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  • Title: [Finite element analysis of evaluating the change of the hip joint biomechanics following femoral neck shortening after cannulated screw fixation for osteoporotic femoral neck fracture].
    Author: Yu X, Zhang DF, Song MS, Chen ZM, Yang K, Pang QJ.
    Journal: Zhonghua Yi Xue Za Zhi; 2020 Sep 08; 100(33):2628-2632. PubMed ID: 32892611.
    Abstract:
    Objective: To evaluate the stress status of femoral head and neck, screws and acetabulum caused by femoral neck shortening after internal fixation of femoral neck fracture with finite element method, and to analyze the stress of proximal femoral neck and acetabulum from the mechanical point of view. Methods: CT scan data of hip of a healthy adult female were collected. Three-dimensional reconstruction MICs and related module function simulation was used to establish the postoperative shortening model of femoral neck fracture with Pauwells angle>50°, which was treated with cannulated screws. The models were divided into four groups: normal femoral neck without shortening, shortening for 2.5 mm, shortening for 7.5 mm and shortening for 12.5 mm. The finite element analysis software MSC. Nastran2012 was used to do the mechanical analysis. The acetabulum surface, femoral head surface, proximal femur and the maximum stress, stress nephogram and other relevant data were collected. Results: The maximum tensile stress and the maximum stress at the fracture site of the femoral neck increased gradually with the increasing of shortening of femoral neck, however, the maximum compressive stress under the femoral neck and the medial cortex decreased gradually; the maximum stress on the surface of the femoral head was 14.9, 15.0, 16.3 and 16.3 MPa, respectively; the maximum stress on the surface of the acetabulum was 10.1, 10.1 and 10.5,11.7 MPa, respectively. Conclusion: The mechanical environment of the hip joint changes with femoral neck shortening. With the increasing of femoral neck shortening, the peak stress of the acetabulum increases continuously. When the femoral neck is shortened seriously, the load distribution is uneven and the complex mobility of hip joint is decreased. In addition, the change of shortening might play a role in the necrosis of femoral head. 目的： 运用有限元分析法评估股骨颈骨折内固定术后股骨颈短缩对股骨头颈、螺钉以及髋臼受力状况，从力学角度对股骨颈及髋臼进行受力分析。 方法： 收集1名健康成年女性髋部CT扫描数据。运用三维重建Mimics软件及相关功能模拟建立Pauwells角>50°的股骨颈骨折空心钉术后短缩模型，分为正常无短缩组、短缩2.5 mm组、短缩7.5 mm组、短缩12.5 mm组，利用有限元分析软件MSC.Nastran 2012进行力学分析，得到不同股骨颈短缩模型的髋臼表面、股骨头表面、股骨近端最大应力、应力云图等相关数据。 结果： 股骨颈无短缩、短缩2.5 mm、短缩7.5 mm和短缩12.5 mm的情况下，股骨颈上方空心钉最大拉伸应力以及股骨颈骨折端最大应力值逐渐增大；股骨颈下方以及内侧皮质区受到的最大压缩应力值逐渐减小；股骨头表面最大应力分别为14.9、15.0、16.3、16.3 MPa，髋臼表面最大应力则分别为10.1、10.1、10.5、11.7 MPa。 结论： 股骨颈短缩后髋关节力学环境发生变化，随着颈短缩程度的加剧髋臼的应力峰值不断增高，当股骨颈重度短缩时，导致负荷分布不均，髋关节复杂活动能力下降，并且股骨颈骨折术后短缩的改变可能在术后股骨头坏死中起一定作用。.
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