中国组织工程研究

中国组织工程研究 ›› 2025, Vol. 29 ›› Issue (27): 5735-5742.doi: 10.12307/2025.823

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

后外侧胫骨平台骨折应用万向螺钉的有限元分析

胡正辉1，张  文2，衡红全3，任伟志1，吴晨颖1，顾增辉1，彭  建1，李柳炳1，徐  炜1   

  1. 1苏州大学附属第二医院关节外科，江苏省苏州市   215000；2苏州大学骨科研究所，江苏省苏州市   215000；3陆军军医大学第一附属医院关节外科中心，重庆市   400000
  • 收稿日期:2024-06-15 接受日期:2024-08-12 出版日期:2025-09-28 发布日期:2025-03-03
  • 通讯作者: 徐炜，博士，主任医师，苏州大学附属第二医院关节外科，江苏省苏州市  215000 并列通讯作者：李柳炳，博士，主任医师，苏州大学附属第二医院关节外科，江苏省苏州市   215000
  • 作者简介:胡正辉，1998年生，硕士，主要从事胫骨平台骨折的研究。 并列第一作者：张文，硕士，高级实验师，主要从事科研实验的研究。 并列第一作者：衡红全，医师，硕士，主要从事关节外科领域的研究。
  • 基金资助:
    姑苏人才计划(2020092)，项目负责人：李柳炳；苏州市重点学科(SZXK202104)；苏州大学第二附属医院临床新技术开发项目(23ZL009)，项目负责人：徐炜；省部共建放射医学与辐射防护国家重点实验室开放项目(GZK1202215)，项目负责人：李柳炳

Finite element analysis of application of variable angle screws in posterolateral tibial plateau fractures

Hu Zhenghui1, Zhang Wen2, Heng Hongquan3, Ren Weizhi1, Wu Chenying1, Gu Zenghui1, Peng Jian1, Li Liubing1, Xu Wei1   

  1. 1Department of Joint Surgery, Second Affiliated Hospital of Soochow University, Suzhou 215000, Jiangsu Province, China; 2Institute of Orthopedic Surgery, Soochow University, Suzhou 215000, Jiangsu Province, China; 3Center for Joint Surgery, First Affiliated Hospital of Army Medical University, Chongqing 400000, China
  • Received:2024-06-15 Accepted:2024-08-12 Online:2025-09-28 Published:2025-03-03
  • Contact: Xu Wei, MD, Chief physician, Department of Joint Surgery, Second Affiliated Hospital of Soochow University, Suzhou 215000, Jiangsu Province, China Co-corresponding author: Li Liubing, MD, Chief physician, Department of Joint Surgery, Second Affiliated Hospital of Soochow University, Suzhou 215000, Jiangsu Province, China
  • About author:Hu Zhenghui, MS, Department of Joint Surgery, Second Affiliated Hospital of Soochow University, Suzhou 215000, Jiangsu Province, China Zhang Wen, MS, Senior experimenter, Institute of Orthopedic Surgery, Soochow University, Suzhou 215000, Jiangsu Province, China Heng Hongquan, Physician, MS, Center for Joint Surgery, First Affiliated Hospital of Army Medical University, Chongqing 400000, China Hu Zhenghui, Zhang Wen, and Heng Hongquan contributed equally to this article.
  • Supported by:
    Suzhou Talent Program, No. 2020092 (to LLB); Suzhou Key Discipline, No. SZXK202104; Clinical New Technology Development Project of Second Affiliated Hospital of Soochow University, No. 23ZL009 (to XW); Provincial and Ministry Joint Construction of State Key Laboratory of Radiation Medicine and Radiation Protection Open Project, No. GZK1202215 (to LLB)

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摘要：

文题释义：
万向螺钉：是一种先进的紧固件，能够在不同角度进行锁紧和连接，以适应多变的结构和空间需求。这种螺钉的设计允许它在安装时调整倾斜角度，从而提供更大的灵活性和精确度。万向螺钉广泛应用于医学骨折创伤手术中，特别是在需要精确角度调整的复杂装配和结构接合处。
有限元分析：通过模拟生物组织和器官在外部力量作用下的反应，帮助研究者和医生理解复杂的生物力学行为。通过将目标结构划分为数以万计的小元素，每个元素的物理反应都可以通过数学方程进行预测和分析。这种方法使得科研人员能够在不对真实生物体进行干预的情况下，预测生物组织对于药物、医疗设备以及外部刺激的响应。

摘要
背景：通过腓骨头上入路治疗后外侧胫骨平台骨折时，腓骨头与外侧平台间隙差无法满足所有患者行钢板后置。
目的：有限元法分析腓骨头上入路治疗后外侧胫骨平台骨折过程中钢板横臂万向螺钉角度以及数量不同导致固定强度的差异。
方法：选用一名30岁健康成年男性志愿者膝关节至踝关节的CT图像，建立有限元模型。根据外侧锁定加压钢板是否后置分为后置组和非后置组，后置组根据2枚万向螺钉的偏移角度分为 A-D 组(0°，5°，10°，15°)；非后置组根据2枚万向螺钉的偏移角度分为 E，F 组(0°，15°)。采用有限元法评估 250，500，750 N 载荷下的von Mises 应力分布、最大 von Mises 应力和压缩位移，探究各组之间的力学差异。
结果与结论：①有限元分析结果显示：750 N载荷水平下，内固定装置的最大压缩位移趋势为D < B=C=F < A < E，最大von Mises应力趋势为B < C < A < D < F < E，骨的最大压缩位移趋势为C=D < B < A < F < E，最大von Mises应力趋势为B < C < A < F < D < E；6组模型在250-750 N的位移和应力趋势相似；②提示通过腓骨头上入路固定后外侧胫骨平台骨折，应尽量满足钢板后置2枚螺钉固定；当术中后置钢板仅满足1枚螺钉固定时，可使用万向螺钉在0°-15°范围内后偏，增加2枚螺钉的固定概率。


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: 后外侧胫骨平台骨折, 腓骨头上入路, 有限元分析, 万向螺钉, 钢板后置, 膝关节, 应力分散, 生物力学

Abstract: BACKGROUND: During the treatment of posterolateral tibial plateau fractures through the fibular head approach, the gap between the fibular head and the lateral plateau cannot accommodate the posterior placement of a plate for all patients.
OBJECTIVE: To analyze, via finite element analysis, the differences in fixation strength resulting from varying the angles and quantities of horizontal arm variable angle screws in the plate during the treatment of posterolateral tibial plateau fractures through the fibular head approach.
METHODS: A finite element model was established based on CT images of the knee to ankle joints of a 30-year-old healthy adult male volunteer. The models were divided into two categories: posteriorly placed group and non-posteriorly placed group based on whether the lateral locking compression plate was posteriorly placed. The posteriorly placed group was further subdivided into groups A-D based on the offset angle of the two variable angle screws (0°, 5°, 10°, and 15°). The non-posteriorly placed group was subdivided into groups E and F based on offset angles (0° and 15°). Finite element analysis was used to evaluate the von Mises stress distribution, maximum von Mises stress, and compressive displacement under loads of 250, 500, and 750 N, exploring the mechanical differences between the groups.
RESULTS AND CONCLUSION: (1) Finite element analysis results showed that under a 750 N load, the maximum compressive displacement trend of the internal fixation device was D < B=C=F < A < E. The trend for maximum von Mises stress was B < C < A < D < F < E. The trend for maximum compressive displacement on the bone was C=D < B < A < F < E, and for maximum von Mises stress, it was B < C < A < F < D < E. The displacement and stress trends for the six models were similar under loads ranging from 250 N to 750 N. (2) These results suggest that for posterolateral tibial plateau fractures fixed through the fibular head approach, posterior placement of the plate should aim to accommodate two screws. If only one screw can be fixed during surgery, variable angle screws should be offset in the range of 0-15° to increase the probability of securing two screws. 

Key words: posterolateral tibial plateau fracture, fibular head approach, finite element analysis, variable angle screw, plate posterior placement, knee joint, stress dispersion, biomechanics

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