Prediction of proximal femur strength using a CT-based nonlinear finite element method: Differences in predicted fracture load and site with changing load and boundary conditions
Prediction of proximal femur strength using a CT-based nonlinear finite element method: Differences in predicted fracture load and site with changing load and boundary conditions
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DOI：
10.1016/j.bone.2009.04.241
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发表时间：
2009-08-01
期刊：
影响因子：
4.1
通讯作者：
Nakamura, Kozo
中科院分区：
文献类型：
--
作者：
Bessho, Masahiko;Ohnishi, Isao;Nakamura, Kozo
截至2002年，日本因骨质疏松症导致的髋部骨折年发病数已达12万例，且增长迅速。从生物力学角度来看，在实际情况中，髋部骨折被认为是由不同的受力方向引起的。因此，明确股骨近端最易骨折的受力方向，将有助于阐明骨折力学原理并制定预防措施。本研究旨在利用基于CT的非线性有限元方法，明确受力方向对股骨近端强度和骨折部位的影响，以确定股骨近端最易骨折的受力方向。对42名髋部骨折女性（平均年龄82.4岁，其中包括20例股骨颈骨折和22例转子间骨折）的对侧股骨进行了分析。在骨折后1周内，对每位患者的对侧股骨进行定量CT检查，并创建三维有限元模型。设定了一种站立受力配置（SC）和四种不同的跌倒受力配置（FC），并进行了非线性有限元分析。分析了因受力方向不同而导致的骨折载荷差异，并评估了不同受力方向的骨折载荷之间的相关性。接下来，还对骨折部位进行了分析。SC中的平均预测骨折载荷为3150 N。FC1中的平均骨折载荷为2270 N，FC2中为1060 N，FC3中为980 N，FC4中为710 N。SC中的预测骨折载荷与各FC中的预测骨折载荷之间的相关性显著，相关系数为0.467 - 0.631。SC中的预测骨折部位在所有患者中均出现在股骨头下区域，归类为股骨颈骨折。然而，除FC1外，所有跌倒受力配置中均出现转子间骨折。在FC1中，实际骨折类型与预测类型之间存在显著相关性。本研究有助于获取有用知识，从而建立更有效的髋部骨折预防方法。（C）2009爱思唯尔公司。保留所有权利。
The annual occurrence of hip fracture due to osteoporosis as of 2002 had reached 120,000 in Japan. The increase has been very rapid. From a biomechanical perspective, hip fractures are thought to be caused in real settings by different directions of loading. Thus, clarification of the loading directions under which the proximal femur is most vulnerable to fracture would be helpful for elucidating fracture mechanics and establishing preventive interventions. The purpose of the current study was to clarify the influence of loading direction on strength and fracture site of the proximal femur using the CT-based nonlinear FE method to determine loading directions under which the proximal femur is most vulnerable to fracture. Contralateral femora were analyzed in 42 women with hip fracture (mean age, 82.4 years), comprising 20 neck fractures and 22 trochanteric fractures. Within I week after fracture, quantitative CT of the contralateral femur was performed in each patient and 3-dimensional FE models were created. One stance loading configuration (SC) and four different fall loading configurations (FC) were assigned. Nonlinear FE analysis was performed. Differences in fracture loads depending on differences in loading direction were analyzed and correlations among fracture loads in different loading directions were assessed. Next, fracture sites were also analyzed. Mean predicted fracture load in the SC was 3150 N. Mean fracture loads were 2270 N in FC1, 1060 N in FC2, 980 N in FC3, and 710 N in FC4. The correlation between predicted fracture loads in SC and those in each FC was significant with a correlation coefficient of 0.467-0.631. Predicted fracture sites in the SC appeared at the subcapital region in all patients and were categorized as neck fracture. However, trochanteric fractures occurred in all fall configurations except FC1. In FC1, a significant correlation was seen between real fracture type and predicted type. The current investigation could contribute to the acquisition of useful knowledge allowing the establishment of more efficacious means of preventing hip fractures. (C) 2009 Elsevier Inc. All rights reserved.