髓内钉固定不同股骨近端骨折的数值比较

IF 1.4 3区医学 Q4 ENGINEERING, BIOMEDICAL

Clinical Biomechanics Pub Date : 2025-02-01 DOI:10.1016/j.clinbiomech.2025.106438

Yen-Nien Chen PhD , Chih-Wei Chang PhD , Kuo-Chih Su PhD , Chia-Jung Chang PhD

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引用次数: 0

摘要

本研究旨在通过有限元模拟比较不同髓内系统稳定股骨近端骨折的力学响应，包括稳定性和植入物应力。此外，还研究了滞后螺钉数（包括1个和2个螺钉）的影响。方法首先建立数值髋模型，然后采用股骨近端股骨颈骨折、股骨粗隆间骨折、反向股骨粗隆间骨折和股骨粗隆下骨折四种不同类型的股骨近端骨折进行研究。髓内钉系统用于固定四种骨折类型。此外，还比较了两种不同数量的滞后螺钉，其中一个较大或两个较小。采用水平行走时股骨的峰值负荷进行比较。结果表明，逆转子间骨折的峰值位移和间隙开放距离均明显高于其他骨折。此外，逆转子间骨折髓内钉的峰值等效应力是所有骨折中最高的。反向转子间骨折的钉应力分别比使用1枚和2枚拉力螺钉的转子间骨折高4.6倍（132.9 ~ 616.8 MPa）和4.4倍（126 ~ 556 MPa）。髓内钉是一种机械有效的固定股骨近端骨折的装置。然而，为了避免指甲断裂，与颈骨折、粗隆间骨折和粗隆下骨折相比，逆行性粗隆间骨折的术后康复过程应较慢。

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Numerical comparison of the intramedullary nail for the fixation of different proximal femoral fractures

Background

This study aimed to compare the mechanical responses, including the stability and implant stress, of different proximal femoral fractures stabilized with an intramedullary system by finite element simulation. Furthermore, the effect of number of the lag screws, including one and two screws, was also investigated.

Methods

A numerical hip model was created first, and then four different types of proximal femoral fractures—namely femoral neck, intertrochanteric, reverse intertrochanteric, and subtrochanteric fractures—were employed in this study. An intramedullary nail system was used to fix the four fracture types. Furthermore, two different number of lag screws, either one bigger or two smaller, was also compared. The peak loading of the femur in level walking was used for comparison.

Findings

The results showed that both the peak displacement and the gap opening distance in the reversed intertrochanteric fracture were obviously higher than in the other fractures. Additionally, the peak equivalent stress of the intramedullary nail in the reversed intertrochanteric fracture was the highest among all the fractures. The stress on the nail in cases of reversed intertrochanteric fracture was 4.6 times (ranging from 132.9 to 616.8 MPa) and 4.4 times (ranging from 126 to 556 MPa) higher than in intertrochanteric fractures with one and two lag screws, respectively.

Interpretation

The intramedullary nail is a mechanically effective device for the fixation of proximal femoral fractures. However, to avoid the nail breakage the postoperative rehabilitation process for reversed intertrochanteric fracture should be slower compared to the neck, intertrochanteric and subtrochanteric fractures.

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来源期刊

Clinical Biomechanics 医学-工程：生物医学

CiteScore

3.30

自引率

5.60%

发文量

189

审稿时长

12.3 weeks

期刊介绍： Clinical Biomechanics is an international multidisciplinary journal of biomechanics with a focus on medical and clinical applications of new knowledge in the field. The science of biomechanics helps explain the causes of cell, tissue, organ and body system disorders, and supports clinicians in the diagnosis, prognosis and evaluation of treatment methods and technologies. Clinical Biomechanics aims to strengthen the links between laboratory and clinic by publishing cutting-edge biomechanics research which helps to explain the causes of injury and disease, and which provides evidence contributing to improved clinical management. A rigorous peer review system is employed and every attempt is made to process and publish top-quality papers promptly. Clinical Biomechanics explores all facets of body system, organ, tissue and cell biomechanics, with an emphasis on medical and clinical applications of the basic science aspects. The role of basic science is therefore recognized in a medical or clinical context. The readership of the journal closely reflects its multi-disciplinary contents, being a balance of scientists, engineers and clinicians. The contents are in the form of research papers, brief reports, review papers and correspondence, whilst special interest issues and supplements are published from time to time. Disciplines covered include biomechanics and mechanobiology at all scales, bioengineering and use of tissue engineering and biomaterials for clinical applications, biophysics, as well as biomechanical aspects of medical robotics, ergonomics, physical and occupational therapeutics and rehabilitation.