胫骨远端骨折3种不同固定方式的有限元分析
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摘要
背景:目前临床上对于胫骨远端髓内钉及锁定钢板的生物力学性能研究相对较少。目的:采用三维有限元分析胫骨远端骨折3种固定方案在不同受力下内固定及骨头的受力情况。方法:使用数字化技术构建胫骨远端内外侧锁定钢板及胫骨远端髓内钉模型,根据内固定原则设置模型组合,胫骨内侧钢板固定模型为模型1,胫骨外侧钢板固定模型为模型2,髓内钉固定模型为模型3,分别给予3个模型轴向力侧向力及扭转力的加载方式,模拟人体在不同受力情况下内固定及胫骨骨折模型的受力及位移情况。结果与结论:胫骨远端骨折不同的固定方式在给予不同方向的受力时,每个内固定的特性不一。(1)在给予轴向力时胫骨远端内侧钢板及骨折模型受力均匀,并且移位最小,稳定性最佳;而胫骨远端外侧钢板及胫骨髓内钉的稳定性无明显差异,但胫骨远端外侧内固定承担较多的力量;(2)给予侧向力时三者的内固定承担相似的力量,但胫骨髓内钉的骨折模型需承担较多的力量;但是胫骨远端外侧钢板的位移最大,稳定性差;(3)给予三者模型扭转力时,胫骨远端骨折内侧钢板的较其他内固定方式承担最大的力量,其胫骨远端外侧钢板固定承担最小的扭转力,而髓内钉固定方式中,胫骨本身分担较多的力量,并且位移最大,其稳定性最差;(4)结果证实,胫骨远端骨折内侧钢板固定较远端外侧钢板及髓内钉固定分散应力,内固定及胫骨受力较均匀,稳定性更好。该试验方案已经四川省骨科医院伦理委员会讨论批准。
BACKGROUND: The biomechanical properties of distal tibial intramedullary nails and locking plates are relatively rare. OBJECTIVE: Three-dimensional finite element analysis was used to analyze internal fixation and bone under different stresses with three different fixation schemes. METHODS: The digital technique was used to construct the distal tibial medial and lateral locking plate andand torsion force to simulate the force and displacement of the internal fixation and tibial fracture model under different stress conditions. distal tibial nail model. The model combination was set according to the principle of internal fixation. The model of the medial plate fixation was model 1. The model of the lateral plate of the tibia was model 2. The fixed model of intramedullary nail was model 3. The three models received the loading mode of axial lateral force. RESULTS AND CONCLUSION: Different fixation methods of distal tibial fractures had different characteristics of internal fixation when giving different directions of force.(1) When the axial force was given, the medial plate and fracture model of the distal tibia were uniformly stressed and the displacement was minimal. The stability was the best. There was no significant difference in the stability of the lateral tibial plate and the tibial bone marrow nail, but the lateral fixation of the distal tibia took more force.(2) When the internal fixation of the three forces bore similar strength, the fracture model of the intramedullary nail had to bear more strength; but the outer plate of the distal tibia had the largest displacement and poor stability.(3) When the model was torsion, the medial plate of the distal tibial fracture bore the greatest strength compared with other internal fixation methods. The distal plate fixation at the distal end of the humerus bore the minimum torsional force. In the intramedullary nail fixation method, the tibia itself shared more force. The displacement was largest, and its stability was worst.(4) It is concluded that the medial plate fixation of the distal tibial fracture is more stable than the distal lateral plate and intramedullary nail. The internal fixation and the tibia are more uniform and the stability is better. This study was approved by the Ethics Committee of Sichuan Provincial Orthopedic Hospital.
BACKGROUND: The biomechanical properties of distal tibial intramedullary nails and locking plates are relatively rare. OBJECTIVE: Three-dimensional finite element analysis was used to analyze internal fixation and bone under different stresses with three different fixation schemes. METHODS: The digital technique was used to construct the distal tibial medial and lateral locking plate andand torsion force to simulate the force and displacement of the internal fixation and tibial fracture model under different stress conditions. distal tibial nail model. The model combination was set according to the principle of internal fixation. The model of the medial plate fixation was model 1. The model of the lateral plate of the tibia was model 2. The fixed model of intramedullary nail was model 3. The three models received the loading mode of axial lateral force. RESULTS AND CONCLUSION: Different fixation methods of distal tibial fractures had different characteristics of internal fixation when giving different directions of force.(1) When the axial force was given, the medial plate and fracture model of the distal tibia were uniformly stressed and the displacement was minimal. The stability was the best. There was no significant difference in the stability of the lateral tibial plate and the tibial bone marrow nail, but the lateral fixation of the distal tibia took more force.(2) When the internal fixation of the three forces bore similar strength, the fracture model of the intramedullary nail had to bear more strength; but the outer plate of the distal tibia had the largest displacement and poor stability.(3) When the model was torsion, the medial plate of the distal tibial fracture bore the greatest strength compared with other internal fixation methods. The distal plate fixation at the distal end of the humerus bore the minimum torsional force. In the intramedullary nail fixation method, the tibia itself shared more force. The displacement was largest, and its stability was worst.(4) It is concluded that the medial plate fixation of the distal tibial fracture is more stable than the distal lateral plate and intramedullary nail. The internal fixation and the tibia are more uniform and the stability is better. This study was approved by the Ethics Committee of Sichuan Provincial Orthopedic Hospital.
引文
[1]Wai IH,Ui Gani N,Yaseen M,et al.Operative management of distal tibial extra-articalar fractures-intramedul lary nail versus minmally invasive percutaneous plate osteosynthesis.Ortop Traumatol Rehabil.2017;19(6):537-541.
[2]Vaienti E,Schiavi P,Ceccarelli F,et al.Treatment of distal tibial fractures:prospective comparative study evaluating two surgical procedures with investigation for predictive factors of unfavourable outcome.Int Orthop.2019;43(1):201-207.
[3]Daolagupu AK,Mudgal A,Agarwala V,et al.A Comparative study of intramedullary interlocking nailling and minimally invasive plate osteosynthesis inextra articular distal tibial fractures.Indian J Orthop.2017;51(3):292-298.
[4]Maredza M,Petrou S,Dritsaki M,et al.Acomparison of the cost-effectiveness of in tramedullary nail fixation and locking plate ication in the treatment of adult patients with anextra-articular fracture of the dital tibia.Bone Joint J.2018;100B(5):624-633.
[5]Costa ML,Achten J,Griffin J,et al.Effect of locking plate fixations vs intramedullary nail fixation on 6-month disability among adult with displaced fracture of the distal tibia the UKFixDT randomized clinical trial.JAMA.2017;318(18):1767-1776.
[6]钟华,朱智敏,刘立华.MIPPO技术下LCP锁定和加压固定后应力遮挡的有限元研究[J].中国骨与关节损伤杂志,2011,26(3):213-216.
[7]李赞罡,陈为坚,李贵涛.不同运动步态下锁定加压钢板固定胫骨干骨折的有限元分析[J].中国组织工程研究,2013,17(4):612-619.
[8]刘易军,宫赫,刘百奇,等.胫骨上端外部形状及内部结构的模拟[J].中国生物医学工程学,2006,25(5):563-579.
[9]Sitthiseripratip K,Van Oosterwyck H,Vander Sloten J,et al.Finite element study of trochanteric gamma nail for trochanteric fracture.Med Eng Phys.2003;25(2):99-106.
[10]李维新,袁斌云.跟骨骨折锁定钢板内固定与普通钢板内固定的有限元分析[J].中医正骨,2013,25(4):10-11.
[11]Galloway F,Kahnt M,Ramm H,et al.A Large scale finite element study of a cementless ossointegrated tibial tray.JBiomech.2013;46(11):1900-1906.
[12]Wong C,Mikkelsen P,Hansen LB,et al.Finite element analysis of tibial fractures.Dan Med Ball.2010;57(5):A4148.
[13]Chen FC,Huang XW,Ya YS,et al.Finite element analysis of intramedullary nailing and double locking plate for treating extra-articular proximal tibial fractures.J Orthop Surg Res.2018;13(1):2-8.
[14]Atmaca H,Ozkan A,Matla I,et al.The effect of proximal tibial corrective osteotomy on menisci tibia and tarsal bones:a finit element model study of tibia vara.Int J Med Robot.2014;10(1):93-97.
[15]Sawatari T,Tsamura H,Iesaka K,et al.Three-dimensional finite element analysis of unicompartmental knee arthroplasty the influence of tibial component inclination.J Orthop Res.2005;23(3):541-554.
[16]Sowmianarayanan S,Chandrasekaran A,Kumar RK.Finite element analysis of a subtrochanteric fractured femur with dynamic hip screw,dynamic condylar screw,and proximal femur nail implants a comparative study.Proc Inst Mech Eng H.2008;222(1):117-127.
[17]马童,蔡珉巍,涂意辉,等.经皮微创钢板固定技术Meta接骨板治疗胫骨远端干骺端骨折[J].生物骨科材料与临床研究,2011,8(3):30-34.
[18]赵勇,申才佳,李勇,等.胫骨远端前外侧解剖型钢板治疗不稳定性Pilon骨折[J].临床骨科杂志,2013,15(6):666-667.
[19]Kuo LT,Chi CC,Chuang CH.Surgical interventions for treating distal tibial metaphyseal fractures in adultes.Cochrane Database Syst Rev.2015;(3):CD010261.
[20]Beytemur O,Barl A,Albay C,et al.Comparison of intramedullary nailing and minimal invasive plate osteosynthesis in the treatment of simple intra-articular fractures of the distal tibia(AO-OTA type43C1-C2).Acta orthop Traumatol Turc.2017;51(1):12-16.
[21]Guo C,Ma J,Ma X,et al.Comparing intramedullary nailing and plate fixation for treating distal tibail fractures:ameta-analysis of randomizedcontroll edtrials.Int J Surg.2018;53:5-11.
[22]Lai TC,Fleming JJ.Minimally invasive plate osteosynthesis for distal tibia fractures.Clin Podiatr Med Surg.2018;35(2):223-232.
[23]Redfern DJ,Syed SU,Davies SJ.Fractures of the distal tibia:minimally invasive plate osteosynthesis.Injury.2004;35(6):615-620.
[24]Park KC,Oh CW,Kim JW,et al.Minimally invasive plate augmentation in the treatment of long bone non unions.Arch Orthop Trauma Surg.2017;137(11):8-18.
[25]Nork SE,Schwartz AK,Agel J,et al.Intramedullary nailing of distal meta physeal tibial fractures.J Bone Joint Surg Am.2005;87(6):1213-1221.
[26]Shukla R,Jain N,Jain RK,et al.Minimally invasive plate osteosynthesis using locking plates for AO 43-type fractures lessons learnt from a prospective study.Foot Ankle Spec.2018;11(3):1-5.
[27]Bisaccia M,Cappiello A,Meccariello L,et al.Nail orplate in the management of distal extra-articular tibial fracture,what is better?Valutation of out comes.SICOT J.2018;4:2.
[28]Guo C,Ma J,Ma X,et al.Comparing intramedullary nailing and plate fixation for treating distal tibail fractures:a meta-analysis of randomized controlled trials.Int J Surg.2018;53:5-11.
[29]Wang Z,Cheng Y,Xin D,et al.Expert tibial nails for treating distal tibial fractures with soft tissue damage:apatient series.J Foot Ankle Surg.2017;56(6):1232-1235.
[30]Oken OF,Yildirim AO,Asilturk M,et al.Finite element analysis of the stability of AO/OTA 43-C1 type distal tibial fractures treated with distal tibia medial anatomic plate versus anterolateral anatomic plate.Acta Orthop Traumatol Turc.2017;51(5):1-5.
[31]Garg S,Khanna V,Goyal MP,et al.Comparative prospective study between medial and lateral distal tibial locking compression plates for distal third tibia fractures.Chin JTraumatol.2017;20(3):151-154.
[32]Choudhari P,Padia D.Minimally invasive osteosynthesis of distal tibia fractures using anterolateral locking plate.Malays Orthop J.2018;12(3):38-42.
[33]Muzaffar N,Bhat R,Yasin M.Complications of minmally invasive percutaneous plating for distal tibail fractures.Trauma Mon.2016;21(3):e22131.
[34]Akra GA,Lazarides S,Nanu AM.Early results of minimally invasive percutaneou splate osteosynthesis for fractures of the distal tibia;aretrospective case series and review of the literature.Clin Med Insights Arthritis Musculoskelet Disord.2017;10:1179544117701724.
[35]Kim JW,Kim HU,Oh CW,et al.A prospective randomized study on operative treatment for simple distal tibial fractures-minimally invasive plate osteosynthesis versus minimal open reduction and inter nail fixation.J Orthop Trauma.2018;32(1):e19-e24.
[2]Vaienti E,Schiavi P,Ceccarelli F,et al.Treatment of distal tibial fractures:prospective comparative study evaluating two surgical procedures with investigation for predictive factors of unfavourable outcome.Int Orthop.2019;43(1):201-207.
[3]Daolagupu AK,Mudgal A,Agarwala V,et al.A Comparative study of intramedullary interlocking nailling and minimally invasive plate osteosynthesis inextra articular distal tibial fractures.Indian J Orthop.2017;51(3):292-298.
[4]Maredza M,Petrou S,Dritsaki M,et al.Acomparison of the cost-effectiveness of in tramedullary nail fixation and locking plate ication in the treatment of adult patients with anextra-articular fracture of the dital tibia.Bone Joint J.2018;100B(5):624-633.
[5]Costa ML,Achten J,Griffin J,et al.Effect of locking plate fixations vs intramedullary nail fixation on 6-month disability among adult with displaced fracture of the distal tibia the UKFixDT randomized clinical trial.JAMA.2017;318(18):1767-1776.
[6]钟华,朱智敏,刘立华.MIPPO技术下LCP锁定和加压固定后应力遮挡的有限元研究[J].中国骨与关节损伤杂志,2011,26(3):213-216.
[7]李赞罡,陈为坚,李贵涛.不同运动步态下锁定加压钢板固定胫骨干骨折的有限元分析[J].中国组织工程研究,2013,17(4):612-619.
[8]刘易军,宫赫,刘百奇,等.胫骨上端外部形状及内部结构的模拟[J].中国生物医学工程学,2006,25(5):563-579.
[9]Sitthiseripratip K,Van Oosterwyck H,Vander Sloten J,et al.Finite element study of trochanteric gamma nail for trochanteric fracture.Med Eng Phys.2003;25(2):99-106.
[10]李维新,袁斌云.跟骨骨折锁定钢板内固定与普通钢板内固定的有限元分析[J].中医正骨,2013,25(4):10-11.
[11]Galloway F,Kahnt M,Ramm H,et al.A Large scale finite element study of a cementless ossointegrated tibial tray.JBiomech.2013;46(11):1900-1906.
[12]Wong C,Mikkelsen P,Hansen LB,et al.Finite element analysis of tibial fractures.Dan Med Ball.2010;57(5):A4148.
[13]Chen FC,Huang XW,Ya YS,et al.Finite element analysis of intramedullary nailing and double locking plate for treating extra-articular proximal tibial fractures.J Orthop Surg Res.2018;13(1):2-8.
[14]Atmaca H,Ozkan A,Matla I,et al.The effect of proximal tibial corrective osteotomy on menisci tibia and tarsal bones:a finit element model study of tibia vara.Int J Med Robot.2014;10(1):93-97.
[15]Sawatari T,Tsamura H,Iesaka K,et al.Three-dimensional finite element analysis of unicompartmental knee arthroplasty the influence of tibial component inclination.J Orthop Res.2005;23(3):541-554.
[16]Sowmianarayanan S,Chandrasekaran A,Kumar RK.Finite element analysis of a subtrochanteric fractured femur with dynamic hip screw,dynamic condylar screw,and proximal femur nail implants a comparative study.Proc Inst Mech Eng H.2008;222(1):117-127.
[17]马童,蔡珉巍,涂意辉,等.经皮微创钢板固定技术Meta接骨板治疗胫骨远端干骺端骨折[J].生物骨科材料与临床研究,2011,8(3):30-34.
[18]赵勇,申才佳,李勇,等.胫骨远端前外侧解剖型钢板治疗不稳定性Pilon骨折[J].临床骨科杂志,2013,15(6):666-667.
[19]Kuo LT,Chi CC,Chuang CH.Surgical interventions for treating distal tibial metaphyseal fractures in adultes.Cochrane Database Syst Rev.2015;(3):CD010261.
[20]Beytemur O,Barl A,Albay C,et al.Comparison of intramedullary nailing and minimal invasive plate osteosynthesis in the treatment of simple intra-articular fractures of the distal tibia(AO-OTA type43C1-C2).Acta orthop Traumatol Turc.2017;51(1):12-16.
[21]Guo C,Ma J,Ma X,et al.Comparing intramedullary nailing and plate fixation for treating distal tibail fractures:ameta-analysis of randomizedcontroll edtrials.Int J Surg.2018;53:5-11.
[22]Lai TC,Fleming JJ.Minimally invasive plate osteosynthesis for distal tibia fractures.Clin Podiatr Med Surg.2018;35(2):223-232.
[23]Redfern DJ,Syed SU,Davies SJ.Fractures of the distal tibia:minimally invasive plate osteosynthesis.Injury.2004;35(6):615-620.
[24]Park KC,Oh CW,Kim JW,et al.Minimally invasive plate augmentation in the treatment of long bone non unions.Arch Orthop Trauma Surg.2017;137(11):8-18.
[25]Nork SE,Schwartz AK,Agel J,et al.Intramedullary nailing of distal meta physeal tibial fractures.J Bone Joint Surg Am.2005;87(6):1213-1221.
[26]Shukla R,Jain N,Jain RK,et al.Minimally invasive plate osteosynthesis using locking plates for AO 43-type fractures lessons learnt from a prospective study.Foot Ankle Spec.2018;11(3):1-5.
[27]Bisaccia M,Cappiello A,Meccariello L,et al.Nail orplate in the management of distal extra-articular tibial fracture,what is better?Valutation of out comes.SICOT J.2018;4:2.
[28]Guo C,Ma J,Ma X,et al.Comparing intramedullary nailing and plate fixation for treating distal tibail fractures:a meta-analysis of randomized controlled trials.Int J Surg.2018;53:5-11.
[29]Wang Z,Cheng Y,Xin D,et al.Expert tibial nails for treating distal tibial fractures with soft tissue damage:apatient series.J Foot Ankle Surg.2017;56(6):1232-1235.
[30]Oken OF,Yildirim AO,Asilturk M,et al.Finite element analysis of the stability of AO/OTA 43-C1 type distal tibial fractures treated with distal tibia medial anatomic plate versus anterolateral anatomic plate.Acta Orthop Traumatol Turc.2017;51(5):1-5.
[31]Garg S,Khanna V,Goyal MP,et al.Comparative prospective study between medial and lateral distal tibial locking compression plates for distal third tibia fractures.Chin JTraumatol.2017;20(3):151-154.
[32]Choudhari P,Padia D.Minimally invasive osteosynthesis of distal tibia fractures using anterolateral locking plate.Malays Orthop J.2018;12(3):38-42.
[33]Muzaffar N,Bhat R,Yasin M.Complications of minmally invasive percutaneous plating for distal tibail fractures.Trauma Mon.2016;21(3):e22131.
[34]Akra GA,Lazarides S,Nanu AM.Early results of minimally invasive percutaneou splate osteosynthesis for fractures of the distal tibia;aretrospective case series and review of the literature.Clin Med Insights Arthritis Musculoskelet Disord.2017;10:1179544117701724.
[35]Kim JW,Kim HU,Oh CW,et al.A prospective randomized study on operative treatment for simple distal tibial fractures-minimally invasive plate osteosynthesis versus minimal open reduction and inter nail fixation.J Orthop Trauma.2018;32(1):e19-e24.