转子间骨折高 91%和 140%。
结论
与 Gamma 钉和 PFNA 固定相比，TSIN 在应力分布和结构稳定性方面具有优势。我们认为，三角形固定概念有助于降低与 PFNA 和 Gamma 钉相关的术后并发症风险，提高转子间骨折的临床疗效。
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