螺钉间夹角对桡骨远端不稳定骨折接骨板应力影响仿真研究
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摘要
目的比较4种螺钉间夹角排布对治疗桡骨远端不稳定骨折的术后掌侧接骨板应力分布情况,并找出最优固定角度。方法选取1例健康男性志愿者,对其左手桡骨分别建立含骨折断面和骨痂的桡骨远端不稳定骨折的三维有限元模型。掌侧锁定钢板远端螺钉间夹角分别采用0°、5°、10°、15°。选择竖直提起重物情况作为生理载荷和约束条件,在竖直方向施加100 N的载荷,模拟手臂提起重物的情况,并计算分析出4种不同螺钉排布角度情况的应力分布。通过比较4种排布方式,选择出其中应力最小的排列方式。结果螺钉间夹角0°～15°时最大应力分别为580.06 MPa、493.13 MPa、594.38 MPa和604.20 MPa。在螺钉间夹角5°的情况下竖直提起重物,掌侧锁定钢板上的最大应力小于其他螺钉间夹角排列方式。结论增加远端头部螺钉夹角角度确实能降低接骨板的局部应力。采用螺钉间夹角5°的排列方式可以有效地防止掌侧锁定接骨板应力集中,提高掌侧锁定接骨板使用寿命。
Objective To compare the stress distribution of volar plate after treatment of unstable distal radius fractures with 4 kinds of screws angle, and find the best adapted angle. Methods A 30-year-old male healthy volunteer was selected to establish three-dimensional finite element models of the left hand unstable distal radius fracture in fracture section and callus,respectively. The angle between distal locking screws of volar locking plates was set at 0°, 5°, 10° and 15°, respectively. The vertical lifting heavy load was set as physiological load and constraint conditions. The load of 100 N in vertical direction was applied and the weight lifting condition of the arm was simulated. The stress distributions of 4 different screw angles were calculated and analyzed. Compared the stresses at 4 angles, the least stress distribution was selected. Results The maximum stress at 0°-15° angles were 580.06 MPa, 493.13 MPa, 594.38 MPa and 604.20 MPa, respectively. When the weight was lifted vertically at 5°, the maximum stress on locking plate was smaller than that at other stress angles. Conclusion It is demonstrated that increasing the distal screws angle could reduce the stress of bone locking plate effectively. At screw angle of5°, the stress concentration of volar locking plate is effectively prevented, and the service life of volar locking plate could be extended.
Objective To compare the stress distribution of volar plate after treatment of unstable distal radius fractures with 4 kinds of screws angle, and find the best adapted angle. Methods A 30-year-old male healthy volunteer was selected to establish three-dimensional finite element models of the left hand unstable distal radius fracture in fracture section and callus,respectively. The angle between distal locking screws of volar locking plates was set at 0°, 5°, 10° and 15°, respectively. The vertical lifting heavy load was set as physiological load and constraint conditions. The load of 100 N in vertical direction was applied and the weight lifting condition of the arm was simulated. The stress distributions of 4 different screw angles were calculated and analyzed. Compared the stresses at 4 angles, the least stress distribution was selected. Results The maximum stress at 0°-15° angles were 580.06 MPa, 493.13 MPa, 594.38 MPa and 604.20 MPa, respectively. When the weight was lifted vertically at 5°, the maximum stress on locking plate was smaller than that at other stress angles. Conclusion It is demonstrated that increasing the distal screws angle could reduce the stress of bone locking plate effectively. At screw angle of5°, the stress concentration of volar locking plate is effectively prevented, and the service life of volar locking plate could be extended.
引文
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[3]Williksen JH,Frihagen F,Hellund JC,et al.Volar locking plates versus external fixation and adjuvant pin fixation in unstable distal radius fractures:a randomized,controlled study[J].J Hand Surg Am,2013,38(8):1469-1476.
[4]Ruch DS,Ginn TA,Yang CC,et al.Use of a distraction plate for distal radial fractures with metaphyseal and diaphyseal comminution[J].J Bone Joint Surg Am,2005,87(5):945-954.
[5]Moss DP,Means KR Jr,Parks BG,et al.A biomechanical comparison of volar locked plating of intra-articular distal radius fractures:Use of 4 versus 7 screws for distal fixation[J].J Hand Surg,2011,36(12):1907-1911.
[6]Ynez A,Carta JA,Garcés G.Biomechanical evaluation of a new system to improve screw fixation in osteoporotic bones[J].Med Eng Phys,2010,32(5):532-541.
[7]Anderson DD,Deshpande BR,Daniel TE,et al.A three dimensional finite element model of the radiocarpal joint:Distal radius fracture step-off and stress transfer[J].Lowa Orthop J,2005,25:108-117.
[8]Sakai R,Kanai N,Itoman M,et al.Assessment of the fixation stiffness of some femoral stems of different designs[J].Clin Biomech(Bristol,Avon),2006,21(4):370-378.
[9]LI Shi-yun,XIAO Zheng-ming.Elastic mechanics and finite element method[M].Beijing:Machine Press,2015.[李世芸,肖正明.弹性力学及有限元[M].北京:机械工业出版社,2015.]
[10]LI Jing-yong.Finite element method[M].Beijing:Beijing U-niversity of Posts and Telecommunications Press,1999.[李景涌.有限元法[M].北京:北京邮电大学出版社,1999.]
[11]TAN Jian-guo.Finite element analysis using ANSYS 6.0[M].Beijing:Peking University Press,2002.[谭建国.使用AN-SYS 6.0进行有限元分析[M].北京:北京大学出版社,2002.]
[12]YANG Guo-tao,WANG Xu-kai,WANG Ying.Comparison of T-locking compression plate and common T-plate in the treatment of distal radius fractures[J].Clinical Journal of Medical Officers,2008,36(3):429-430.[杨国涛,王旭凯,王英.T型锁定加压钢板与普通T型钢板治疗桡骨远端骨折的疗效比较[J].临床军医杂志,2008,36(3):429-430.]
[13]MA Heng,LI Chu-yong,SUN Zeng-rong.Treatment of distal radius fracture with locking plate:a report of 27 cases[J].China Practical Medicine,2018,13(15):83-84.[马恒,李初勇,孙增荣.应用锁定钢板治疗桡骨远端骨折27例体会[J].中国实用医药,2018,13(15):83-84.]
[14]SHU Chang,CHEN Hong-lu,LI Zhi-hao.Treatment of complex and unstable distal radius fractures with double-plate internal fixation at the dorsal palm[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2017,29(1):63-64.[舒畅,陈虹炉,李智豪.掌背侧双钢板内固定治疗桡骨远端复杂不稳定性骨折[J].中医正骨,2017,29(1):63-64.]
[15]LU Qing-you,HAO Ying-xin.Progress in treatment of distal radius fracture[J].International Journal of Orthopaedics,2017,38(3):154-155.[陆晴友,郝迎新.桡骨远端骨折治疗进展[J].国际骨科学杂志,2017,38(3):154-155.]
[2]Raduan Neto J,de Moraes VY,Gomes Dos Santos JB,et al.Treatment of reducible unstable fractures of the distal radius:randomized clinical study comparing the locked volar plate and external fixator methods:study protocol[J].BMC Musculoskelet Disord,2014,15:65-65.
[3]Williksen JH,Frihagen F,Hellund JC,et al.Volar locking plates versus external fixation and adjuvant pin fixation in unstable distal radius fractures:a randomized,controlled study[J].J Hand Surg Am,2013,38(8):1469-1476.
[4]Ruch DS,Ginn TA,Yang CC,et al.Use of a distraction plate for distal radial fractures with metaphyseal and diaphyseal comminution[J].J Bone Joint Surg Am,2005,87(5):945-954.
[5]Moss DP,Means KR Jr,Parks BG,et al.A biomechanical comparison of volar locked plating of intra-articular distal radius fractures:Use of 4 versus 7 screws for distal fixation[J].J Hand Surg,2011,36(12):1907-1911.
[6]Ynez A,Carta JA,Garcés G.Biomechanical evaluation of a new system to improve screw fixation in osteoporotic bones[J].Med Eng Phys,2010,32(5):532-541.
[7]Anderson DD,Deshpande BR,Daniel TE,et al.A three dimensional finite element model of the radiocarpal joint:Distal radius fracture step-off and stress transfer[J].Lowa Orthop J,2005,25:108-117.
[8]Sakai R,Kanai N,Itoman M,et al.Assessment of the fixation stiffness of some femoral stems of different designs[J].Clin Biomech(Bristol,Avon),2006,21(4):370-378.
[9]LI Shi-yun,XIAO Zheng-ming.Elastic mechanics and finite element method[M].Beijing:Machine Press,2015.[李世芸,肖正明.弹性力学及有限元[M].北京:机械工业出版社,2015.]
[10]LI Jing-yong.Finite element method[M].Beijing:Beijing U-niversity of Posts and Telecommunications Press,1999.[李景涌.有限元法[M].北京:北京邮电大学出版社,1999.]
[11]TAN Jian-guo.Finite element analysis using ANSYS 6.0[M].Beijing:Peking University Press,2002.[谭建国.使用AN-SYS 6.0进行有限元分析[M].北京:北京大学出版社,2002.]
[12]YANG Guo-tao,WANG Xu-kai,WANG Ying.Comparison of T-locking compression plate and common T-plate in the treatment of distal radius fractures[J].Clinical Journal of Medical Officers,2008,36(3):429-430.[杨国涛,王旭凯,王英.T型锁定加压钢板与普通T型钢板治疗桡骨远端骨折的疗效比较[J].临床军医杂志,2008,36(3):429-430.]
[13]MA Heng,LI Chu-yong,SUN Zeng-rong.Treatment of distal radius fracture with locking plate:a report of 27 cases[J].China Practical Medicine,2018,13(15):83-84.[马恒,李初勇,孙增荣.应用锁定钢板治疗桡骨远端骨折27例体会[J].中国实用医药,2018,13(15):83-84.]
[14]SHU Chang,CHEN Hong-lu,LI Zhi-hao.Treatment of complex and unstable distal radius fractures with double-plate internal fixation at the dorsal palm[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2017,29(1):63-64.[舒畅,陈虹炉,李智豪.掌背侧双钢板内固定治疗桡骨远端复杂不稳定性骨折[J].中医正骨,2017,29(1):63-64.]
[15]LU Qing-you,HAO Ying-xin.Progress in treatment of distal radius fracture[J].International Journal of Orthopaedics,2017,38(3):154-155.[陆晴友,郝迎新.桡骨远端骨折治疗进展[J].国际骨科学杂志,2017,38(3):154-155.]