مناسبترين زاويه والگوس استئوتومي هيپ براي درمان عدم جوش خوردن شكستگي گردن فمور با شبي هسازي رايان هاي

The Best Valgus Angle of Hip Joint for the Treatment of Nonunio‎n in Femoral Neck Fracture by Computational Simulation

ﺯﻣﻴﻨﻪ ﻭ ﻫﺪﻑ: ﺷﻜﺴﺘﮕﻲ ﮔﺮﺩﻥ ﻓﻤﻮﺭ ﻳﻜﻲ ﺍﺯ ﭘﺮﻋﺎﺭﺿﻪﺗﺮﻳﻦ ﺷﻜﺴﺘﮕﻲﻫﺎ ﺍﺳﺖ ﻭ ﻋﺎﺭﺿﻪ ﺷﺎﻳﻊ ﺁﻥ ﻋﺪﻡ ﺟﻮﺵ ﺧﻮﺭﺩﻥ ﺍﺳﺖ. ﻳﻜﻲ ﺍﺯ ﺭﻭﺵﻫﺎﻱ ﺩﺭﻣﺎﻥ ﺍﻳﻦ ﻋﺎﺭﺿﻪ ﺩﺭ ﺻﻮﺭﺕ ﺯﻧﺪﻩ ﺑﻮﺩﻥ ﺳﺮ ﺍﺳﺘﺨﻮﺍﻥ ﻓﻤﻮﺭ ﺗﻐﻴﻴﺮ ﺯﺍﻭﻳﻪ ﺧﻂ ﺷﻜﺴﺘﮕﻲ ﻭ ﺗﺒﺪﻳﻞ ﻧﻴﺮﻭﻱ ﺟﺎﺑﺠﺎ ﻛﻨﻨﺪﻩ ﺑﻪ ﻧﻴﺮﻭﻱ ﻓﺸﺎﺭﻱ ﺩﺭ ﻣﺤﻞ ﺷﻜﺴﺘﮕﻲ ﺍﺳﺖ ﻛﻪ ﺳﺒﺐ ﺟﻮﺵ ﺧﻮﺭﺩﻥ ﻣﺤﻞ ﺷﻜﺴﺘﮕﻲ ﻣﻲﺷﻮﺩ ﻭﻟﻲ ﺍﺯ ﻃﺮﻑ ﺩﻳﮕﺮ ﺑﺎ ﺑﺮ ﻫﻢ ﺯﺩﻥ ﺑﻴﻮﻣﻜﺎﻧﻴﻚ ﻫﻴﭗ، ﺍﻳﻦ ﻣﻔﺼﻞ ﺭﺍ ﻣﺴﺘﻌﺪ ﺗﺨﺮﻳﺐ ﺯﻭﺩﺭﺱ ﻣﻲﻛﻨﺪ. ﻟﺬﺍ ﻫﺪﻑ ﻣﺎ ﺑﻪ ﺩﺳﺖ ﺁﻭﺭﺩﻥ ﺯﺍﻭﻳﻪ ﺍﻱ ﺍﺳﺖ ﻛﻪ ﺍﺯ ﻳﻚ ﻃﺮﻑ ﺳﺒﺐ ﺗﺴﺮﻳﻊ ﺩﺭ ﺟﻮﺵ ﺧﻮﺭﺩﻥ ﺷﻮﺩ ﻭ ﺍﺯ ﻃﺮﻑ ﺩﻳﮕﺮ ﻣﻔﺼﻞ ﺭﺍ ﺑﻪ ﺳﻤﺖ ﺁﺭﺗﺮﻭﺯ ﻭ ﺗﺨﺮﻳﺐ ﺳﻮﻕ ﻧﺪﻫﺪ. ﻣﻮﺍﺩ ﻭ ﺭﻭﺵ ﻫﺎ: ﺑﺎ ﺗﺤﻠﻴﻞ ﺑﻴﻮﻣﮑﺎﻧﻴﻜﻲ ﻭ ﺍﺳﺘﻔﺎﺩﻩ ﺍﺯ ﺷﺒﻴﻪﺳﺎﺯﻱ ﺭﺍﻳﺎﻧﻪﺍﻱ، ﻧﻴﺮﻭﻱ ﻟﻐﺰﺍﻧﻨﺪﻩ ﻭ ﺟﺎﺑﺠﺎ ﻛﻨﻨﺪﻩ ﺷﻜﺴﺘﮕﻲ ﮔﺮﺩﻥ ﺍﺳﺘﺨﻮﺍﻥ ﺭﺍﻥ ﻭ ﻧﻴﺮﻭﻱ ﻭﺍﺭﺩ ﺷﺪﻩ ﺑﻪ ﺳﺮ ﻓﻤﻮﺭ ﺭﺍ ﺩﺭ ﺯﻭﺍﻳﺎﻱ ﻣﺨﺘﻠﻒ ﻭﺍﻟﮕﻮﺱ ﺑﺎ ﺩﺭ ﻧﻈﺮ ﮔﺮﻓﺘﻦ ﻓﺎﻛﺘﻮﺭﻫﺎﻱ ﻫﻨﺪﺳﻲ ﻭ ﺑﻴﻮﻟﻮﮊﻳﻜﻲ ﻓﺮﺩ ﺑﺮﺭﺳﻲ ﺷﺪ. ﺟﻬﺖ ﺍﻳﺠﺎﺩ ﺷﮑﺴﺘﮕﻲ ﺩﺭ ﻓﻤﻮﺭ ﻭ ﻣﺪﻝﺳﺎﺯﻱ Blade ﺍﺯ ﻧﺮﻡ ﺍﻓﺰﺍﺭ Solidworks ﺍﺳﺘﻔﺎﺩﻩ ﺷﺪ ﻭ ﺳﭙﺲ Blade ﺩﺭ ﻣﻮﻗﻌﻴﺖ ﻣﻨﺎﺳﺐ ﺑﺮﺍﻱ ﺍﺳﺘﺌﻮﺗﻮﻣﻲ ﻗﺮﺍﺭ ﺩﺍﺩﻩ ﺷﺪ، ﺳﭙﺲ ﺟﻬﺖ ﺍﻧﺠﺎﻡ ﺷﺒﻴﻪ ﺳﺎﺯﻱ ﻫﻨﺪﺳﻪ ﻣﺴﺌﻠﻪ ﺑﻪ ﻧﺮﻡ ﺍﻓﺰﺍﺭ ﺍﻧﺴﻴﺲ ﻭﺍﺭﺩ ﺷﺪ. ﻳﺎﻓﺘﻪ ﻫﺎ: ﺷﺒﻴﻪﺳﺎﺯﻱ ﺑﺮﺍﻱ ﺯﻭﺍﻳﺎ ﻣﺨﺘﻠﻒ ﺷﮑﺴﺘﮕﻲ )ﺍﺯ 30 ﺗﺎ 70 ﺩﺭﺟﻪ( ﻭ ﺯﻭﺍﻳﺎﻱ ﻣﺨﺘﻠﻒ ﺍﺻﻼﺡ )ﺍﺯ 0 ﺗﺎ 40 ﺩﺭﺟﻪ( ﺍﻧﺠﺎﻡ ﺷﺪ. ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﻫﺪﻑ ﮐﺎﺳﺘﻦ ﺍﺯ ﺗﻨﺶ ﺑﺮﺷﻲ ﺩﺭ ﺳﻄﺢ ﺷﮑﺴﺖ ﭘﺎﺭﺍﻣﺘﺮ ﺷﺪﺕ ﺗﻨﺶ )Stress Intensity( ﺩﺭ ﺍﻳﻦ ﺳﻄﺢ ﺑﺮﺍﻱ ﻗﻀﺎﻭﺕ ﺑﻬﺘﺮﻳﻦ ﺯﺍﻭﻳﻪ ﺍﺳﺘﻴﻮﺗﻮﻣﻲ ﺍﺳﺘﻔﺎﺩﻩ ﺷﺪﻩ ﺍﺳﺖ. ﻻﺯﻡ ﺑﻪ ﺫﮐﺮ ﺍﺳﺖ ﺩﺭ ﺯﻭﺍﻳﺎﻱ 50 ﻭ 55 ﺩﺭﺟﻪ ﭘﺎﻭﻝ، ﺗﻐﻴﻴﺮ ﭼﻨﺪﺍﻧﻲ ﺩﺭ ﻣﻘﺎﺩﻳﺮ ﺗﻨﺶ ﺑﺮﺷﻲ ﺑﺎ ﺗﻐﻴﻴﺮ ﺯﺍﻭﻳﻪ ﺍﺻﻼﺡ ﺩﻳﺪﻩ ﻧﺸﺪ. ﻧﺘﻴﺠﻪ ﮔﻴـﺮﻱ: ﺑﺮ ﺍﺳﺎﺱ ﻧﺘﺎﻳﺞ ﺍﻳﻦ ﻣﻄﺎﻟﻌﻪ ﻣﻘﺎﺩﻳﺮ ﺷﺪﺕ ﺗﻨﺶ ﺑﻪ ﺩﺳﺖ ﺁﻣﺪﻩ ﺍﺯ ﺷﺒﻴﻪﺳﺎﺯﻱﻫﺎﻱ ﺍﻧﺠﺎﻡ ﺷﺪﻩ ﻭ ﻣﻘﺎﺩﻳﺮ ﺯﻭﺍﻳﺎﻱ ﭘﻴﺸﻨﻬﺎﺩﻱ ﺍﺳﺘﺌﻮﺗﻮﻣﻲ ﺑﺮ ﺍﺳﺎﺱ ﮐﻤﻴﻨﻪ ﻣﻴﺰﺍﻥ ﺗﻨﺶ ﺑﺮﺷﻲ ﺍﺭﺍﻳﻪ ﺷﺪ. ﺩﺭ ﻣﺤﺪﻭﺩﻩ ﺍﺻﻼﺣﯽ 0 ﺗﺎ 40 ﺩﺭﺟﻪ ﺍﻓﺰﺍﻳﺶ ﺩﺭﺟﻪ ﻭﺍﻟﮕﻮﺱ، ﺗﻐﻴﻴﺮ ﺯﺍﻭﻳﻪ ﺗﺄﺛﻴﺮ ﭼﻨﺪﺍﻧﯽ ﺩﺭ ﻧﻴﺮﻭﯼ ﻭﺍﺭﺩ ﺷﺪﻩ ﺑﻪ ﺳﺮ ﻓﻤﻮﺭ ﻧﺪﺍﺭﺩ.

Introduction & Objective: Femoral neck fracture is one of the most complicated fractures in orthopedic diseases, and its common complication is nonunio‎n. If the head of femur is alive, one of treatments of nonunio‎n is to alter the fracture line angle and the conversion of displacing force to pressure force at the site of fracture, and this leads to unio‎n. On the other hand, it changes the biomechanic of hip and disposes it early destruction that will affect patient’s life adverse. Our aim in this study was to achieve an angle that accelerates unio‎n and on the other hand does not lead to Arthrosis and joint destruction. Materials & Methods: With biomechanical analysis and using computational simulation, we assessed the displacing force of femur neck fracture and the pressure force on the head of femur at different angles of valgus. Considering individual geometrical and biological factores and producing graphs to be able to determine the proper angle for valgus osteotomy. It must be able to produce proper pressure force for unio‎n at the fracture site, not leading at the destruction of femur head, and not exceeding the physiological limits. To produce fracture in femur and Blade modeling we used solid work software, and then located the blade at the proper place for osteotomy. Geometry was used in the software to perform simulation. Results: We offered values of stress intensity for fracture angles 30 to 70 and correction angles 0 to 40, and obtained from simulations suitable angles for osteotomy, based on the minimum of shear stress. Furthermore, at the angles 50 and 55 there was no significant change in the shear stress. Conclusions: According to the results of this study, we offered stress intensity suggested through simulations and recommended angles for osteotomy, based on the minimum of shear stress. Changing the fracture line between 0 to 40 degree had no obvious effect on the force on the head of the femur