Department of Orthopedics, Chenggong Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.
Eur J Trauma Emerg Surg. 2023 Aug;49(4):1845-1853. doi: 10.1007/s00068-023-02253-5. Epub 2023 Mar 25.
There is no specific literature on the best implantation position of the Femoral Neck System (FNS) for treating Pauwels type III femoral neck fracture in young adults.
Use finite-element analysis to compare the mechanical properties of implantation positions: FNS in the central position, FNS in the low position, and FNS in the low position combined with cannulated screw (CS). The CT data of the femur were imported into the mimics20.0 to obtain the three-dimensional model of the femur; imported into geomagic2017 and SolidWorks 2017 for optimizations; models of FNS and CS are built on the basis of the device manuals. Grouping is as follows: FNS group, FNS-LOW group, and FNS-CS group. Assemble and import them into abaques6.14 for load application. The displacement distribution and von Mises Stress value of them were compared.
On femoral stability and stress distribution, the FNS-CS group performs best, followed by the FNS-LOW group, and finally FNS group. The FNS-LOW group has an improvement over the FNS group but not by much.
In operations, when the implantation position of the central guide wire is not at the center of the femoral neck but slightly lower, it is recommended not to adjust the wire repeatedly in pursuit of the center position; for femoral neck fractures that are extremely unstable at the fracture end or require revision, the insertion strategy of FNS in the low position combined with CS can be adopted to obtain better fixation effects.
对于青壮年 Pauwels Ⅲ型股骨颈骨折,目前尚无关于股骨颈系统(FNS)最佳植入位置的具体文献。
采用有限元分析比较三种植入位置的力学性能:FNS 中心位、FNS 低位和 FNS 低位联合空心钉(CS)。将股骨 CT 数据导入 mimics20.0 以获得股骨三维模型;导入 geomagic2017 和 SolidWorks 2017 进行优化;根据设备手册建立 FNS 和 CS 的模型。分组如下:FNS 组、FNS-LOW 组和 FNS-CS 组。将它们组装并导入到 abaques6.14 中进行加载。比较它们的位移分布和 von Mises 应力值。
在股骨稳定性和应力分布方面,FNS-CS 组表现最佳,其次是 FNS-LOW 组,最后是 FNS 组。FNS-LOW 组相对于 FNS 组有所改善,但改善不大。
在手术中,当中心导丝的植入位置不在股骨颈中心而略低时,不建议为了追求中心位置而反复调整导丝;对于骨折端极不稳定或需要翻修的股骨颈骨折,可以采用 FNS 低位联合 CS 的插入策略,以获得更好的固定效果。