股骨颈动力交叉钉系统(FNS)的临床疗效观察及有限元分析

Clinical Observation and Finite Element Analysis of Dynamic Cross-Pinning System of Femoral Neck (FNS)

摘要: 目的：探讨股骨颈动力交叉钉系统(FNS)的有限元分析及其治疗股骨颈骨折(FNF)的临床疗效。方法：选择自2021.12~2022.12在青岛市市立医院接受内固定治疗的年轻股骨颈骨折患者60例，以手术方式进行分组，空心加压螺钉(CCS)组30例接受CCS固定治疗，FNS组30例接受FNS固定治疗。观察两组患者围手术期相关指标，术后采用X线摄片、髋关节CT评估骨折愈合及股骨头是否出现缺血坏死，采用髋关节功能Harris评分对术后临床功能疗效进行评估。利用Solid Works建立股骨颈模型，Ansys workbench软件模拟并分析FNS固定股骨颈骨折的受力情况及特点，通过上述有限元分析技术探究FNS在治疗股骨颈骨折时的力学机制。结果：1) 两组患者性别、年龄、BMI水平、受伤致手术时间等基本资料比较，无统计学意义(P > 0.05)；而FNS组患者术前术后血红蛋白差值、手术时间、透视次数、失血量、切口长度等指标均低于CCS组，有统计学意义(P < 0.05)。2) FNS组患者的骨折愈合时间及术后6个月复诊时Harris评分均优于CCS组，有统计学意义(P < 0.05)。3) FNS组患者术后并发症发生率6.67%、低于CCS组患者并发症22.22%，有统计学意义(P < 0.05)。4) FNS组件在杨氏模量、泊松比、体积模量、剪切模量、拉伸屈服强度、拉伸极限强度等力学指标的分析研究中，各项性能均优于股骨。结论：1) 对于年轻股骨颈骨折患者使用CCS与FNS内固定手术治疗，结果分析表明FNS内固定治疗更符合微创理念，手术创伤更小，减少透视次数，操作简单，有助于术后快速康复。2) FNS内固定手术可以降低患者术后并发症的发生。3) FNS固定治疗对恢复患者髋关节功能作用更为显著，可早期功能锻炼，可更好提高患者生活质量。4) FNS内固定材料可以满足人体功能需求，可以作为一种可靠的内固定方式供临床选择。

Abstract: Objectiye: To investigate the finite element analysis of femoral neck dynamic cross pinning system (FNS) and its clinical effect in the treatment of femoral neck fracture. Methods: A total of 60 young patients with femoral neck fracture who received internal fixation treatment in Qingdao Municipal Hospital from December, 2021 to December, 2022 were selected and divided into surgical groups. 30 patients in the hollow compression screw (CCS) group received CCS fixation treatment, and 30 patients in the FNS group received FNS fixation treatment. Perioperative relevant indexes of the two groups were observed. Postoperative radiography and hip CT were used to evaluate fracture healing and ischemic necrosis of the femoral head. Postoperative clinical efficacy was evaluated by Harris score of hip function. SolidWorks was used to establish the femoral neck model, Ansys workbench software simulated and analyzed the stress situation and characteristics of FNS fixed femoral neck fracture, and explored the mechanical mechanism of FNS in the treatment of femoral neck fracture through the above finite element analysis technology. Result: 1) There was no statistical significance in gender, age, BMI level and operation time between the two groups (P > 0.05); The difference of hemoglobin before and after operation, operation time, fluoroscopy times, blood loss and incision length in FNS group were all lower than those in CCS group, with statistical significance (P < 0.05). 2) The fracture healing time and Harris score of patients in FNS group were better than those in CCS group at 6 months after surgery, with statistical significance (P < 0.05). 3) The incidence of postoperative complications in FNS group was 6.67%, lower than that in CCS group by 22.22%, with statistical significance (P < 0.05). 4) In the analysis and study of mechanical indexes such as Young’s modulus, Poisson’s ratio, volume modulus, shear modulus, tensile yield strength and tensile ultimate strength, FNS components are superior to femur. Conclusion: 1) For young patients with femoral neck fractures, CCS and FNS internal fixation surgery were used, and the analysis of the results showed that FNS internal fixation treatment was more in line with the concept of minimally invasive surgery, less surgical trauma, less fluoroscopy times, simple operation, and conducive to rapid postoperative recovery. 2) FNS internal fixation can reduce the incidence of postoperative complications. 3) FNS fixation therapy has a more significant effect on restoring the hip function of patients, and can provide early functional exercise and better improve the quality of life of patients. 4) FNS internal fixation materials can meet the functional needs of the human body and can be used as a reliable internal fixation method for clinical selection.