中国组织工程研究

中国组织工程研究 ›› 2022, Vol. 26 ›› Issue (9): 1367-1371.doi: 10.12307/2022.430

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

步态周期下不同克氏针张力带治疗髌骨横行骨折的有限元分析

刘  峰1，冯  毅2   

  1. 1曲靖市第一人民医院，云南省曲靖市   655000；2山西医科大学第二人民医院，山西省太原市   030001
  • 收稿日期:2021-05-10 修回日期:2021-05-12 接受日期:2021-07-01 出版日期:2022-03-28 发布日期:2021-12-09
  • 通讯作者: 冯毅，博士，副主任医师，山西医科大学第二人民医院，山西省太原市 030001
  • 作者简介:刘峰，男，1980年生，山东省菏泽市人，汉族，硕士，副主任医师，主要从事脊椎、关节类退变疾病研究。

Finite element analysis of different Kirschner wire tension bands on transverse patella fractures during gait cycle

Liu Feng1, Feng Yi2   

  1. 1First People’s Hospital of Qujing City, Qujing 655000, Yunnan Province, China; 2Second Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
  • Received:2021-05-10 Revised:2021-05-12 Accepted:2021-07-01 Online:2022-03-28 Published:2021-12-09
  • Contact: Feng Yi, MD, Associate chief physician, Second Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
  • About author:Liu Feng, Master, Associate chief physician, First People’s Hospital of Qujing City, Qujing 655000, Yunnan Province, China

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摘要：

文题释义：
生物力学：是应用力学原理和方法对生物体中的力学问题定量研究的生物物理学分支，其研究范围从生物整体到系统、器官(包括血液、体液、脏器、骨骼等)，研究的重点是与生理学、医学有关的力学问题。
克氏针：一种骨科常用的内固定材料，用于短小骨折或撕脱骨折等应力不大的骨折固定，也常被用在骨科手术中临时骨折块的固定。由于广泛应用，克氏针的最大直径逐渐增加到4 mm，可配合外固定锁钉来固定骨盆骨折、跟骨骨折等应激较大的骨折。

背景：不同种克氏针张力带固定治疗髌骨横行骨折的动态生物力学分析研究较少。
目的：利用三维重建技术，分析“8”字型克氏针张力带和“0”字型克氏针张力带治疗髌骨横行骨折术后在完整步态周期内的生物力学
差异。
方法：基于人体膝关节CT扫描数据，利用Mimics，Geomagic Studio，Hypermesh以及Abaqus等三维重建软件建立“8”字型和“0”字型克氏针张力带治疗髌骨横行骨折有限元模型，通过加载材料属性、设置边界条件、施加载荷等操作模拟术后膝关节的一个完整步态周期，分析2种固定模型位移和应力方面的差异。
结果与结论：①在完整步态周期内，应力值的变化与屈曲角度的变化呈正相关趋势，且在步态周期的70%处达到应力最大值；在同一个步态瞬时，“0”字型模型各部件应力均小于“8”字型模型所受应力；②在一个完整周期内2种模型各部件位移变化随着屈曲角度的增加而增大，在步态周期的70%处达到位移峰值，而在同一个步态瞬时，“0”字型模型各部件位移均小于“8”字型模型各部件的位移；在位移峰值处，“0”字型模型髌骨、克氏针与钢丝的位移分别比“8”字型模型小10%，11%和13%；③结果表明，在完整步态周期内，2种张力带模型高应力区均主要集中在髌骨骨折线附近以及内固定的接触部位，但“0”字型模型中各部件的应力峰值均小于“8”字型模型，并且在骨折端及内固定物的稳定性上更优于“8”字型张力带模型，具有更优秀的生物力学效果。

https://orcid.org/0000-0002-2246-4688 (刘峰) 

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: 髌骨, 横行骨折, 张力带, 生物力学, 步态周期, 克氏针, 有限元

Abstract: BACKGROUND: There are few studies on dynamic biomechanical analysis of Kirschner wire tension band steel wire in different winding methods for the treatment of transverse patella fractures.  
OBJECTIVE: To analyze the biomechanical difference between the “8”-shaped Kirschner wire tension band fixation and the “0”-shaped Kirschner wire tension band for the treatment of transverse patella fractures in the complete gait cycle using three-dimensional reconstruction technology.
METHODS:  Based on the CT scan data of the human knee joint, Mimics, Geomagic Studio, Hypermesh and Abaqus and other three-dimensional reconstruction softwares were used to establish the “8” and “0” shape Kirschner wire tension band to treat the finite element model of the patella transverse fracture. A complete gait cycle of the knee joint after surgery was simulated by loading the material properties, setting boundary conditions, applying loads and other operations. The difference in displacement and stress between the two fixed models was analyzed.  
RESULTS AND CONCLUSION: (1) In the complete gait cycle, the change of stress value was positively correlated with the change of buckling angle, and the maximum stress reached at 70% of the gait cycle. In the same gait instant, the stress of each component of the “0” model was less than that of the “8” model. (2) The displacement value of each component of the two models increased with the increase of the flexion angle during a complete cycle, and reached the peak displacement at 70% of the gait cycle. In the same gait instantaneously, the “0”-shaped model was different. The displacement values of the components were all smaller than those in the “8” model. At the peak of the displacement, the displacement values of the patella, Kirschner wire and steel wire of the “0” model were 10%, 11%, and 13% smaller than those of the “8” model. (3) The results show that during the complete gait cycle, the high stress areas of the two tension band models are mainly concentrated near the patella fracture line and the contact part of the internal fixation, but the stress peak value of each component in the “0” model is less than “8”-shaped model, and it is better than the “8”-shaped tension band model in terms of the stability of the fracture end and internal fixation, and has a better biomechanical effect.

Key words: patella, transverse fracture, tension band, biomechanics, gait cycle, Kirschner wire, finite element

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