中国组织工程研究

中国组织工程研究 ›› 2023, Vol. 27 ›› Issue (13): 1999-2004.doi: 10.12307/2023.254

• 骨与关节生物力学 bone and joint biomechanics • 上一篇    下一篇

经皮逆向螺钉模拟治疗耻骨上支骨折的有限元分析

鲁  辉1，2，徐  玲1，蒋代翔1，2，吴启梅3，刘  融1，2，4   

  1. 1武汉科技大学医学院，湖北省武汉市   430081；武汉科技大学附属普仁医院，2医学创新与转化研究所，4骨科，湖北省武汉市   430080；3武汉刘三屋中医骨伤医院，湖北省武汉市   431400
  • 收稿日期:2022-02-25 接受日期:2022-04-23 出版日期:2023-05-08 发布日期:2022-08-11
  • 通讯作者: 刘融，博士，副教授，副主任医师，硕士生导师，武汉科技大学医学院，湖北省武汉市 430081；武汉科技大学附属普仁医院，医学创新与转化研究所，骨科，湖北省武汉市 430080 吴启梅，副主任医师，武汉刘三屋中医骨伤医院，湖北省武汉市 431400
  • 作者简介:鲁辉，男，1994年生，湖北省洪湖市人，汉族，武汉科技大学医学院在读硕士，主要从事智能医学、3D打印及数字骨科研究。 徐玲，女，武汉科技大学医学院在读硕士，主要从事甲乳外科方面的研究。
  • 基金资助:
    武汉科技大学2021年研究生创新创业基金项目(JCX2021116)：不同长度和直径的经皮逆向螺钉治疗耻骨上支骨折的生物力学研究；项目负责人：鲁辉；2021年度职业危害识别与控制湖北省重点实验室开放基金一般项目(OHIC2021G06)：基于深度学习与有限元分析的职业司机颈腰痛综合评估与干预研究；项目负责人：刘融；湖北省自然科学基金委员会一般面上项目(2020CFB548)：基于拓扑优化技术的3D打印康复辅具设计关键技术的研发；项目负责人：刘融；武汉市中医药类及中西医结合类一般面上项目(WZ20C29)：传统中医正骨术结合混合现实技术在儿童股骨骨折治疗中的应用研究；项目负责人：刘融

Finite element analysis of percutaneous reverse screw for treatment of superior pubic ramus fracture

Lu Hui1, 2, Xu Ling1, Jiang Daixiang1, 2, Wu Qimei3, Liu Rong1, 2, 4   

  1. 1School of Medicine, Wuhan University of Science and Technology, Wuhan 430081, Hubei Province, China; 2Institute of Medical Innovation and Transformation, 4Department of Orthopedics, Puren Hospital Affiliated to Wuhan University of Science and Technology, Wuhan 430080, Hubei Province, China; 3Wuhan Liu Sanwu Traditional Chinese Medicine Bone Injury Hospital, Wuhan 431400, Hubei Province, China
  • Received:2022-02-25 Accepted:2022-04-23 Online:2023-05-08 Published:2022-08-11
  • Contact: Liu Rong, PhD, Associate professor, Associate chief physician, Master’s supervisor, School of Medicine, Wuhan University of Science and Technology, Wuhan 430081, Hubei Province, China; Institute of Medical Innovation and Transformation, and Department of Orthopedics, Puren Hospital Affiliated to Wuhan University of Science and Technology, Wuhan 430080, Hubei Province, China Wu Qimei, Associate chief physician, Wuhan Liu Sanwu Traditional Chinese Medicine Bone Injury Hospital, Wuhan 431400, Hubei Province, China
  • About author:Lu Hui, Master candidate, School of Medicine, Wuhan University of Science and Technology, Wuhan 430081, Hubei Province, China; Institute of Medical Innovation and Transformation, Puren Hospital Affiliated to Wuhan University of Science and Technology, Wuhan 430080, Hubei Province, China Xu Ling, Master candidate, School of Medicine, Wuhan University of Science and Technology, Wuhan 430081, Hubei Province, China Lu Hui and Xu Ling contributed equally to this article.
  • Supported by:
    Graduate Innovation and Entrepreneurship Fund Project of Wuhan University of Science and Technology in 2021, No. JCX2021116 (to LH); General Project of Hubei Provincial Key Laboratory Open Fund for Occupational Hazard Identification and Control in 2021, No. OHIC2021G06 (to LR); General Project of Hubei Provincial Natural Science Foundation of China, No. 2020CFB548 (to LR); Wuhan City Traditional Chinese Medicine and Integrated Traditional Chinese and Western Medicine General Project, No. WZ20C29 (to LR)

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摘要：

文题释义：
经皮螺钉固定：经皮螺钉固定耻骨支最早是由ROUTT等提出，随后，该技术广泛应用于临床。经皮螺钉固定作为一种微创技术，因其具备对软组织损伤小、术中出血量少等优势，近年来在骨盆前环骨折中逐渐得到应用。根据经皮螺钉置入方向分为经皮顺向螺钉固定和经皮逆向螺钉固定。
有限元分析：是融合理论知识、数字成像技术、计算机立体三维力学分析方法于一体，其基本理念是把一个复杂整体分解为有限个简单物体的组合来模拟、计算、分析的方法。该方法用于骨盆的生物力学分析，能模拟人体骨盆的生理状态，分析骨盆在人体站立位时的位移和应力分布情况。

背景：经皮螺钉固定耻骨支在临床上得到广泛应用，但对于螺钉进针点位置的选择缺乏力学验证。
目的：通过有限元方法探讨经皮逆向螺钉治疗耻骨上支骨折不同进针点位置的生物力学特点。
方法：将健康志愿者的CT数据导入Mimics软件中，对骨盆进行三维重建，3-Matic软件划分耻骨上支骨折模型，并建立不同进针点位置的经皮逆向螺钉，模拟治疗耻骨上支骨折；Mimics软件材料赋值后，Ansys软件模拟在S1椎体终板上施加600 N载荷站立位时的受力情况，并比较力学稳定性。
结果与结论：①对于Ⅰ区耻骨上支骨折，如果进针点位于上部，对整个模型及螺钉产生的最大应力，均低于下部；进针点位于上部、下部，螺钉最大应力分别为4.57，10.50 MPa，上部明显低于下部，建议选择耻骨嵴中点上方作为进针点；②对于Ⅱ区耻骨上支骨折，进针点位于上部或下部效果相当；③对于Ⅲ区耻骨上支骨折，建议选择耻骨嵴中点下方作为进针点。

https://orcid.org/0000-0001-5919-8259 (鲁辉)

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

关键词: 经皮逆向螺钉, 耻骨上支骨折, 有限元分析, 进针点, 生物力学

Abstract: BACKGROUND: Percutaneous screw fixation of pubic ramus is widely used in clinical practice, but the selection of screw insertion point is lacking in mechanical verification.  
OBJECTIVE: To investigate the biomechanical characteristics of different insertion points of percutaneous reverse screw for superior pubic ramus fracture by finite element method.
METHODS:  CT data of healthy volunteers were input into Mimics software for 3D reconstruction of the pelvis. 3-Matic software was used to divide the model of superior pubic ramus fracture, and percutaneous reverse screws with different insertion points were established to simulate the treatment of superior pubic ramus fracture. After material assignment by Mimics software, Ansys software was used to simulate the force of standing position with 600 N load on S1 vertebral endplate and to compare the mechanical stability.  
RESULTS AND CONCLUSION: (1) For the fracture of superior pubic ramus in area I, if the insertion point was located in the upper part, the maximum stress on the whole model and screw was lower than that on the lower part. The insertion point was located at the upper part and the lower part, and the maximum stress of the screw was 4.57 MPa and 10.50 MPa. The upper part was significantly lower than the lower part, and the upper part was recommended as the insertion point above the midpoint of the pubic crest. (2) For the fracture of superior pubic ramus in area II, the effect of the insertion point on the upper or lower part was similar. (3) For fractures of superior pubic ramus in area III, it is recommended to select the insertion point below the midpoint of the pubic crest.

Key words: percutaneous reverse screw, superior pubic ramus fracture, finite element analysis, insertion point, biomechanics

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