股骨近端重建抗旋髓内钉设计及有限元分析

作者	单位	邮编
陈光龙^*	蚌埠医科大学附属铜陵医院关节外科,安徽铜陵,244000	244000
夏良政^*	蚌埠医科大学附属铜陵医院关节外科,安徽铜陵,244000	244000
邓英虎	蚌埠医科大学附属铜陵医院关节外科,安徽铜陵,244000	244000
李胜华	蚌埠医科大学附属铜陵医院关节外科,安徽铜陵,244000	244000
汪康	蚌埠医科大学附属铜陵医院关节外科,安徽铜陵,244000	244000

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中文摘要:

目的通过有限元分析比较本研究设计的股骨近端重建抗旋髓内钉（PFRNA）与PFNA治疗股骨粗隆间骨折合并外侧壁骨折的生物力学效果，分析股骨近端重建抗旋髓内钉内固定的有效性。方法将1例男性正常股骨CT数据导入软件，提取正常的股骨模型，将正常股骨模型进行切割得到骨折模型。在软件中设计股骨近端重建抗旋髓内钉模型与PFNA模型，后将骨折模型与内固定模型进行组装。最后将骨折内固定模型导入分析软件进行生物力学分析。结果在提供600 N的竖直载荷的情况下：PFNA组的股骨最大位移、内固定装置最大位移、骨折块最大位移分别为2.544 0 mm、2.432 9 mm、2.169 4 mm；PFRNA组的股骨最大位移、内固定装置最大位移、骨折块最大位移分别为2.075 5 mm、1.985 3 mm、1.759 2 mm。PFNA组的股骨最大应力、内固定装置最大应力、骨折块最大应力分别为75.292 3 MPa、75.292 3 MPa、12.254 0 MPa；PFRNA组的股骨最大应力、内固定装置最大应力、骨折块最大应力分别为47.675 0 MPa、47.675 0 MPa、7.148 4 MPa。PFNA组外侧壁骨折线、粗隆间骨折线沿x、y、z轴的定向位移分别为（-1.530 1 mm，-1.127 1 mm，0.165 5 mm）、（-1.272 9 mm，-1.379 4 mm，0.011 6 mm）；PFRNA组外侧壁骨折线、粗隆间骨折线沿x、y、z轴的定向位移分别为（-1.010 3 mm，-1.153 0 mm，0110 3 mm）、（-0.773 1 mm，-1.308 7 mm，0.034 1 mm）。结论在模拟正常双足站立的情况下，通过有限元对两种内固定装置进行生物力学分析，PFRNA模型在股骨、内固定装置方面的位移和应力以及骨折线的位移情况优于PFNA，在治疗股骨粗隆间骨折的基础上能够对外侧壁骨折进行有效的固定。

英文摘要:

Objective To compare the biomechanical effects of the proximal femoral reconstruction nail antirotation (PFRNA), designed by our research group, with the proximal femoral nail antirotation (PFNA) in the treatment of intertrochanteric femoral fractures combined with lateral wall fractures using finite element analysis, and to evaluate the efficacy of PFRNA fixation.Methods The CT data of a normal male femur were imported into software to extract a standard femoral model, which was then segmented to create a fracture model. The PFRNA and PFNA models were designed in the software and assembled with the fracture model. Finally, the fracture-fixation models were imported into analysis software for biomechanical evaluation.Results Under a 600 N vertical load: In the PFNA group, the maximum displacements of the femur, internal fixation device, and fracture fragment were 2.544 0 mm, 2.432 9 mm, and 2.169 4 mm. In the PFRNA group, these values were 2.075 5 mm, 1.985 3 mm, and 1.759 2 mm, respectively. The peak von Mises stresses in the femur, internal fixation device, and fracture fragment for the PFNA group were 75.292 3 MPa, 75.292 0 MPa, and 12.254 0 MPa, respectively. For the PFRNA group, these stresses were 47.675 0 MPa, 47.675 0 MPa, and 7.148 4 MPa, respectively. The displacement of the lateral wall fracture line and intertrochanteric fracture line along the x, y, and z axes in the PFNA group was (-1.530 1 mm, -1.127 1 mm, 0.165 5 mm) and (-1.272 9 mm, -1.379 4 mm, 0.011 6 mm), respectively. In the PFRNA group, the displacement of the lateral wall fracture line and intertrochanteric fracture line along the x, y, and z axes was (-1.010 3 mm, -1.153 0 mm, 0.110 3 mm) and (-0.773 1 mm, -1.308 7 mm, 0.034 1 mm), respectively.Conclusion Under simulated bipedal standing conditions, FEA demonstrated that the PFRNA model outperformed PFNA in femoral/implant displacement, stress distribution, and fracture line stability. PFRNA provides effective fixation for both intertrochanteric fractures and concomitant lateral wall fractures.

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