Finite element analysis on interlocking intramedullary nail and locking compression plate in treating older children with fracture of femoral shaft
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摘要: 目的 使用有限元方法对比分析交锁髓内钉与锁定加压钢板治疗大龄儿童股骨干横行骨折的生物力学特性。 方法 建立2种骨折内固定有限元模型,进行轴向压缩实验、四点弯曲实验及扭转实验,分析实验中模型的应力及位移情况。 结果 交锁髓内钉在轴向压缩实验及四点弯曲实验中的最大应力值与平均值均大于锁定加压钢板。在扭转实验中,交锁髓内钉的最大应力值与平均值小于锁定加压钢板。锁定加压钢板骨折内固定模型中,股骨骨折线处的应力大于交锁髓内钉骨折内固定模型中的应力,故交锁髓内钉的应力遮蔽较大。锁定加压钢板骨折内固定模型中股骨的最大位移较大。 结论 交锁髓内钉内固定术相较于锁定加压钢板内固定术对骨折部位的应力遮蔽大,但其抗弯曲能力强,抗扭转能力强,手术创伤小,对股骨血运的影响小。在骨折愈合后期可将静力性固定改为动力性固定,更符合股骨原有的生物力学特性。因此,对于大龄儿童的股骨干横行骨折,交锁髓内钉内固定术可以作为首选治疗方案。Abstract: Objective To compare and analyze biomechanical characteristics of interlocking intramedullary nail and locking compression plate in treating older children with transverse fracture of femoral shaft. Methods Two kinds of finite element models for internal fixation of fractures were established. Axial compression experiment, four-point bending experiment and torsion experiment were conducted, and the stress as well as displacement of the models in the experiments were analyzed. Results The maximum stress values and average stress values of the interlocking intramedullary nail in the axial compression test and four-point bending test were larger than those of the locking compression plate. In the torsion test, the maximum and average stress values of interlocking intramedullary nail were less than that of locking compression plate. In fracture model with internal fixation of locking compression plate, the stress at the femoral fracture line was greater than that in fracture model with internal fixation of interlocking intramedullary nail, so the stress shielding of interlocking intramedullary nail was greater. The maximum femoral displacement in the internal fracture fixation model of locking compression plate was larger. Conclusion Compared with the internal fixation of locking compression plate, the internal fixation of interlocking intramedullary nail has larger stress shielding in fracture site, but it is more powerful to resist bending and torsion, has less operative wound and slight influence upon - the femoral blood supply. The static fixation can be changed to dynamic fixation at the late stage of the healing, thereby making the stress distribution more conform to the original biomechanical characteristics of the femur. Therefore, for the transverse fracture of femoral shaft of the older children, the internal fixation of interlocking intramedullary nail can be taken as a preferred treatment.
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