空心螺钉联合同种异体腓骨治疗股骨颈骨折的三维有限元力学分析

Application value of hollow screw combined with allogeneic fibula internal fixation in the treatment of femoral neck fracture

目的观察并分析空心螺钉结合同种异体腓骨内固定治疗在股骨颈骨折中的应用价值。方法选择1名生理解剖正常的中国健康成年男性志愿者,通过X线和CT扫描检查显示髋关节发育正常,保存股骨中上段影像学数据。通过三维重建等技术,构建空心螺钉结合同种异体腓骨固定股骨颈骨折的三维模型,以及关节软骨、韧带、肌肉的三维模型并进行力学分析,对两种骨折内固定方式的生物力学稳定性进行评估。结果股骨头皮质的头顶部是出现最大应力的位置,两种内固定方式最大应力差异无统计学意义。两种固定方式的股骨头颈位移都是从股骨头颈上缘开始逐渐减小,直至股骨头颈的下缘。由于股骨头颈外上缘的张力最大,两种固定方式的最大位移都发生在该部位,但两者最大位移差异无统计学意义。空心螺钉结合同种异体腓骨内固定方式和多枚空心螺钉内固定方式对股骨颈骨折骨组织的最大应力都是出现在皮质骨部位。两种内固定的最大应力都是在骨折断端和内固定尾部。结论对于股骨颈骨折患者,通过空心螺钉结合同种异体腓骨内固定和多枚空心螺钉内固定的力学稳定性基本相同,都可以为骨折愈合提供较为稳定的力学环境,可以有效预防股骨头坏死、塌陷,是股骨颈骨折较理想的治疗方式。

Objective To observe and analyze the application value of hollow screw combined with allogeneic fibula internal fixation in the treatment of femoral neck fractures,aiming to provide a safer and more effective method for clinical treatment of femoral neck fractures.Methods A healthy Chinese adult male volunteer with normal physiological anatomy was selected.X-ray examination confirmed normal hip joint development.Three-dimensional models of femoral neck fractures fixed by hollow screws combined with allograft fibula and models of articular cartilage,ligaments,and muscles were constructed using three-dimensional reconstruction techniques.Mechanical analysis was performed to evaluate the biomechanical stability of the two internal fixation methods.Results The maximum stress occurred at the top of the femoral head cortex in femoral neck fractures fixed with multiple hollow screws and also when combined with allograft fibula.There was no significant difference in maximum stress between the two methods.In both fixation methods,displacement of the femoral head and neck decreases from the upper to the lower margin.The maximum displacement occurs at the external upper margin due to the highest tension,with no significant difference between the two methods.The maximum stress on the bone tissue of femoral neck fractures was observed in the cortical bone for both fibular allograft fixation with hollow screws and multiple hollow screw fixation.The maximum stress of interosseous fixation for femoral neck fractures with hollow screws combined with allograft fibula and multiple hollow screws was at the fracture's broken end and the fixed tail.Although there was no significant difference in the position of maximum stress distribution,the maximum stress values in bone tissue and internal fixation for allograft fibula fixation combined with hollow screws were smaller than those for multiple hollow screw fixation.Conclusions For patients with femoral neck fractures,the mechanical stability of allograft fibular internal fixation with hollow screws is comparable to that of multiple hollow screws.Both methods can provide a stable mechanical environment for fracture healing and effectively prevent femoral head necrosis and collapse,making them ideal treatments for femoral neck fractures.