钉棒内固定Tile B2型骨盆骨折的生物力学效果
|
摘要
目的通过对比钉棒系统和钢板内固定Tile B2型骨盆骨折的生物力学行为,研究钉棒系统固定骨盆骨折的有效性。方法构建包含韧带结构的正常骨盆和2钉、3钉患侧、3钉健侧、钢板内固定Tile B2型骨盆有限元模型,在S1椎体上施加500 N均布载荷,模拟骨盆在双腿站立、单腿站立和坐位下的受力情况,对比正常骨盆与钉棒内固定、钢板内固定骨盆的位移和应力分布。结果钉棒系统和钢板均能对骨盆骨折进行有效固定,两者显示出与正常骨盆相似的位移和应力分布。各内固定中,3钉患侧内固定骨盆的最大位移在各工况下均最小,同时其应力水平明显低于其他内固定,双腿站立下其最大等效应力比2钉、3钉健侧和钢板内固定分别降低30.4%、20.8%、20.3%;坐位下分别降低31.8%、25.4%、18.5%;单腿站立下分别降低-6.5%、28.0%、61.1%。结论钉棒系统能够对Tile B2型骨盆骨折进行有效固定,且3钉患侧固定效果最佳。研究结果能够为临床骨盆骨折的方案选择提供理论依据。
Objective To investigate the validity of screw-rod system for fixing pelvic fractures by comparing the biomechanical behaviors from using screw-rod system or steel plate for fixing Tile B2 type pelvic fractures. Methods The finite element models of normal pelvis including ligaments,and Tile B2 fractured pelvis fixed by different screw-rod fixations( 2 screws at fractured side,3 screws at fractured side and at healthy side),and steel plate fixation were established. The vertical load( 500 N) was applied on the upper terminal plate of the first body of the sacrum to simulate pelvis load during double-leg standing,single-leg standing and sitting. The displacement and stress distributions on normal pelvis and fractured pelvis with screw-rod fixation or with steel plate fixation were compared and analyzed. Results Both the screw-rod system and steel plate could effectively fix the fractured pelvis,and the fixation models showed similar displacement and stress distribution as normal pelvis. The largest displacement of fractured pelvis with 3-screw fixation on the diseased side was smallest under each working condition,and its stress level was also obviously lower than that of the other internal fixation models. During double-leg standing,compared with 2 screws fixation,3 screws at healthy side fixation,and steel plate fixation,the Von Mises stress for 3 screws at fractured side fixation was reduced by 30. 4%,20. 8%,20. 3%; during single-leg standing,the Von Mises stress for 3 screws at fractured side fixation was reduced by 31. 8%,25. 4%,18. 5%; during sitting,the Von Mises stress for 3 screws at fractured side fixation is reduced by- 6. 5%,28. 0%,61. 1%,respectively. Conclusions The screw-rod system can fix Tile B2 pelvic fracture effectively,especially for3-screw fixation on the fractured side. The results can provide the theory basis for clinical treatment of pelvic fracture.
Objective To investigate the validity of screw-rod system for fixing pelvic fractures by comparing the biomechanical behaviors from using screw-rod system or steel plate for fixing Tile B2 type pelvic fractures. Methods The finite element models of normal pelvis including ligaments,and Tile B2 fractured pelvis fixed by different screw-rod fixations( 2 screws at fractured side,3 screws at fractured side and at healthy side),and steel plate fixation were established. The vertical load( 500 N) was applied on the upper terminal plate of the first body of the sacrum to simulate pelvis load during double-leg standing,single-leg standing and sitting. The displacement and stress distributions on normal pelvis and fractured pelvis with screw-rod fixation or with steel plate fixation were compared and analyzed. Results Both the screw-rod system and steel plate could effectively fix the fractured pelvis,and the fixation models showed similar displacement and stress distribution as normal pelvis. The largest displacement of fractured pelvis with 3-screw fixation on the diseased side was smallest under each working condition,and its stress level was also obviously lower than that of the other internal fixation models. During double-leg standing,compared with 2 screws fixation,3 screws at healthy side fixation,and steel plate fixation,the Von Mises stress for 3 screws at fractured side fixation was reduced by 30. 4%,20. 8%,20. 3%; during single-leg standing,the Von Mises stress for 3 screws at fractured side fixation was reduced by 31. 8%,25. 4%,18. 5%; during sitting,the Von Mises stress for 3 screws at fractured side fixation is reduced by- 6. 5%,28. 0%,61. 1%,respectively. Conclusions The screw-rod system can fix Tile B2 pelvic fracture effectively,especially for3-screw fixation on the fractured side. The results can provide the theory basis for clinical treatment of pelvic fracture.
引文
[1]Connor GS,Me Gwin G,Mac Lennan PA,et al.Early versus delayed fixation of pelvic ring fractures[J].Am Surg,2003,69(12):1019-1023.
[2]Riemer BL,Butterfield SL,Diamond DL,et al.Acute mortality associated with injuries to the pelvic ring:The role of early patient mobilization and external fixation[J].J Trauma,1993,35(5):671-677.
[3]李尚政,苏伟,赵劲民,等.钉-棒系统与外固定支架固定骨盆不稳定损伤模型的生物力学比较[J].中华创伤骨科杂志,2013,15(6):517-519.
[4]Gardner MJ,Mehta S,Mirza A,et al.Anterior pelvic reduction and fixation using a subcutaneous internal fixator[J].J Orthop Trauma,2012,26(5):314-321.
[5]Vaidya R,Colen R,Vigdorchik J,et al.Treatment of unstable pelvic ring injuries with an internal anterior fixator and posterior fixation:Initial clinical series[J].J Oahop Trauma,2012,26(1):1-8.
[6]Martins JA,Pato MP,Pires EB,et al.Finite element studies of the deformation of the pelvic floor[J].Ann N Y Acad Sci,2007,1101:316-334.
[7]肖进,尹庆水,张美超,等.垂直载荷作用下骨盆的三维有限元分析[J].中国组织工程研究与临床康复,2008,12(39):7615-7619.
[8]汪方,石杜芳,王秋根,等.基于冰冻切片的人体骨盆有限元模型的建立与初步验证[J].复旦学报(医学版),2010,37(4):384-390.
[9]Anderson AE,Peters GJ,Tuttle BD,et al.Subjectspecific finite element model of the pelvis:Development,validation and sensitivity studies[J].J Biomech Eng,2005,127(3):364-373.
[10]Garcia JM,Doblare M,Seral B,et al.Three-dimensional finite element analysis of several internal and external pelvis fixations[J].J Biomech Eng,2000,122(5):516-522.
[11]Zheng N,Watson LG,Yong-Hing K.Biomechanical modelling of the human sacroiliac joint[J].Med Biol Eng Comput,1997,35(2):77-82.
[12]雷建银,刘海波,王志华,等.站立位下骨盆与骨折内固定稳定性分析[J].医用生物力学,2014,29(6):517-523.Lei YJ,Liu HB,Wang ZH,et al.Stability analysis of the pelvis and fracture fixation in standing position[J].J Med Biomech,2014,29(6):517-523.
[13]张宁华,汪方,石杜芳,等.骶髂融合治疗下腰痛的生物力学效应[J].医用生物力学,2013,28(4):425-431.Zhang NH,Wang F,Shi DF,et al.Biomechanical effects on sacroiliac fusion for treating low back pain[J].J Med Biomech,2013,28(4):425-431.
[14]高应超,郭征,付军,等.坐位骨盆的三维有限元分析[J].中国组织工程研究与临床康复,2011,15(22):3997-4001.
[15]汪方,陈博,王秋根,等.髂骨翼与髋臼上置钉技术在Tile B1型骨盆骨折外固定的有限元研究[J].中华创伤骨科杂志,2011,13(6):524-538.
[16]Garcia JM,Doblare M,Seral B,et al.Three-dimensional finite element analysis of several internal and external pelvis fixations[J].J Biomech Eng,2000,122(5):516-522.
[17]Phillips AT,Pankaj P,Howie CR,et al.Finite element modelling of the pelvis:Inclusion of muscular and ligamentous boundary conditions[J].Med Eng Phys,2007,29(7):739-748.
[18]程黎明,贾永伟,俞光荣,等.人体全骨盆三维有限元模型的建立与验证[J].中华医学杂志,2007,87(47):3346-3348.
[19]姜雨辰.骨盆弓状线上下缘解剖型内固定器的设计及有限元分析[D].上海:上海交通大学硕士学位论文,2015.
[20]Vigdorchik JM,Esquivel AO,Jin X,et al.Biomechanical stability of a supra-acetabular pedicle screw internal fixation device(INFIX)vs external fixation and plates for vertically unstable pelvic fractures[J].J Orthop Surg Res,2012,7(1):1-5.
[21]Vaidya R,Colen R,Vigdorchik J,et al.Anterior pelvic reduction and fixation using a subcutaneous internal fixator[J].J Orthop Trauma,2012,26(1):1-8.
[22]姬涛,高相飞,郭卫,等.骨盆环三维有限元模型的建立[J].中国组织工程研究与临床康复,2009,13(9):1625-1628.
[23]高应超,郭征,付军,等.坐位骨盆的三维有限元分析[J].中国组织工程研究与临床康复,2011,15(22):3997-4001.
[2]Riemer BL,Butterfield SL,Diamond DL,et al.Acute mortality associated with injuries to the pelvic ring:The role of early patient mobilization and external fixation[J].J Trauma,1993,35(5):671-677.
[3]李尚政,苏伟,赵劲民,等.钉-棒系统与外固定支架固定骨盆不稳定损伤模型的生物力学比较[J].中华创伤骨科杂志,2013,15(6):517-519.
[4]Gardner MJ,Mehta S,Mirza A,et al.Anterior pelvic reduction and fixation using a subcutaneous internal fixator[J].J Orthop Trauma,2012,26(5):314-321.
[5]Vaidya R,Colen R,Vigdorchik J,et al.Treatment of unstable pelvic ring injuries with an internal anterior fixator and posterior fixation:Initial clinical series[J].J Oahop Trauma,2012,26(1):1-8.
[6]Martins JA,Pato MP,Pires EB,et al.Finite element studies of the deformation of the pelvic floor[J].Ann N Y Acad Sci,2007,1101:316-334.
[7]肖进,尹庆水,张美超,等.垂直载荷作用下骨盆的三维有限元分析[J].中国组织工程研究与临床康复,2008,12(39):7615-7619.
[8]汪方,石杜芳,王秋根,等.基于冰冻切片的人体骨盆有限元模型的建立与初步验证[J].复旦学报(医学版),2010,37(4):384-390.
[9]Anderson AE,Peters GJ,Tuttle BD,et al.Subjectspecific finite element model of the pelvis:Development,validation and sensitivity studies[J].J Biomech Eng,2005,127(3):364-373.
[10]Garcia JM,Doblare M,Seral B,et al.Three-dimensional finite element analysis of several internal and external pelvis fixations[J].J Biomech Eng,2000,122(5):516-522.
[11]Zheng N,Watson LG,Yong-Hing K.Biomechanical modelling of the human sacroiliac joint[J].Med Biol Eng Comput,1997,35(2):77-82.
[12]雷建银,刘海波,王志华,等.站立位下骨盆与骨折内固定稳定性分析[J].医用生物力学,2014,29(6):517-523.Lei YJ,Liu HB,Wang ZH,et al.Stability analysis of the pelvis and fracture fixation in standing position[J].J Med Biomech,2014,29(6):517-523.
[13]张宁华,汪方,石杜芳,等.骶髂融合治疗下腰痛的生物力学效应[J].医用生物力学,2013,28(4):425-431.Zhang NH,Wang F,Shi DF,et al.Biomechanical effects on sacroiliac fusion for treating low back pain[J].J Med Biomech,2013,28(4):425-431.
[14]高应超,郭征,付军,等.坐位骨盆的三维有限元分析[J].中国组织工程研究与临床康复,2011,15(22):3997-4001.
[15]汪方,陈博,王秋根,等.髂骨翼与髋臼上置钉技术在Tile B1型骨盆骨折外固定的有限元研究[J].中华创伤骨科杂志,2011,13(6):524-538.
[16]Garcia JM,Doblare M,Seral B,et al.Three-dimensional finite element analysis of several internal and external pelvis fixations[J].J Biomech Eng,2000,122(5):516-522.
[17]Phillips AT,Pankaj P,Howie CR,et al.Finite element modelling of the pelvis:Inclusion of muscular and ligamentous boundary conditions[J].Med Eng Phys,2007,29(7):739-748.
[18]程黎明,贾永伟,俞光荣,等.人体全骨盆三维有限元模型的建立与验证[J].中华医学杂志,2007,87(47):3346-3348.
[19]姜雨辰.骨盆弓状线上下缘解剖型内固定器的设计及有限元分析[D].上海:上海交通大学硕士学位论文,2015.
[20]Vigdorchik JM,Esquivel AO,Jin X,et al.Biomechanical stability of a supra-acetabular pedicle screw internal fixation device(INFIX)vs external fixation and plates for vertically unstable pelvic fractures[J].J Orthop Surg Res,2012,7(1):1-5.
[21]Vaidya R,Colen R,Vigdorchik J,et al.Anterior pelvic reduction and fixation using a subcutaneous internal fixator[J].J Orthop Trauma,2012,26(1):1-8.
[22]姬涛,高相飞,郭卫,等.骨盆环三维有限元模型的建立[J].中国组织工程研究与临床康复,2009,13(9):1625-1628.
[23]高应超,郭征,付军,等.坐位骨盆的三维有限元分析[J].中国组织工程研究与临床康复,2011,15(22):3997-4001.