Abstract：Objective The biomechanical effect of reinforced screw cement intramedullary nail fixation for severe osteoporotic type Evans Ⅱ femoral intertrochanteric fractures was investigated by finite element analysis. Methods Computerized tomography(CT) data were collected from a patient with severe osteoporosis and left intertrochanteric fracture (femoral intertrochanteric fracture type Evans Ⅱ) admitted to the Orthopedic Center of the First Affiliated Hospital of Xinjiang Medical University on October 5,2020. The patient was 73 years old and had a height of 160 cm and body mass of 56 kg. The CT data were optimized in Mimics 20 software and Geomagic Wrap 2017 software to obtain the right side femoral 3D model. Solidworks 2017 software was used to draw an internal fixation model with standard surgical technique as reference. Osteotomy of the assembled model in 3-Matic software yielded the Evans Ⅱ femoral intertrochanteric fracture model. A portion of the cancellous bone around the proximal end of the intercepting screw was set as cemented parts and saved as models A (ordinary proximal femoral nail anti-rotation [PFNA]), B (nail reinforced PFNA), and C (reinforced screws), respectively. The corresponding parameters and conditions were obtained according to the patient CT data and the material standard of internal fixation according to the force of human mechanics in the femur and the body weight of the patient. The data were stored separately and analyzed using the Explicit Dynamics module in ansys 2019 software. Outcome measures: The measures included the inward turning angle of the femoral neck, the internal rotation angle of the femoral neck, the distribution of stress in the femoral bone, and the displacement of the proximal femoral head in comparison with the cutting degree of the three model screws in the proximal end of the femur. Results The three model screws cut, deform, and sink from the cement surface of the spiral blade to the distal end, with C, B, and A from light to heavy. The endrolus angle and femoral neck rotation angle were 0.37° and 0.16°, and those of model C were 0.32° and 0.15°, respectively. The stress of model A was mainly concentrated at the junction of spiral blade and main nail. Compared with models B and C, the stress transfered and dispersed to bone cement; the distance of femoral fracture was 5.8 mm, which was less compared with those in models A and B (both 6.7 mm). Conclusion Finite element analysis shows that intensive screw internal fixation for severe osteoporosis femoral intertrochanteric type Evans Ⅱ fracture has a better biomechanical effect than the common bone PFNA and nail tract-reinforced PFNA.
安慧刚, 杨毅, 麦合苏木·阿卜杜瓦克, 冯兴超, 叶尔扎提·哈加合曼, 曹力, 金格勒. 强化螺钉骨水泥髓内钉固定治疗重度骨质疏松性股骨转子间Evans Ⅱ型骨折的生物力学有限元分析[J]. 中华解剖与临床杂志, 2023, 28(2): 121-127.
An Huigang, Yang Yi, Maihesumu Abuduwake, Feng Xingchao, Yeerzhati Hajiaheman, Cao Li, Jin Gele. Biomechanical finite element analysis of reinforced screw fixation of intertrochanteric Evans Ⅱ fractures with severe osteoporosis. Chinese Journal of Anatomy and Clinics, 2023, 28(2): 121-127.
Nie SB, Zhao YP, Li JT, et al.Medial support nail and proximal femoral nail antirotation in the treatment of reverse obliquity inter-trochanteric fractures (Arbeitsgemeinschaft fur Osteosynthesfrogen/Orthopedic Trauma Association 31-A3.1): a finite-element analysis[J]. Chin Med J, 2020,133(22):2682-2687. DOI: 10.1097/CM9.0000000000001031
[2]
Xie H, Wang Z, Zhang J, et al.Clinical outcome of dynamic hip locking plates and proximal femoral nails anti-rotation-Asia for treating intertrochanteric femur fracture with lateral wall fractures in the elder patients[J]. Oncotarget, 2017,8(47):82700-82704. DOI: 10.18632/oncotarget.19754
[3]
Guo Y, Yang HP, Dou QJ, et al.Efficacy of femoral nail anti-rotation of helical blade in unstable intertrochanteric fracture[J]. Eur Rev Med Pharmacol Sci, 2017,21(3 Suppl):6-11
[4]
Wang J, Ma JX, Lu B, et al.Comparative finite element analysis of three implants fixing stable and unstable subtrochanteric femoral fractures: proximal femoral nail antirotation (PFNA), proximal femoral locking plate (PFLP), and reverse less invasive stabilization system (LISS)[J]. Orthop Traumatol Surg Res, 2020,106(1):95-101. DOI: 10.1016/j.otsr.2019.04.027
[5]
Vélez M, Palacios-Barahona U, Arango-Posada MM, et al.Functional results and complications of the use of the proximal femoral nail in the treatment of intertrochanteric hip fractures[J]. Acta Ortop Mex, 2018,32(3):126-130
[6]
Xu R, Ru J, Ji F, et al.Comparison of efficacy, complications and TGF-β2 expression between DHS and PFNA in elderly patients with osteoporotic femoral intertrochanteric fracture[J]. Exp Ther Med, 2018,16(1):394-399. DOI: 10.3892/etm.2018.6177
[7]
武政, 刘向栋, 常宝生. PFNA治疗高龄不稳定性股骨转子间骨折内固定失败的危险因素分析[J].局解手术学杂志,2017,26(8):616-619. DOI: 10.11659/jjssx.03E017091.Wu Z, Liu XD, Chang BS.Risk factor analysis on failure of internal fixation of unstable femoral intertrochanteric fractures treated with PFNA in elderly patients[J].Journal of Regional Anatomy and Operative Surgery,2017,26(8):616-619. DOI: 10.11659/jjssx.03E017091
Kumar A, Ghosh R.Fracture toughness of acrylic PMMA bone cement: a mini-review[J]. Indian J Orthop, 2021,55(5):1208-1214. DOI: 10.1007/s43465-021-00495-2
[10]
罗培杰, 袁凯, 李大星, 等. 长、短节段椎弓根螺钉并骨水泥强化治疗骨质疏松性胸腰段椎体骨折的有限元分析[J].中国组织工程研究,2020,24(3):342-347. DOI: 10.3969/j.issn.2095-4344.1926.Luo PJ, Yuan K, Li DX, et al.Comparison of the short-segment and long-segment cement-augmented pedicle screw fixation for osteoporotic thoracolumbar fracture: a finite element study[J]. Chinese Journal of Tissue Engineering Research,2020,24(3):342-347. DOI: 10.3969/j.issn.2095-4344.1926
[11]
杨红军, 苏高建, 冯智海, 等. 新型骨水泥椎弓根螺钉内固定系统治疗重度骨质疏松腰椎退变性疾病的临床研究[J].中国骨与关节杂志,2019,8(9):703-708. DOI: 10.3969/j.issn.2095-252X.2019.09.014.Yang HJ, Su GJ, Feng ZH, et al.A clinical study of a novel bone cement pedicle screw internal fixation system for the treatment of lumbar degenerative diseases with severe osteoporosis[J]. Chinese Journal of Bone and Joint,2019,8(9):703-708. DOI: 10.3969/j.issn.2095-252X.2019.09.014
[12]
黄培镇, 陈心敏, 郑利钦, 等. 骨水泥增强股骨近端防旋髓内钉治疗高龄不稳定型股骨转子间骨折的有限元分析[J].天津医药,2020,48(5):385-390,466. DOI: 10.11958/20193661.Huang PZ, Chen XM, Zheng LQ, et al.Finite element analysis of the treatment of unstable femoral intertrochanteric fractures with bone cement augmented proximal femoral anti rotation nail in elderly[J]. Tianjin Medical Journal,2020, 48(5):385-390,466. DOI: 10.11958/20193661
[13]
陈心敏, 李文标, 熊凯凯, 等. 钉道强化股骨近端防旋髓内钉治疗老年A3.3型股骨转子间骨折:最佳骨水泥量有限元分析[J].中国组织工程研究,2021,25(9):1404-1409. DOI: 10.3969/j.issn.2095-4344.4014.Chen XM, Li WB, Xiong KK, et al.Type A3.3 femoral intertrochanteric fracture with augmented proximal femoral nail anti-rotation in the elderly: finite element analysis of the optimal amount of bone cement[J]. Chinese Journal of Tissue Engineering Research,2021,25(9):1404-1409. DOI: 10.3969/j.issn.2095-4344.4014
王勇, 潘骏. 标准骨水泥强化型PFNA治疗老年股骨粗隆间不稳定骨折[J].中国矫形外科杂志,2018,26(18):1653-1658. DOI: 10.3977/j.issn.1005-8478.2018.18.05.Wang Y, Pan J.Preliminary clinical results of standardized cement augmented PFNA for unstable femoral intertrochanteric fracture in elderly[J]. Orthopedic Journal of China,2018,26(18):1653-1658. DOI: 10.3977/j.issn.1005-8478.2018.18.05
[16]
麦合苏木·阿卜杜瓦克,金格勒, 安慧刚, 等. 强化螺钉治疗重度骨质疏松股骨转子间Evans Ⅱ型骨折最佳骨水泥量的有限元分析[J].中华解剖与临床杂志, 2022,27(12):823-830. DOI: 10.3760/cma.j.cn101202-20220217-00049.Maihesumu A, Jin GL, An HG, et al.Finite element analysis of the optimal amount of bone cement in the treatment for elderly patients with severe osteoporotic intertrochanteric Evans Ⅱ fracture with reinforced screws[J]. Chin J Anat Clin, 2022,27(12): 823-830. DOI: 10.3760/cma.j.cn101202-20220217-00049
[17]
朱云, 陈渝, 邱皓, 等. 对侧皮质锁定螺钉治疗骨质疏松股骨骨折的有限元分析[J].中国组织工程研究,2021,25(24):3832-3837. DOI: 10.12307/2021.088.Zhu Y, Chen Y, Qiu H, et al.Finite element analysis for treatment of osteoporotic femoral fracture with far cortical locking screw[J]. Chinese Journal of Tissue Engineering Research,2021,25(24):3832-3837. DOI: 10.12307/2021.088
[18]
何祥鑫,林梓凌,李鹏飞,等. 基于Hypermesh 14.0和LS-DYNA的老年转子间骨折有限元建模分析[J].中国组织工程研究,2018,22(11):1725-1730. DOI: 10.3969/j.issn.2095-4344.0170.He XX, Lin ZL, Li PF, et al.Finite element analysis of intertrochanteric fractures in older adults based on Hypermesh 14.0 and LS-DYNA software[J]. Chinese Journal of Tissue Engineering Research, 2018,22(11):1725-1730. DOI: 10.3969/j.issn.2095-4344.0170
[19]
郑利钦, 林梓凌, 何祥鑫, 等. 动态载荷下股骨转子间区域皮质骨厚度对骨折类型影响的有限元分析[J].医学研究生学报,2018,31(10):1043-1046. DOI: 10.16571/j.cnki.1008-8199.2018.10.007.Zheng LQ, Lin ZL, He XX, et al.Impact of intertrochanteric cortical thickness on hip fracture types under dynamic load: a finite element analysis[J]. Journal of Medical Postgraduates,2018,31(10):1043-1046. DOI: 10.16571/j.cnki.1008-8199.2018.10.007
[20]
Kim Y, Bahk WJ, Yoon YC, et al.Radiologic healing of lateral femoral wall fragments after intramedullary nail fixation for A3.3 intertrochanteric fractures[J]. Arch Orthop Trauma Surg, 2015,135(10):1349-1356. DOI: 10.1007/s00402-015-2284-9
[21]
Kawabata Y, Matsuo K, Nezu Y, et al.The risk assessment of pathological fracture in the proximal femur using a CT-based finite element method[J]. J Orthop Sci, 2017,22(5):931-937. DOI: 10.1016/j.jos.2017.05.015
[22]
Goffin JM, Pankaj P, Simpson AH, et al.Does bone compaction around the helical blade of a proximal femoral nail anti-rotation (PFNA) decrease the risk of cut-out? A subject-specific computational study[J]. Bone Joint Res, 2013,2(5):79-83. DOI: 10.1302/2046-3758.25.2000150
[23]
Hinüber C, Kleemann C, Friederichs RJ, et al.Biocompatibility and mechanical properties of diamond-like coatings on cobalt-chromium-molybdenum steel and titanium-aluminum-vanadium biomedical alloys[J]. J Biomed Mater Res A, 2010,95(2):388-400. DOI: 10.1002/jbm.a.32851
[24]
Santoni BG, Diaz MA, Stoops TK, et al.Biomechanical investigation of an integrated 2-screw cephalomedullary nail versus a sliding hip screw in unstable intertrochanteric fractures[J]. J Orthop Trauma, 2019,33(2):82-87. DOI: 10.1097/BOT.0000000000001351
[25]
Gao Z, Lv Y, Zhou F, et al.Risk factors for implant failure after fixation of proximal femoral fractures with fracture of the lateral femoral wall[J]. Injury, 2018,49(2):315-322. DOI: 10.1016/j.injury.2017.11.011
[26]
郭良煜, 郭卫春. 磷酸钙骨水泥在骨修复应用研究的新进展[J].中国骨与关节杂志,2020,9(2):157-160.DOI: 10.3969/j.issn.2095-252X.2020.02.015.Guo LY,Guo WC.Recent advances in the application of calcium phosphate cement in bone regeneration[J].Chinese Journal of Bone and Joint,2020,9(2):157-160. DOI: 10.3969/j.issn.2095-252X.2020.02.015
[27]
张磊, 汪凌骏, 杨惠林, 等. 椎体后凸成形骨水泥注射治疗不同部位骨质疏松性椎体压缩骨折的疗效分析[J].中国组织工程研究,2019,23(14):2140-2146. DOI: 10.3969/j.issn.2095-4344.1633.Zhang L, Wang LJ,Yang HL, et al.Kyphoplasty with bone cement injection for the treatment of osteoporotic vertebral compression fractures in different parts of the spine[J]. Chinese Journal of Tissue Engineering Research,2019,23(14):2140-2146. DOI: 10.3969/j.issn.2095-4344.1633
2023, Vol. 28 
