中国组织工程研究

中国组织工程研究 ›› 2024, Vol. 28 ›› Issue (33): 5283-5288.doi: 10.12307/2024.657

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

过伸内翻型胫骨平台骨折新型钢板的设计及有限元分析

梁钟帅1，王仁崇1，张  璐1，胡居正1，石展英2，谢  友1，毛春华1   

  1. 1柳州市工人医院创伤骨科，广西壮族自治区柳州市   545005；2柳州市人民医院创伤骨科，广西壮族自治区柳州市   545006
  • 收稿日期:2023-06-20 接受日期:2023-10-12 出版日期:2024-11-28 发布日期:2024-01-30
  • 通讯作者: 石展英，硕士，主任医师，柳州市人民医院创伤骨科，广西壮族自治区柳州市 545006
  • 作者简介:梁钟帅，男，1996年生，广西壮族自治区都安县人，壮族，广西医科大学在读硕士，医师，主要从事四肢骨骨折治疗方向的研究。 王仁崇，男，1981年生，四川省成都市人，汉族，副主任医师，主要从事骨创伤方面的研究。
  • 基金资助:
    柳州市科技计划项目(2022SB016)，新型胫骨平台骨折组合万向锁定钢板的研发，项目负责人：王仁崇；广西科技项目(桂科AB22080096)，基于大数据的骨科人工智能康复平台的建立和应用，项目参与人：谢友；广西重点研发计划(桂科AB17129001)，区域性创伤急救体系的创新与应用示范，项目负责人：石展英

Design and finite element analysis of a new type of plate for hyperextension varus tibial plateau fractures

Liang Zhongshuai1, Wang Renchong1, Zhang Lu1, Hu Juzheng1, Shi Zhanying2, Xie You1, Mao Chunhua1   

  1. 1Department of Trauma and Orthopedics, Liuzhou Worker’s Hospital, Liuzhou 545005, Guangxi Zhuang Autonomous Region, China; 2Department of Trauma and Orthopedics, Liuzhou People’s Hospital, Liuzhou 545006, Guangxi Zhuang Autonomous Region, China
  • Received:2023-06-20 Accepted:2023-10-12 Online:2024-11-28 Published:2024-01-30
  • Contact: Shi Zhanying, Master, Chief physician, Department of Trauma and Orthopedics, Liuzhou People’s Hospital, Liuzhou 545006, Guangxi Zhuang Autonomous Region, China
  • About author:Liang Zhongshuai, Master candidate, Physician, Department of Trauma and Orthopedics, Liuzhou Worker’s Hospital, Liuzhou 545005, Guangxi Zhuang Autonomous Region, China Wang Renchong, Associate chief physician, Department of Trauma and Orthopedics, Liuzhou Worker’s Hospital, Liuzhou 545005, Guangxi Zhuang Autonomous Region, China
  • Supported by:
    Liuzhou Science and Technology Plan Project, No. 2022SB016 (to WRC); Guangxi Science and Technology Project, No. AB22080096 (to XY); Guangxi Key Research & Development Program, No. AB17129001 (to SZY)

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摘要：


文题释义：

过伸内翻型胫骨平台骨折：是在膝关节处于过伸且内翻状态下受伤所导致的前内侧柱的压缩性骨折，同时也可能同时出现后外侧胫骨平台的撕裂型骨折和神经血管的损伤。
桡骨远端万向锁定钢板：是一款成功应用于临床治疗桡骨远端骨折的接骨钢板，其特点在于钢板远端2.4 mm的螺钉在钉孔的中轴方向上有30°的自由度。术者可以根据术中骨折块的具体情况，灵活选择螺钉置入的角度和方向，从而实现对骨折块的有效固定。


背景：目前尚无适用于前内侧平台的解剖型锁定钢板，因此通常采用胫骨平台内侧锁定钢板偏前放置来固定过伸内翻损伤导致的前内侧压缩骨折。由于锁定螺钉无法实现对骨折线的垂直固定，再加上髌韧带的影响，临床效果仍不尽人意。

目的：通过有限元分析比较新型钢板与传统内固定方式治疗胫骨平台前内侧骨折的生物力学性能。
方法：收集20例内翻型胫骨平台前内侧骨折的CT数据，并对其形态学特征，如前内侧胫骨平台后倾角、骨折面角度、骨折块表面积、高度和角度等进行测量。选择1位24岁、身高175 cm、体质量65 kg的男性志愿者，将其胫骨CT数据导入Mimics 21.0软件生成三维模型。在SolidWorks 2017软件中导入内固定模型，根据测量的形态学数据建立新型钢板、内侧锁定钢板、后内侧锁定钢板和6.5 mm拉力螺钉固定数据模型。使用Ansys 17.0软件对4种固定模型进行应力加载，比较其生物力学性能。

结果与结论：①随着轴向载荷的增加，不同内固定模型的应力峰值近似同比增大，500 N时应力峰值：螺钉组(6.973 7 MPa) <新型钢板组(14.733 MPa) <内侧钢板组(16.445 MPa) <后内侧钢板组(25.199 MPa)；②500 N时骨折块的应力峰值：螺钉组(3.657 9 MPa) <新型钢板组(4.510 8 MPa) <内侧钢板组(5.225 9 MPa) <后内侧钢板组(6.181 2 MPa)；③随着轴向载荷的增加，骨折块和内固定位移也近似等比增大，位移分布特征无明显变化；500 N时钢板位移：新型钢板组(1.030 7 mm) <内侧钢板组(1.503 mm) <螺钉组(2.096 5 mm) <后内侧钢板组(2.258 2 mm)；500 N时骨折块位移：新型钢板组(0.212 8 mm) <内侧钢板组(0.311 54 mm) <螺钉组(0.427 79 mm) <后内侧钢板组(0.454 98 mm)；④提示在治疗过伸内翻型胫骨平台骨折时，新型钢板的稳定性和力学性能优于传统内固定方式。

https://orcid.org/0000-0002-9276-3704 (梁钟帅) 

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: 胫骨平台, 骨折固定术, 过伸损伤, 新型钢板, 前内侧, 有限元分析

Abstract: BACKGROUND: There is currently no anatomic locking plate suitable for the anteromedial platform, so the medial locking plate of the tibial plateau is usually placed forward to fix anteromedial compression fractures caused by hyperextension varus injury. Due to the inability of the locking screw to achieve vertical fixation of the fracture line, coupled with the influence of the patellar ligament, the clinical results are still unsatisfactory.
OBJECTIVE: To compare the biomechanical performance of a new type of plate with traditional internal fixation methods in treating hyperextension varus tibial plateau fractures through finite element analysis. 
METHODS: CT data of 20 cases of hyperextension varus tibial plateau fractures were collected, and their morphological characteristics, such as medial posterior tibial slope, the medial articular fracture angle, surface area, and anterior cortical height were measured. A 24-year-old male volunteer with a height of 175 cm and a weight of 65 kg was selected, and his tibial CT data were imported into Mimics 21.0 software to generate a 3D model. Then, internal fixation models were imported into SolidWorks 2017 software. New type of plate, medial locking plate, posterior medial locking plate, and 6.5 mm hollow screws fixed data models were established based on the measured morphological data. Ansys 17.0 software was used to load stress on the four fixation models and compare their biomechanical performance.
RESULTS AND CONCLUSION: (1) With the increase of axial load, the peak stresses of different internal fixation models approximately increased proportionally. At 500 N, the peak stress values were as follows: screw group (6.973 7 MPa) < new steel plate group (14.733 MPa) < medial locking plate group (16.445 MPa) < posterior medial locking plate group (25.199 MPa). (2) The peak stresses of the fracture block were as follows: at 500 N, screw group (3.657 9 MPa) < new steel plate group (4.510 8 MPa) < medial locking plate group (5.225 9 MPa) < posterior medial locking plate group (6.181 2 MPa). (3) With the increase of axial load, the displacement of the fracture block and internal fixation approximately increased proportionally, and the displacement distribution characteristics showed no significant changes. At 500 N, the steel plate displacement values were as follows: new steel plate group (1.030 7 mm) < medial locking plate group (1.503 mm) < screw group (2.096 5 mm) < posterior medial locking plate group (2.258 2 mm). At 500 N, the fracture block displacement values were as follows: new steel plate group (0.212 8 mm) < medial locking plate group (0.311 54 mm) < screw group (0.427 79 mm) < posterior medial locking plate group (0.454 98 mm). (4) It is concluded that in the treatment of hyperextension varus tibial plateau fractures, the stability and mechanics of the new steel plate are superior to traditional internal fixation methods. 

Key words: tibial plateau, fracture fixation, hyperextension injury, new steel plate, anteromedial, finite element analysis

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