Finite element analysis of proximal femoral nail anti-rotation in the treatment of non-anatomical reduction of basicervical femoral neck fracture in elderly
TU Shijie1 ZOU Yang1 XIONG Zhaoping1 CHEN Xinmin2▲ LIN Ziling2 ZOU Xia1
1.Department of Traumatic Orthopedics, Fengcheng Hospital of Traditional Chinese Medicine, Jiangxi Province, Fengcheng 331100, China;
2.Department of Traumatic Orthopedics, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Province, Guangzhou 510405, China
Abstract：Objective To investigate the biomechanics of proximal femoral nail anti-rotation in the treatment of femoral neck basicervical fracture in elderly with three different reduction states by using finite element method. Methods Based on the CT data of the volunteers′ hips, the proximal femoral model was extracted and optimized by Mimics, Geomagic and other softwar, then assembled with proximal femoral nail anti-rotation in Solidworks software and segmented into simulated fracture lines. Three models of different reduction states (positive support fracture, neutral support fracture, negative support fracture) were obtained by moving fracture fragments. Finally, all the three models were imported into Abaqus software to set material parameters, boundary conditions, etc., and then the calculation was carried out to check the Von Mises nephogram of the model. Results The stress distribution of the positive support fracture end was the most uniform and the displacement of the fracture end was the least. The stress of negative support fracture end was concentrated and the displacement of the fracture end was the greatest. The stress distribution of neutral support fracture end was uniform and the displacement of the fracture end was larger. Conclusion The use of proximal femoral nail anti-rotation in the treatment of basicervical femoral neck fracture should avoid the negative support reduction state, and try to maintain the anatomical reduction or positive support.
涂世杰1 邹洋1 熊赵平1 陈心敏2▲ 林梓凌2 邹霞1. 股骨近端防旋髓内钉治疗高龄非解剖复位股骨颈基底部骨折的有限元分析[J]. 中国医药导报, 2020, 17(15): 71-75.
TU Shijie1 ZOU Yang1 XIONG Zhaoping1 CHEN Xinmin2▲ LIN Ziling2 ZOU Xia1. Finite element analysis of proximal femoral nail anti-rotation in the treatment of non-anatomical reduction of basicervical femoral neck fracture in elderly. 中国医药导报, 2020, 17(15): 71-75.
[1] Watson ST，Schaller TM，Tanner SL，et al. Outcomes of Low-Energy Basicervical Proximal Femoral Fractures Treated with Cephalomedullary Fixation [J]. J Bone Joint Surg Am，2016，98（13）：1097-1102.
[2] Guo J，Dong W，Jin L，et al. Treatment of basicervical femoral neck fractures with proximal femoral nail antirotation [J]. J Int Med Res，2019，47（9）：4333-4343.
[3] Bernstein J，Weintraub S，Hume E，et al. The New APGAR SCORE：A Checklist to Enhance Quality of Life in Geriatric Patients with Hip Fracture [J]. J Bone Joint Surg Am，2017，99（14）：e77.
[4] Wilk R，Skrzypek M，Kowalska M，et al. Standardized incidence and trend of osteoporotic hip fracture in Polish women and men： a nine year observation [J]. Maturitas，2014，77（1）：59-63.
[5] Broderick JM，Bruce-Brand R，Stanley E，et al. Osteoporotic hip fractures：the burden of fixation failure [J]. ScientificWorldJournal，2013，2013：515197.
[6] 张乃栋，陈方民.微创闭合复位经皮空心加压螺丝钉及股骨近端抗旋髓内钉（PFN A）治疗股骨颈基底型骨折的临床疗效对比[J].滨州医学院学报，2016，39（3）：186-188，191.
[7] Lee YK，Yoon BH，Hwang JS，et al. Risk factors of fixation failure in basicervical femoral neck fracture：Which device is optimal for fixation? [J]. Injury，2018，49（3）：691-696.
[8] 郑利钦，陈心敏，张彪，等.股骨转子间骨折股骨近端防旋髓内钉内固定切割失效的有限元仿真[J].中国组织工程研究，2019，23（36）：5794-5799.
[9] Chang SM，Zhang YQ，Ma Z，et al. Fracture reduction with positive medial cortical support：a key element in stability reconstruction for the unstable pertrochanteric hip fractures [J]. Arch Orthop Trauma Surg，2015，135（6）：811-818.
[10] 任德新，顾海伦，李赫，等.股骨近端防旋髓内钉固定治疗累及外侧壁的股骨转子间骨折有限元分析[J].中华创伤骨科杂志，2018，20（4）：346-351.
[11] 周宇萍.股骨颈基底部内收型骨折不同内固定方式的三维有限元分析[D].长沙：中南大学，2010.
[12] 樊健，李山珠，袁锋，等.股骨小转子未固定的抗旋髓内钉治疗Evans-Jensen Ⅲ型转子间骨折的有限元分析[J].中华实验外科杂志，2016，33（12）：2794-2796.
[13] 张建国.INTERTAN与PFNA治疗股骨转子间骨折的有限元学分析[D].太原：山西医科大学，2019.
[14] Xiong WF，Du SC，Chang SM. Choosing an optimal implant fixation for basicervical femoral neck fractures [J]. Injury，2018，49（6）：1238-1239.
[15] 楼宇梁，洪建军，余可和，等.不同直径空心钉闭合复位内固定治疗股骨颈骨折疗效分析[J].中国骨伤，2015， 28（9）：792-795.
[16] 张弓，李松军，董杰.股骨颈加压锁定骨板与空心拉力螺钉治疗青年股骨颈骨折的效果比较[J].中国当代医药，2018，25（22）：25-28.
[17] Kweon SH，Lee SH，Kook SH，et al. Outcomes of Cephalome-dullary Nailing in Basicervical Fracture [J]. Hip Pelvis，2017，29（4）：270-276.
[18] Tasy?覦kan L，Ugutmen E，Sanel S，et al. Short-term results of surgical treatment with cephalomedullary nails for basicervical proximal femoral fractures [J]. Acta Orthop Belg，2015，81（3）：427-434.
[19] Hu SJ，Yu GR，Zhang SM. Surgical treatment of basicervical intertrochanteric fractures of the proximal femur with cephalomeduallary hip nails [J]. Orthop Surg，2013， 5（2）：124-129.
[20] Okano I，Sawada T，Kushima N，et al. Treatment With Helical Blade Cephalomedullary Nail for Two-Part Basicervical Proximal Femoral Fracture in Elderly Patients： A Retrospective Observational Study [J]. Geriatr Orthop Surg Rehabil，2017，8（4）：244-251.
[21] Imren Y，Gurkan V，Bilsel K，et al. Biomechanical comparison of dynamic hip screw，proximal femoral nail，cannulated screw，and monoaxial external fixation in the treatment of basicervical femoral neck fractures [J]. Acta Chir Orthop Traumatol Cech，2015，82（2）：140-144.
[22] Gotfried Y. The Gotfried（nonanatomic，closed）reduction of unstable subcapital femoral fractures [J]. Tech Orthop，2014，29（4）：194-196.
[23] 张世民，张英琪，李清，等.内侧皮质正性支撑复位对老年股骨粗隆间骨折内固定效果的影响[J].中国矫形外科杂志，2014，22（14）：1256-1261.
[24] 王亦璁.骨与关节损伤[M].3版.北京：人民卫生出版社,2001：1148-1149.
[25] 赵璞，王洪彪，刘永国，等.非解剖复位治疗股骨转子间骨折的临床观察[J].中国中医骨伤科杂志，2018，26（4）：50-53.
[26] 冼树强，李学良，潘德悦.阳性支撑对股骨粗隆间骨折内固定效果的影响[J].创伤外科杂志，2018，20（10）：770-773.
[27] 辛景义，曹红彬.克氏针辅助闭合复位治疗难复性股骨颈骨折[J].中华骨科杂志，2013，33（7）：708-713.
[28] 邢秀峰.切开复位内固定联合带血供骨瓣移植治疗股骨颈骨折的疗效及安全性观察[J].中国现代医生，2019， 57（26）：72-75.
[29] 田力升.解剖复位、Gotfried支撑复位用于青年股骨颈骨折的远期随访观察[J].中国现代医药杂志，2018，20（1）：26-29.
2020, Vol. 17 
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