中国组织工程研究 ›› 2021, Vol. 25 ›› Issue (15): 2329-2333.doi: 10.3969/j.issn.2095-4344.3815

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

胫骨近端关节外骨折两种内固定方式的有限元分析

韩世翀,李  昌,刑海洋,葛文龙,王  刚   

  1. 吉林大学中日联谊医院,吉林省长春市   130033
  • 收稿日期:2020-06-16 修回日期:2020-06-19 接受日期:2020-07-09 出版日期:2021-05-28 发布日期:2021-01-04
  • 通讯作者: 王刚,副主任医师,硕士生导师,副教授,吉林大学中日联谊医院,吉林省长春市 130033
  • 作者简介:韩世翀,男,1995年生,河南省开封市人,汉族,吉林大学中日联谊医院骨科在读硕士,主要从事四肢创伤骨科及足踝创伤方面的研究。

Finite element analysis of two internal fixation methods for treating extra-articular proximal tibial fractures

Han Shichong, Li Chang, Xing Haiyang, Ge Wenlong, Wang Gang    

  1. China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
  • Received:2020-06-16 Revised:2020-06-19 Accepted:2020-07-09 Online:2021-05-28 Published:2021-01-04
  • Contact: Wang Gang, Associate chief physician, Master’s supervisor, Associate professor, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
  • About author:Han Shichong, Master candidate, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China

摘要:

文题释义:
胫骨近端关节外骨折:胫骨近端是指按胫骨分区法分为 6 个解剖区:Ⅰ区为胫骨头区,Ⅱ区为胫骨结节区,Ⅲ区为近端中段骨干区,Ⅳ区为中段骨干区,Ⅴ区为远侧中段骨干区,Ⅵ区为踝上区。临床上胫骨近端常指Ⅰ-Ⅲ区,该部位骨折多由严重暴力导致,骨折损伤重,常伴有严重的软组织损伤。
有限元分析:通过计算机建立三维模型,利用数学近似的方法对真实的物理系统进行模拟。利用简单而又相互作用的元素,即单元,将简单的问题代替复杂问题,就可以用有限数量的未知量去逼近无限未知量的真实系统。近年来随着计算机技术的发展,有限元分析法已在骨科的生物力学研究领域中广泛应用。

背景:随着髓内钉技术的不断改进,使用髓内钉内固定治疗胫骨近端骨折逐渐增多,然而髓内钉与双侧锁定钢板固定胫骨近端关节外骨折的生物力学稳定性尚不明确。
目的:采用三维有限元方法模拟胫骨近端关节外粉碎性骨折,分析髓内钉与双侧锁定钢板内固定在不同受力情况下的生物力学特点。
方法:采用胫骨CT数据通过相关软件建立胫骨近端关节外粉碎性骨折的有限元模型,根据内固定原则,分别装配胫骨近端双侧锁定钢板与胫骨近端髓内钉,并应用有限元分析法分析胫骨近端关节外粉碎性骨折两种内固定方式在不同加载状态下的位移及应力情况。
结果与结论:①在轴向载荷下,髓内钉模型内固定系统及胫骨所受应力最小、骨折断端位移最小,内固定物应力主要集中于骨折断端附近,其中髓内钉内固定应力分布更均匀;②在三点弯曲加载下,髓内钉模型的内固定系统及胫骨所受应力最小,但骨折断端位移大于双钢板模型;髓内钉近端第3枚锁钉与主钉的相交处出现应力集中,双侧钢板内固定应力主要集中于锁定螺钉周围;③在扭转力加载下,髓内钉模型的内固定系统所承担的应力最小,骨折断端位移最小;髓内钉内固定应力均匀分布于各个锁钉与主钉的相交处,双钢板应力主要集中于外侧钢板与胫骨近端的接触面;④提示对于胫骨近端关节外粉碎性骨折,髓内钉抗轴向加载及扭转加载能力更好,而双侧锁定钢板在对抗弯曲时更具优势。

https://orcid.org/0000-0003-3823-4286 (韩世翀) 

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: 骨, 骨折, 胫骨近端骨折, 三维重建, 髓内钉, 钢板, 位移, 应力, 有限元分析

Abstract: BACKGROUND: With the development of intramedullary nail technique, use of intramedullary nailing to treat proximal tibia fractures has gradually increased. However, it is not so clear about the biomechanical stability of intramedullary nails and double locking plate fixation of proximal tibial fractures.   
OBJECTIVE: To simulate extra-articular comminuted proximal tibia fracture using three-dimensional finite element, and to analyze biomechanical characteristics of intramedullary nailing and bilateral locking plate fixation under different forces. 
METHODS: The finite element model of the extra-articular comminuted proximal tibia fracture was established by using the CT tibial data. According to the principle of internal fixation, the proximal tibia bilateral locking plate and proximal tibia intramedullary nail were assembled. The finite element analysis method was used to analyze the displacement and stress of the two internal fixation methods of the comminuted proximal tibia fracture under different loading conditions. 
RESULTS AND CONCLUSION: (1) Under the axial load, in the intramedullary nail model, the stress of internal fixation and the tibia was minimal. The displacement of the fractured end was smallest. The stress of the internal fixation was mainly concentrated near the fractured end, and the stress distribution was more uniform in the intramedullary nail model. (2) Under the three-point bending load, in the intramedullary nail model, the stress of internal fixation and the tibia was minimal, but the displacement of the fractured end was higher than the double-plate model. Stress concentration occurred at the intersection of the third locking nail and the main nail at the proximal end of the intramedullary nail. The internal fixation stress was mainly concentrated around the locking screw on both sides of the steel plate. (3) Under the torsional force, the internal fixation system of the intramedullary nail model bore the smallest stress and generated the smallest fracture end displacement. The internal fixation stress was evenly distributed at the intersection of each locking nail and the main nail in the intramedullary nail model. The stress of the double steel plate was mainly concentrated on the contact surface of the lateral steel plate and the proximal tibia. (4) The results demonstrate that the intramedullary nail has better resistance to axial loading and torsional loading for comminuted extra-articular fractures of the proximal tibia. However, the double locking plate is more advantageous when it is against bending. 

Key words: bone, fractures, proximal tibial fracture, three-dimensional reconstruction, intramedullary nail, locking plate, displacement, stress, finite element analysis

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