中国组织工程研究

中国组织工程研究 ›› 2016, Vol. 20 ›› Issue (4): 559-563.doi: 10.3969/j.issn.2095-4344.2016.04.019

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

可吸收螺钉置入固定简单外踝骨折的有限元分析

黄晓微1，龚中华2，禹宝庆1，李泽湘1，敖荣广1   

  1. 上海市浦东医院，1骨科，2影像科，上海市 201399
  • 收稿日期:2015-11-17 出版日期:2016-01-22 发布日期:2016-01-22
  • 通讯作者: 禹宝庆，博士，主任医师，上海市浦东医院骨科，上海市 201399
  • 作者简介:黄晓微，男，1991年生，江苏省海安县人，汉族，复旦大学上海医学院在读硕士，主要从事骨创伤方面的研究。
  • 基金资助:
    上海市卫生局重点课题(20124021)《可显影可吸收骨折内固定器械的研制》；上海市浦东新区卫生系统重点专科建设资助项目(PWZz2013-09)《可显影可吸收加压髓内钉的研制》

Absorbable screw fixation repairs simple lateral malleolus fracture: a finite element analysis

Huang Xiao-wei1, Gong Zhong-hua2, Yu Bao-qing1, Li Ze-xiang1, Ao Rong-guang1   

  1. 1Department of Orthopedics, 2Department of Radiology, Shanghai Pudong Hospital, Shanghai 201399, China
  • Received:2015-11-17 Online:2016-01-22 Published:2016-01-22
  • Contact: Yu Bao-qing, M.D., Chief physician, Department of Orthopedics, Shanghai Pudong Hospital, Shanghai 201399, China
  • About author:Huang Xiao-wei, Studying for master’s degree, Department of Orthopedics, Shanghai Pudong Hospital, Shanghai 201399, China
  • Supported by:

    the Key Project of Shanghai Municipal Health Bureau, China, No. 20124021; the Key Specialty Construction Project of Pudong New Area Health System of Shanghai City, No.PWZz2013-09

PDF

771

被引次数

6

摘要：

文章快速阅读：

文题释义：

可吸收螺钉：可吸收内固定材料不同于金属内固定物，主要运用于关节内及松质骨骨折，可在体内完全降解为水和二氧化碳，使患者免受二次手术之苦。48 h内自身发生膨胀，增强了坚固性，固定强度维持时间达6个月，可提供足够的踝部松质骨愈合时间。而且随着聚合物的降解，应力逐渐转移至骨组织，有利于消除应力遮挡效应，使骨密度增加，防止骨质疏松，促进骨折愈合和骨的塑型改建。在愈合过程中，无金属固定物的电解腐蚀作用，不干扰骨痂生成。

外踝骨折：通常发生在小腿不动足部强力外旋，或足不动小腿强力内转时，距骨体的前外侧挤压外踝前内侧，造成腓骨下端斜行或螺旋形骨折。

 

背景：可吸收螺钉与金属螺钉相比具有明显优势，例如无需行内固定去除，不含金属成分，不会影响患者置入后的核磁共振检查。而且置入操作相对简单，即钻孔-攻丝-螺钉固定更加符合骨科微创原则。
目的：借助于有限单元技术探讨可吸收螺钉固定简单外踝骨折的生物力学特性。
方法：建立简单外踝骨折的三维有限元模型以及可吸收螺钉模型，按照标准骨科手术技术予以固定，加载模拟正常成人一个步态周期中腓距关节承载最大值时的参考负载，分析腓骨和可吸收螺钉的应力分布状态和位移。

结果与结论：单一螺钉固定模型共有38 542个单元，8 790个节点。当外踝关节面加载300 N力时，螺钉最大应力为89.35 MPa，螺钉最大位移为0.5 mm，骨折远端最大位移0.5 mm。当外踝关节面加载450 N力时，螺钉最大应力为152.58 MPa，螺钉最大位移为0.59 mm，骨折远端最大位移0.77 mm。双螺钉固定模型共有43 115个单元，9 496个节点。当外踝关节面加载300 N力时，螺钉最大应力为38 MPa，螺钉最大位移为0.44 mm，骨折远端最大位移0.44 mm。当外踝关节面加载450 N力时，螺钉最大应力为66.68 MPa，螺钉最大位移为0.48 mm，骨折远端最大位移0.49 mm。实验验证了可吸收螺钉用于简单外踝骨折的生物力学可行性。对于简单的只累及腓骨下段的外踝骨折，可吸收螺钉固定是完全可行的，而且通常需要至少2枚螺钉以维持关节面的稳定复位。 

 

ORCID: 0000-0003-2092-7228(黄晓微)

关键词: 骨科植入物, 数字化骨科, 有限元分析, 可吸收螺钉, 腓距关节, 应力, 位移

Abstract:

BACKGROUND: Compared with the metal screws, absorbable screws have more obvious advantages, such as does not have to conduct internal fixation removal, non-metallic components, no influence on the magnetic resonance imaging of patients after implantation, relatively simple operations, namely drilling-tapping-screws fixation, more in line with the principles of minimally invasive in orthopedics.
OBJECTIVE: To investigate the biomechanical characteristics of absorbable screw fixation in repair of simple lateral malleolus fractures by means of finite element technology.
METHODS: The three-dimensional model of simple lateral malleolus fractures and absorbable screw model were established, and then fixed according to standard orthopedic surgical techniques. The reference load when the load bearing of fibulotalar joint reaching the peak value in a normal adult gait cycle was loaded. The stress distribution and displacement of fibula and absorbable screws were analyzed.
RESULTS AND CONCLUSION: There were totally 38 542 units, 8 790 nodes in the single screw fixation model. When the articular facet of lateral malleolus loading 300 N, the maximum stress of screws was 89.35 MPa, the maximum displacement was 0.5 mm, the maximum displacement of the distal fracture was 0.5 mm. When the articular facet of lateral malleolus loading 450 N, the maximum stress of screws was 152.58 MPa, the maximum displacement was 0.59 mm, the maximum displacement of the distal fracture was 0.77 mm. There were totally 43 115 units, 9 496 nodes in the double screws fixation model. When the articular facet of lateral malleolus loading 300 N, the maximum stress of screws was 38 MPa, the maximum displacement was 0.44 mm, the maximum displacement of the distal fracture was 0.44 mm. When the articular facet of lateral malleolus loading 450 N, the maximum stress of screws was 66.68 MPa, the maximum displacement was 0.48 mm, the maximum displacement of the distal fracture was 0.49 mm. The experiment verified the biomechanical feasibility of absorbable screw fixation in repair of simple lateral malleolus fractures. For simple involving only the lower lateral fibular fracture, absorbable screw fixation is entirely feasible, and usually requires at least two screws to maintain the stability of the articular surface of the reset.