不同内固定方式固定骶髂关节脱位的三维有限元分析
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摘要
目的应用三维有限元分析法比较3种不同内固定器械治疗骶髂关节脱位的生物力学稳定性。方法随机挑选1名健康成年男性,收集层厚1.0mm骨盆CT图像,经过Mimics 10.01、Geomagic Studio 12、SolidWorks、Abaqus 6.11-1等软件处理,构建完整的骨盆模型及骶髂关节脱位模型,分别使用2枚骶髂螺钉、可调式微创接骨板、张力带接骨板固定骨盆后环,对骶骨加载500N负荷,比较整个模型和内固定器械的整体位移值、应变值、应力分布以及脱位的缝隙分离值。结果上半身的重力经过骶骨翼、双侧骶髂关节、坐骨大切迹、髂骨弓状线到双侧髋臼。在500N垂直载荷下,固定后的模型的整体位移值依次是2枚骶髂螺钉1.377mm、可调式微创接骨板为2.517mm、张力带接骨板为5.132 mm,脱位缝隙的分离移位值依次是2枚骶髂螺钉0.887 mm、可调式微创接骨板为2.502mm、张力带接骨板为5.117mm。结论 2枚骶髂螺钉固定骶髂关节脱位的稳定性优于可调式微创接骨板的稳定性,更优于张力带接骨板的稳定性。
Objective To compare the biomechanical stability of three kinds of internal fixation for sacroiliac joint dislocation by three-dimensional finite element analysis.Methods A healthy adult male was randomly seclected and the CT images of pelvis(1.0 mm thickness)were collected.Intact pelvis model and sacroiliac dislocation model were made using software of Mimics10.01,Geomagic Studio 12,SolidWorks,Abaqus 6.11-1.Two iliosacral(IS)screws,the minimally invasive adjustable plate(MIAP)and the tension band plate(TBP)were used to fix the posterior pelvic ring respectively,and a loading of 500 N was put on the sacrum.Total displacement,strain value,stress distribution and the shift of dislocation gap of the whole model and internal fixator were compared.Results The stress of upper body passed through sacral wing,bilateral sacroiliac joint,the large sciatic notch,arcuate line of the iliac bone to the bilateral acetabulum.Under 500 Nload,displacements of the fixed models were two IS screws model(1.377 mm),the MIAP model(2.517 mm),and the TBP model(5.132 mm).The shifts of dislocation gap were two IS screws model(0.887 mm),MIAP model(2.502 mm)and TBP model(5.117 mm).Conclusion The stability of sacroiliac dislocation fixed with the MIAP was less than that fixed with the two IS screws,and better than that fixed with the TBP.
Objective To compare the biomechanical stability of three kinds of internal fixation for sacroiliac joint dislocation by three-dimensional finite element analysis.Methods A healthy adult male was randomly seclected and the CT images of pelvis(1.0 mm thickness)were collected.Intact pelvis model and sacroiliac dislocation model were made using software of Mimics10.01,Geomagic Studio 12,SolidWorks,Abaqus 6.11-1.Two iliosacral(IS)screws,the minimally invasive adjustable plate(MIAP)and the tension band plate(TBP)were used to fix the posterior pelvic ring respectively,and a loading of 500 N was put on the sacrum.Total displacement,strain value,stress distribution and the shift of dislocation gap of the whole model and internal fixator were compared.Results The stress of upper body passed through sacral wing,bilateral sacroiliac joint,the large sciatic notch,arcuate line of the iliac bone to the bilateral acetabulum.Under 500 Nload,displacements of the fixed models were two IS screws model(1.377 mm),the MIAP model(2.517 mm),and the TBP model(5.132 mm).The shifts of dislocation gap were two IS screws model(0.887 mm),MIAP model(2.502 mm)and TBP model(5.117 mm).Conclusion The stability of sacroiliac dislocation fixed with the MIAP was less than that fixed with the two IS screws,and better than that fixed with the TBP.
引文
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[18]赵勇,马玉鹏,成功,等.不同长度骶髂螺钉固定中央型骶骨纵行骨折的生物力学比较研究[J].中华创伤杂志,2017,33(10):896-903.
[19]张觅,刘洋,谭俊峰,等.两种不同材料外固定器修复胫骨骨折:新型PEEK复合材料外固定器更有优势[J].中国组织工程研究,2015,19(38):6145-6149.
[20]郝廷,冯卫,薛飞.肱骨远端骨折内植物有限元分析及临床应用[J].临床医药文献杂志,2017,4(58):11287-11289.
[21]郑占乐,张晓然,于贤,等.X线引导下双针定位器置入骶髂螺钉的初步临床研究[J].河北医科大学学报,2014,35(7):842-843.
[22]Khaled SA,Soliman O,Wahed MA.Functional outcome of unstable pelvic ring injuries after iliosacral screw fixation:single versus two screw fixation[J].Eur J Trauma Emerg Surg,2015,41(4):387-392.
[23]Salasek M,Pavelka T,Kren J,et al.Minimally invasive stabilization of posterior pelvic ring injuries with a transiliac internal fixator and two iliosacral screws:comparison of outcome[J].Acta Chir Orthop Traumatol Cech,2015,82(1):41-47.
[24]刘连涛,任栋,王鹏程.不稳定骨盆骨折内外固定方法的生物力学研究[J].河北医科大学学报,2012,33(4):485-489.
[2]Salasek M,Jansova M,Kren J,et al.Biomechanical comparison of a transiliac internal fixator and two iliosacral screws in transforaminal sacral fractures:a finite element analysis[J].Acta Bioeng Biomech,2015,17(1):39-49.
[3]Oberkircher L,Ruchholtz S,Rommens PM,et al.Osteoporotic pelvic fractures[J].Dtsch Arztebl Int,2018,115(5):70-80.
[4]Lee CH,Hsu CC,Huang PY.Biomechanical study of different fixation techniques for the treatment of sacroiliac joint injuries using finite element analyses and biomechanical test[J].Comput Biol Med,2017,87(8):250-257.
[5]Herman A,Keener E,Dubose C,et al.Simple mathematical model of sacroiliac screws safe-zone-easy to implement by pelvic inlet and outlet views[J].J Orthop Res,2017,35(7):1478-1484.
[6]Bai Z,Gao S,Liu J,et al.Anatomical evidence for the anterior plate fixation of sacroiliac joint[J].J Orthop Sci,2018,23(1):132-136.
[7]谭振,黄仲,李亮,等.骶髂关节脱位的分型方法及手术治疗方案[J].四川大学学报:医学版,2017,48(5):661-667.
[8]李升,张奇,张英泽,等.应用微创可调式接骨板与张力带接骨板固定骶骨纵行骨折对骨盆后环应力传导的影响[J].河北医科大学学报,2012,33(3):344-345.
[9]Wu T,Chen W,Li X,et al.Biomechanical comparison of three types of internal fixation in a type C zoneⅡpelvic fracture model[J].Int J Clin Exp Med,2015,8(2):1853-1861.
[10]崔蕴威,吴涛,李升,等.应用有限元法比较3种内固定器械固定不稳定骨盆骨折的效果[J].河北医科大学学报,2016,37(2):137-142.
[11]吴涛,崔蕴威,张奇,等.应用2种内固定方法对骨盆后环应力传导的生物力学比较[J].河北医科大学学报,2015,36(2):125-128.
[12]唐凡,闵理,王延岭,等.骨盆后环微创螺钉的钉道设计及骨盆三维有限元分析[J].四川大学学报:医学版,2017,48(5):673-680.
[13]Noda M,Saequsa Y,Takahashi M,et al.Biomechanical study using the finite element method of internal fixation in Pauwels typeⅢvertical femoral neck fractures[J].Arch Trauma Res,2015,4(3):e23167.
[14]Li J,Zhao X,Hu X,et al.A theoretical analysis and finite element simulation of fixator-bone system stiffness on healing progression[J].J Appl Biomater Funct Mater,2018,16(3):115-125.
[15]Jin XZ,Homaei E,Matinlinna JP,et al.A new concept and finite-element study on dental bond strength test[J].Dent Mater,2016,32(10):e238-250.
[16]Molina-Rueda F,Alquacil-Diego IM,Cuesta-Gomez A,et al.Thorax,pelvis and hip pattern in the frontal plane during walking in unilateral transtibial amputees:biomechanical analysis[J].Braz J Phys Ther,2014,18(3):252-258.
[17]Aach M,Gebert C,Ahrens H,et al.The primary stability of pelvic reconstruction after partial supraacetabular pelvic resection due to malignant tumours of the human pelvis:a biomechanical in vitro study[J].Med Eng Phys,2013,35(12):1731-1735.
[18]赵勇,马玉鹏,成功,等.不同长度骶髂螺钉固定中央型骶骨纵行骨折的生物力学比较研究[J].中华创伤杂志,2017,33(10):896-903.
[19]张觅,刘洋,谭俊峰,等.两种不同材料外固定器修复胫骨骨折:新型PEEK复合材料外固定器更有优势[J].中国组织工程研究,2015,19(38):6145-6149.
[20]郝廷,冯卫,薛飞.肱骨远端骨折内植物有限元分析及临床应用[J].临床医药文献杂志,2017,4(58):11287-11289.
[21]郑占乐,张晓然,于贤,等.X线引导下双针定位器置入骶髂螺钉的初步临床研究[J].河北医科大学学报,2014,35(7):842-843.
[22]Khaled SA,Soliman O,Wahed MA.Functional outcome of unstable pelvic ring injuries after iliosacral screw fixation:single versus two screw fixation[J].Eur J Trauma Emerg Surg,2015,41(4):387-392.
[23]Salasek M,Pavelka T,Kren J,et al.Minimally invasive stabilization of posterior pelvic ring injuries with a transiliac internal fixator and two iliosacral screws:comparison of outcome[J].Acta Chir Orthop Traumatol Cech,2015,82(1):41-47.
[24]刘连涛,任栋,王鹏程.不稳定骨盆骨折内外固定方法的生物力学研究[J].河北医科大学学报,2012,33(4):485-489.