中国组织工程研究

中国组织工程研究 ›› 2012, Vol. 16 ›› Issue (35): 6471-6477.doi: 10.3969/j.issn.2095-4344.2012.35.003

• 数字化骨科 digital orthopedics • 上一篇    下一篇

多针内固定治疗跟骨骨折的有限元及临床分析

孙荣鑫1，姜 侃1，白靖平2   

  1. 1新疆医科大学第六附属医院，新疆维吾尔自治区乌鲁木齐市830002；
    2新疆医科大学附属肿瘤医院，新疆维吾尔自治区乌鲁木齐市 830000
  • 收稿日期:2012-04-10 修回日期:2012-06-16 出版日期:2012-08-26 发布日期:2012-08-26
  • 通讯作者: 白靖平，博士，主任医师，博士生导师，新疆医科大学附属肿瘤医院，新疆维吾尔自治区乌鲁木齐市830000 baijingping@yahoo.cn
  • 作者简介:孙荣鑫★，男，硕士，主治医生，主要从事关节外科的研究。 dadi136@126.com

Finite element analysis and clinical analysis on multi-pin internal fixation for the treatment of calcaneal fractures

Sun Rong-xin1, Jiang Kan1, Bai Jing-ping2   

  1. 1Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi 830002, Xinjiang Uygur Autonomous Region, China;
    2Affiliated Cancer Hospital of Xinjiang Medical University, Urumqi 830000, Xinjiang Uygur Autonomous Region, China
  • Received:2012-04-10 Revised:2012-06-16 Online:2012-08-26 Published:2012-08-26
  • Contact: Bai Jing-ping, Doctor, Chief physician, Doctoral supervisor, Affiliated Cancer Hospital of Xinjiang Medical University, Urumqi 830000, Xinjiang Uygur Autonomous Region, China baijingping@yahoo.cn
  • About author:Sun Rong-xin★, Master, Attending physician, Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi 830002, Xinjiang Uygur Autonomous Region, China dadi136@126.com

PDF

456

被引次数

5

摘要：

背景：选择恰当的治疗方法能明显改善跟骨关节内骨折患者的预后。
目的：旨在分析跟骨骨折多针内固定和钢板内固定两种方法的固定效果，评价2种内固定方式的临床疗效。
方法：①CT扫描正常男性右侧跟骨，建立完整跟骨三维有限元模型，模拟Sanders Ⅱ型跟骨骨折，模拟跟骨骨折钢板和多针两种内固定后受到跟腱载荷的工况，对比研究钢板功能位0°、多针功能位0°组、多针跖屈30° 组2种内固定3种分组模型的应力分布、骨折线相对位移和内固定最大主应力。②回顾性研究59例Sanders Ⅱ型跟骨骨折，其中36例患足行切开复位多针内固定，23例患足行切开复位钢板内固定, 采用Maryland足部评分系统评价跟骨骨折钢板和多针两种内固定后的临床疗效，并分析固定后软组织并发症。
结果与结论：①有限元分析中加载足踝静止状态跟腱最大载荷160 N，3组模型内固定的最大主应力值均小于内固定屈服强度225 MPa。3组模型跟骨骨折线的相对移位均小于跟骨关节内骨折手术指征的骨折线分离或移位≥1 mm的标准。连续加载1~1 000 N载荷的工况，3组模型内固定失效时对应的跟腱载荷均大于160 N。模型的应力分布显示，多针与钢板内固定都均匀分布了应力。②临床研究结果显示SandersⅡ型骨折多针固定组优良率83%，钢板固定组优良率78%，两组固定后疗效差异无显著性意义(P > 0.05)，但多针固定组固定后软组织并发症发生率低于钢板固定组(P < 0.05)。

关键词: 跟骨骨折, SandersⅡ型骨折, 内固定, 有限元分析, 临床分析, 组织工程

Abstract:

BACKGROUND: In the calcaneal fractures, proper treatment can significantly improve prognosis of the patients.
OBJECTIVE: To analyze the effect of multi-pin fixation and plate fixation on calcaneal fractures, and to evaluate clinical efficacy of two kinds of internal fixation methods.
METHODS: ①CT scan was performed on a normal male right calcaneus to establish a complete three-dimensional finite element model of calcaneus, and the model was used to simulate Sanders Ⅱ type fracture of calcaneus, and simulate the tendon loading condition after calcaneal fracture plate and multi-pin internal fixation. The stress distribution, the relative displacement of the fracture line and the maximum principal stress of internal fixation of three groups (plate functional location at 0°; multi-pin functional location at 0°; multi-pin planter flexion location at 30°) were comparatively analyzed. ②Retrospective study of 59 cases of Sanders Ⅱ type fracture, 36 cases of the foot treated with open reduction and multi-pin fixation, 23 cases of the foot treated with open reduction and plate fixation, then the soft tissue complications after fixation was evaluated.
RESULTS AND CONCLUSION: ①The finite element analysis showed the biggest achilles tendon loading load was 160 N, the maximum principal stress values of the models in three groups were less than the yield strength of fixation 225 MPa. The relative displacement of calcaneal fracture line in three groups was less than the intra-articular calcaneal fractures indications standard (surgical separation of the fracture line or displacement ≥ 1 mm). Continuous loading 1- 1 000 N load condition, the achilles tendon loads of internal fixation failure in three groups were greater than 160 N. Stress distribution analysis showed multi-pin and plate fixation evenly distributed the stress. ②The clinical research results showed that good rate of Sanders Ⅱ fracture in multi-pin fixation group was more than 83%, the good rate in the plate fixation group was 78%, there was no significant difference of the efficacy after fixation between two groups (P > 0.05). The occurrence rate of postoperative soft tissue complications in multi-pin fixation group was lower than that in the plate fixation group (P < 0.05).

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