儿童股骨近端溶骨性病变内固定治疗的力学特性有限元分析。

Finite Element Analysis of Mechanical Characteristics of Internal Fixation for Treatment of Proximal Femoral Osteolytic Lesions in Children.

机构信息

Department of Orthopedics, Shanghai Children's Hospital, School of medicine, Shanghai Jiao Tong University, Shanghai, China.

School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China.

出版信息

Orthop Surg. 2023 Feb;15(2):628-638. doi: 10.1111/os.13591. Epub 2023 Jan 3.

DOI:10.1111/os.13591

PMID:36597674

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9891963/

Abstract

OBJECTIVES

Clinically, it is very difficult to prevent pathological fracture caused by high recurrence rate of osteolytic disease of proximal femur in children. At present, there is no consensus in clinical studies of which internal fixation method can significantly reduce the probability of recurrence of pathological fracture. The study aims to research the mechanical properties of different internal fixations in the treatment of osteolytic lesions of proximal femur in children by finite element analysis, and to find out the optimal treatment.

METHODS

Based on finite element analysis, the osteolytic disease models of the femoral neck and intertrochanter in a child (8-year-old, boy) were established respectively, and different internal fixation models (plate and titanium elastic intramedullary nails, TENs) were assembled. For the osteolytic lesion of the femoral neck: model A1 was assembled with a plate; model A2 with two TENs crossing the physis; model A3 with two TENs without crossing the physis. And for pertrochanteric osteolytic lesion: model B1 was assembled with a plate, model B2 with two TENs crossing the physis and model B3 with two TENs without crossing the physis. The Eccentric bearing load, torsional restraintal restraint of calcar femorale and composite load were analyzed for each models.

RESULTS

When the yield strain of each model is reached, the stress concentration points are located in the proximal and distal femoral calcar. In the model of femoral neck lesions, the failure load of model A1 and model A2 are the same (1250 N), and the failure load of model A3 (980 N) is significantly lower than that of the former two; in the model of intertrochanteric lesions, the failure load of model B2 is the largest (1350 N), and the failure load of model B1 (1220 N) is lower than that of model B3 (1260 N), but both are smaller than that of model B2.

CONCLUSION

Through finite element analysis, TENs through the epiphyseal plate, is found to be the better internal fixation method for femoral neck lesions and intertrochanteric lesions under two different working conditions. The results of clinical correlation study provide new biomechanical information for orthopedic doctors to consider different treatment options for osteolytic lesions of proximal femur.

摘要

目的

临床上，由于股骨近端溶骨性疾病的高复发率，很难预防病理性骨折。目前，临床研究对于哪种内固定方法能显著降低病理性骨折的复发率尚无共识。本研究旨在通过有限元分析研究不同内固定方法治疗儿童股骨近端溶骨性病变的力学性能，以找到最佳的治疗方法。

方法

基于有限元分析，分别建立儿童（8 岁，男孩）股骨颈和粗隆间溶骨性疾病模型，并装配不同的内固定模型（钢板和钛弹性髓内钉，TENs）。对于股骨颈溶骨性病变：模型 A1 装配钢板；模型 A2 用两根穿过骺板的 TENs；模型 A3 用两根不穿过骺板的 TENs。对于粗隆间溶骨性病变：模型 B1 装配钢板，模型 B2 用两根穿过骺板的 TENs，模型 B3 用两根不穿过骺板的 TENs。分析各模型的偏心承力、股骨距的扭转约束和复合载荷。

结果

当达到各模型的屈服应变时，应力集中点位于股骨近端和远端骺板。在股骨颈病变模型中，模型 A1 和模型 A2 的失效载荷相同（1250N），模型 A3（980N）的失效载荷明显低于前两者；在粗隆间病变模型中，模型 B2 的失效载荷最大（1350N），模型 B1（1220N）的失效载荷低于模型 B3（1260N），但均低于模型 B2。