Department of Orthopaedics, The Second Affiliated Hospital of XuZhou Medical University, Xuzhou, 221000, China.
Graduate School of Xuzhou Medical University, Xuzhou, China.
J Orthop Surg Res. 2024 Sep 20;19(1):583. doi: 10.1186/s13018-024-05073-4.
Given the recent application of two new types of intramedullary nail devices in the treatment of comminuted femoral intertrochanteric fractures (CFIFs), there is still a lack of deep understanding and comparative evaluation of their biomechanical properties. Therefore, this study aims to systematically compare the advantages and disadvantages of these two new devices with traditional proximal femoral nail antirotation (PFNA) and InterTan nails in the fixation of CFIFs through finite element analysis.
Based on the validated finite element model, this study constructed an accurate CFIFs model. In this model, PFNA, InterTan nails, proximal femoral bionic nails (PFBN), and new intramedullary systems (NIS) were implanted, totaling four groups of finite element models. Each group of models was subjected to simulation tests under a vertical load of 2100 N to evaluate the displacement and Von Mises stress (VMS) distribution of the femur and intramedullary nail devices.
Under a vertical load of 2100 N, a comparative analysis of the four finite element models showed that the NIS device exhibited the most superior performance in terms of peak displacement, while the PFNA device performed relatively poorly. Although the NIS device had the highest peak stress in the femur, it had the smallest peak displacement of both the femur and intramedullary nail devices, and the peak stress was mainly concentrated on the lateral side of the femur, with significantly lower stress in the proximal femur compared to the other three intramedullary nail devices. In contrast, the PFBN device had the lowest peak stress in the femur, and its peak displacement of both the femur and intramedullary nail devices was also less than that of PFNA and InterTan nails.
This study demonstrates that in the treatment of CFIFs, PFBN and NIS devices exhibit superior biomechanical performance compared to traditional PFNA and InterTan nail devices. Especially the NIS device, which can achieve good biomechanical results when fixing femoral intertrochanteric fractures with missing medial wall. Therefore, both PFBN and NIS devices can be considered reliable closed reduction and internal fixation techniques for the treatment of CFIFs, with potential clinical application value.
鉴于最近两种新型髓内钉装置在治疗粉碎性股骨转子间骨折（CFIFs）中的应用，人们对其生物力学性能仍缺乏深入了解和比较评价。因此，本研究旨在通过有限元分析系统比较这两种新型装置与传统股骨近端防旋髓内钉（PFNA）和 InterTan 钉在固定 CFIFs 方面的优缺点。
基于已验证的有限元模型，构建了精确的 CFIFs 模型。在该模型中，植入了 PFNA、InterTan 钉、股骨仿生钉（PFBN）和新型髓内系统（NIS），共建立了 4 组有限元模型。每组模型在 2100N 的垂直载荷下进行模拟测试，以评估股骨和髓内钉装置的位移和 Von Mises 应力（VMS）分布。
在 2100N 的垂直载荷下，对 4 个有限元模型进行对比分析，结果表明 NIS 装置在峰值位移方面表现最为优异，而 PFNA 装置表现相对较差。虽然 NIS 装置在股骨中具有最高的峰值应力，但它的股骨和髓内钉装置的峰值位移最小，且峰值应力主要集中在股骨的外侧，与其他三种髓内钉装置相比，股骨近端的应力明显较低。相比之下，PFBN 装置在股骨中的峰值应力最低，其股骨和髓内钉装置的峰值位移也小于 PFNA 和 InterTan 钉。
本研究表明，在治疗 CFIFs 时，PFBN 和 NIS 装置的生物力学性能优于传统的 PFNA 和 InterTan 钉装置。特别是 NIS 装置，在治疗伴有内侧壁缺失的股骨转子间骨折时，可获得良好的生物力学效果。因此，PFBN 和 NIS 装置均可作为治疗 CFIFs 的可靠闭合复位内固定技术，具有潜在的临床应用价值。
