钢板骨折区增加螺钉帽对胫骨骨折内固定影响的有限元分析
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摘要
目的探讨固定胫骨骨折时骨折区钢板置入螺钉帽对固定结构生物力学性能的影响。方法通过CT扫描数据和三维图像重建,模拟临床手术固定建立胫骨中段粉碎性骨折锁定钢板固定有限元模型,13孔钢板布钉位置为1、2、4、5、9、10、12、13孔,骨折区钉孔为6,7,8,并设计两种钢板固定方式:A(骨折区置入螺钉帽)和B(骨折区不置螺钉帽),对模型A和模型B分别进行600N压缩试验和1000N三点弯曲试验,计算分析模型各部位的力学指标并进行比较分析。结果压缩试验中,模型A钢板最大应力出现在钢板下端,模型B钢板最大应力出现在骨折区,模型A钢板最大应力明显小于模型B;三点弯曲试验中,两种模型钢板最大应力均出现在骨折区,模型A钢板最大应力明显小于模型B。结论在钢板骨折区空螺钉孔处增加螺钉帽,可以明显降低钢板的最大应力,减少钢板骨折区的应力集中,从而减少在骨折端处钢板发生疲劳性断裂的风险。
Objective To investigate the effect of the placement of the screw cap on the biomechanical properties of the fixed structure in the fracture zone when the fixed tibial fracture was performed. Methods Through the CT scan data and 3D image reconstruction, the finite element model of the fixed plate fixation of the comminuted fracture of middle tibia was established by simulated clinical operation. The position of the nail at the 13-hole plate was 1, 2, 4, 5, 9, 10, 12, and 13 holes, and nail holes in the fracture area were 6,7,and 8, and two kinds of plate fixation methods were designed: A(the screw cap placed in the fracture zone) and B(the screw cap not placed in the fracture zone), and model A and model B were tested by 600 N compression test and 1000 N three-point bending test respectively. The mechanical indexes of each part of the model were calculated and analyzed, and the comparison was made. Results In the compression test, the maximum stress of the model A steel plate appeared at the lower end of the steel plate, and the maximum stress of the model B steel plate appeared in the fracture zone. The maximum stress of the model A was significantly smaller than that of the model B. In the three-point bending test, the maximum stress of the two model steel plates appeared in the fracture zone. The maximum stress of model A was significantly smaller than that of model B. Conclusion Adding screw cap at the empty screw hole in the fracture zone of the steel plate can significantly reduce the maximum stress of the steel plate and reduce the stress concentration in the fracture zone of the steel plate, thereby reducing the risk of fatigue fracture of the steel plate at the fracture end.
Objective To investigate the effect of the placement of the screw cap on the biomechanical properties of the fixed structure in the fracture zone when the fixed tibial fracture was performed. Methods Through the CT scan data and 3D image reconstruction, the finite element model of the fixed plate fixation of the comminuted fracture of middle tibia was established by simulated clinical operation. The position of the nail at the 13-hole plate was 1, 2, 4, 5, 9, 10, 12, and 13 holes, and nail holes in the fracture area were 6,7,and 8, and two kinds of plate fixation methods were designed: A(the screw cap placed in the fracture zone) and B(the screw cap not placed in the fracture zone), and model A and model B were tested by 600 N compression test and 1000 N three-point bending test respectively. The mechanical indexes of each part of the model were calculated and analyzed, and the comparison was made. Results In the compression test, the maximum stress of the model A steel plate appeared at the lower end of the steel plate, and the maximum stress of the model B steel plate appeared in the fracture zone. The maximum stress of the model A was significantly smaller than that of the model B. In the three-point bending test, the maximum stress of the two model steel plates appeared in the fracture zone. The maximum stress of model A was significantly smaller than that of model B. Conclusion Adding screw cap at the empty screw hole in the fracture zone of the steel plate can significantly reduce the maximum stress of the steel plate and reduce the stress concentration in the fracture zone of the steel plate, thereby reducing the risk of fatigue fracture of the steel plate at the fracture end.
引文
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[15]张美超,钟世镇.国内生物力学中有限元的应用研究进展[J].解剖科学进展,2003,9(1):53-56.
[16]王志杰,丁自海,钟世镇.有限元法在骨应力分析及骨科内外固定系统研究中的应用[J].中国临床解剖学杂志,2006,24(1):107-110.
[17]王乙琲,许道荣,付茂庆,等.腓骨骨折或缺损对下肢功能影响的研究进展[J].中国临床解剖学杂志,2017,35(1):109-111.
[2]Johnson K.Locked plate stabilization of problem fractures[J].Vet Comp Orthop Traumatol,2016,29(1):V.
[3]刘晓辉,张国川.锁定加压钢板生物力学原理及置入后的失败分析[J].中国组织工程研究与临床康复,2011,15(4):717-720.
[4]张美超,夏虹,樊继宏.人体骨骼有限元几何模型的重建[J].中国临床解剖学杂志,2003,21(5):531-532.
[5]胡新佳,林博文,王华,等.胫骨中段骨折钢板螺钉固定的有限元分析[J].中华创伤骨科杂志,2011,13(7):666-670.
[6]张帆,汪志中,王斌,等.锁定钛板螺孔塞的设计与线性静力有限元分析[J].中华创伤骨科杂志,2017,19(7):608-616.
[7]刘福,吴树建,王立强.新型医用钛合金的特点及发展现状[J].热加工工艺,2008,37(12):100-103.
[8]赵英红,平杰,吴仁愿,等.胫骨骨折有限元模型建立及生物力学分析[J].军事医学,2016,40(12):988-993.
[9]李海岩,翟广凤,赵玮,等.基于有限元模型的下肢长骨动态试验的仿真研究[J].医用生物力学,2013,28(1):31-35.
[10].Smith TO,Hedges C,MacNair R.The clinical and radiological outcomes of the LISS plate for distal femoral fractures:a systematic review[J].Injury,2009,40(10):1049-1063.
[11]胡新佳,林博文,王华.胫骨中段骨折钢板固定螺钉位置的生物力学研究[J].医学临床研究,2011,28(2):197-200.
[12]胡新佳,杨述华,肖德明,等.胫骨中段骨折内固定钢板长度的生物力学研究[J].中国修复重建外科杂志,2008,22(11):1323-1326.
[13]刘晋川,易难,宋晓勇,等.四肢长骨干骨折钢板螺钉断裂的原因分析[J].华西医学,2000,15(2):187-188.
[14]杜增峰,朱强,马晓磊,等.胫骨中段横断骨折内外侧锁定钢板固定的生物力学比较与研究[J].河北医学,2016,22(6):895-898.
[15]张美超,钟世镇.国内生物力学中有限元的应用研究进展[J].解剖科学进展,2003,9(1):53-56.
[16]王志杰,丁自海,钟世镇.有限元法在骨应力分析及骨科内外固定系统研究中的应用[J].中国临床解剖学杂志,2006,24(1):107-110.
[17]王乙琲,许道荣,付茂庆,等.腓骨骨折或缺损对下肢功能影响的研究进展[J].中国临床解剖学杂志,2017,35(1):109-111.