中国组织工程研究

中国组织工程研究 ›› 2023, Vol. 27 ›› Issue (29): 4599-4606.doi: 10.12307/2023.645

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

桥接内固定系统髓内固定治疗锁骨中段骨折的有限元分析

马天勇，王德伟   

  1. 遵义医科大学第五附属(珠海)医院骨二科，广东省珠海市   519100
  • 收稿日期:2022-07-18 接受日期:2022-08-27 出版日期:2023-10-18 发布日期:2022-12-02
  • 通讯作者: 王德伟，博士后，主任医师，硕士生导师，遵义医科大学第五附属(珠海)医院骨二科，广东省珠海市 519100
  • 作者简介:马天勇，男，1987年生，贵州省遵义市人，汉族，遵义医科大学在读硕士，主要从事脊柱和上肢创伤方面的研究。

Finite element analysis of middle clavicle fracture with ortho-bridge system intramedullary fixation

Ma Tianyong, Wang Dewei   

  1. Second Department of Orthopedics, Fifth Affiliated Hospital (Zhuhai) of Zunyi Medical University, Zhuhai 519100, Guangdong Province, China
  • Received:2022-07-18 Accepted:2022-08-27 Online:2023-10-18 Published:2022-12-02
  • Contact: Wang Dewei, MD, Chief physician, Master’s supervisor, Second Department of Orthopedics, Fifth Affiliated Hospital (Zhuhai) of Zunyi Medical University, Zhuhai 519100, Guangdong Province, China
  • About author:Ma Tianyong, Master candidate, Second Department of Orthopedics, Fifth Affiliated Hospital (Zhuhai) of Zunyi Medical University, Zhuhai 519100, Guangdong Province, China

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摘要：


文题释义：

桥接内固定系统髓内固定技术：是作者所在团队利用桥接内固定系统髓内固定治疗锁骨中段骨折的一种新型髓内固定技术，旨在减少传统髓内钉松动移位以及器械相关的软组织激惹。 技术要点是将连接棒从锁骨外侧入路逆行置入潜在髓腔，穿过复位骨折端接近锁骨胸骨端，肩峰端髓外预留一定长度的连接棒，折弯紧贴骨皮质，并安装1枚固定块螺钉组合锁定。
髓内固定锁骨骨折的并发症：在临床应用中，常见的髓内器械固定锁骨骨折都能取得比较满意的疗效。每种髓内器械都有优势和缺陷，大多数都存在固定骨折的稳定性不足，导致多种并发症：髓内钉松动移位、滑脱及钉尾凸起软组织激惹、慢性疼痛、内固定断裂等。

背景：髓内固定治疗锁骨中段骨折已是一种有效且安全的固定方式，然而髓内钉松动移位、钉尾软组织激惹等问题突出。部分带锁髓内钉手术操作难度大，难以推广应用。髓内固定治疗锁骨骨折仍有较大的改进空间，有待设计出一种新型髓内固定产品来减少这些问题。
目的：使用有限元分析方法探讨桥接内固定系统髓内固定治疗锁骨中段骨折的生物力学稳定性，为临床应用提供科学参考。
方法：利用1名青年志愿者的锁骨CT数据通过相关软件建立锁骨中段横行骨折的有限元模型，根据骨折内固定原则，分别组装成锁定板、桥接内固定系统和钛制弹性钉内固定有限元模型。最后使用ANSYS 15.0软件进行网格划分、施加载荷和数据处理，比较各模型锁骨和内固定的应力分布、最大Von Mises应力及最大位移情况。
结果与结论：①不同载荷下，桥接内固定系统髓内固定锁骨中段骨折的应力分布与钛制弹性钉固定类似，髓内连接棒在骨折断端附近出现应力集中现象，异同点是桥接内固定系统髓外锁定处出现次级应力集中，使桥接内固定系统组整体应力较钛制弹性钉组更分散；②轴向压缩载荷下，桥接内固定系统组锁骨最大Von Mises应力为251.96 MPa，高于其他两组；骨折面的最大Von Mises应力为33.79 MPa，低于其他两组；悬臂弯曲、顺/逆时针扭转载荷下，桥接内固定系统组锁骨和骨折面的最大Von Mises应力均小于钛制弹性钉组而大于锁定板组；③不同载荷下，3组中植入物的最大Von Mises应力均出现在骨折端附近，其中钛制弹性钉的应力峰值最大，桥接内固定系统次之，锁定板最小；④不同载荷下，各组中锁骨的最大位移均在锁骨远端，其中钛制弹性钉组中锁骨远端及骨折端的位移峰值最大，桥接内固定系统组次之，锁定板组及无损锁骨较小；⑤提示桥接内固定系统髓内固定治疗锁骨中段骨折的生物力学稳定性优于钛制弹性钉固定，内固定松动移位风险较钛制弹性钉低，但固定强度不如锁定板。
https://orcid.org/0000-0002-4837-2028 (马天勇) 
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: 锁骨骨折, 髓内固定, 桥接内固定系统, 髓内钉, 锁定板, 有限元分析, 生物力学, 并发症

Abstract: BACKGROUND: The intramedullary fixation treatment for the middle clavicle fracture is effective and safe. However, issues such as nail loosening and displacement, as well as soft tissue irritability of the nail tail, are prevalent. Some interlocking intramedullary nails are demanding to operate; thus, their widespread utilization is confined. Treatment of intramedullary clavicle fracture can be further refined. Accordingly, to alleviate these issues, a novel intramedullary fixation instrument needs to be developed.  
OBJECTIVE: To explore the biomechanical stability of ortho-bridge system intramedullary fixation in the treatment of middle clavicle fracture by means of finite element analysis so as to offer a scientific foundation for clinical application.
METHODS: The finite element model of transverse middle clavicle fracture was established by relevant software utilizing the CT data of the clavicle from a young volunteer. The locking plate, ortho-bridge system, and titanium elastic nail finite element models were assembled in accordance with the principle of internal fracture fixation. Finally, meshing, applying loads, and data processing were accomplished with the ANSYS 15.0 program. In each model, the stress distribution, maximum Von Mises stress and maximum displacement of clavicle and internal fixation were compared.  
RESULTS AND CONCLUSION: (1) Under different loads, the stress distribution of the ortho-bridge system intramedullary fixation of the middle clavicle fracture was comparable to that of the titanium elastic nail fixation. Near the fractured end of the intramedullary connecting rod, the phenomenon of stress concentration was observed. The secondary stress concentration occurred in the extramedullary locking area of the ortho-bridge system, causing the overall stress of the ortho-bridge system group to be more dispersed than that of the titanium elastic nail group. (2) Under the axial compression force, the maximum Von Mises stress of the clavicle in the ortho-bridge system group 251.96 MPa was greater than that of the other groups, whereas the maximum Von Mises stress of the fractured surface 33.79 MPa was lower than the two control groups. Under cantilever bending and clockwise/counterclockwise torsion loads, the maximum Von Mises stresses of the clavicle and the fractured surface of the ortho-bridge system group were less than those of the titanium elastic nail group, but greater than those of the locking plate group. (3) Under varying loads, the maximum Von Mises stress of the implant in the three groups of internal fixation appeared near the fractured end. Among them, the titanium elastic nail exhibited the highest peak implant stress, followed by the ortho-bridge system, and the locking plate exhibited the least. (4) Under different loads, the maximum displacement of the clavicle in each group occurred primarily at its distal clavicle. Among them, the titanium elastic nail group displayed the greatest maximum displacement of the distal clavicle and fractured end, followed by the ortho-bridge system group, the locking plate group, and the normal clavicle. (5) The findings indicate that the biomechanical stability of ortho-bridge system intramedullary fixation is superior to that of titanium elastic nail in the treatment of middle clavicle fracture. The risk of loosening and displacement of the internal fixation is lower than the titanium elastic nail; however, the fixation strength is not as strong as the locking plate.

Key words: clavicle fracture, intramedullary fixation, ortho-bridge system, intramedullary nail, locking plate, finite element analysis, biomechanics, complications

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