Chinese Journal of Tissue Engineering Research ›› 2020, Vol. 24 ›› Issue (30): 4769-4774.doi: 10.3969/j.issn.2095-4344.2831
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Li Yongyao1, Zhao Yong1, Cheng Hao1, Xu Huiqing1, Wei Xu1, Liu Guangwei2, Cheng Yongzhong1, Cui Xin1
Received:
2020-01-18
Revised:
2020-01-20
Accepted:
2020-03-03
Online:
2020-10-28
Published:
2020-09-18
Contact:
Cheng Hao, Chief physician, Master’s supervisor, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing 100102, China
About author:
Li Yongyao, MD, Associate chief physician, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing 100102, China
Supported by:
CLC Number:
Li Yongyao, Zhao Yong, Cheng Hao, Xu Huiqing, Wei Xu, Liu Guangwei, Cheng Yongzhong, Cui Xin. Finite element analysis of intervention of splint to ulnar column in the treatment of type Frykman VIII fracture of distal radius[J]. Chinese Journal of Tissue Engineering Research, 2020, 24(30): 4769-4774.
1.4.2 桡骨远端FrykmanⅧ型骨折有限元模型的构建 课题组前期基于Mimics软件已经建立了包含骨骼、韧带、关节软骨及软组织的正常腕关节有限元仿真模型(图1),并进行了有效性的验证[4]。现对该基础模型进行了增加尺桡骨髓腔的优化设计(图2左图),优化后模型单元数量为 859 409,节点数量为324 534。对模型轴向施加100 N载荷后计算出桡腕关节面接触应力最大值为10.6 MPa,获得的桡骨远端关节面应力分布云图(图2右图)与尸体实验报道得出的应力分布图基本吻合[5],证实了优化后模型的有效性。相关技术成果获得国家版权局计算机软件著作权登记(一种桡骨远端骨折的有限元建模系统,2019-7-10,登记号:2019SR1037684.)。 "
1.4.2 桡骨远端FrykmanⅧ型骨折有限元模型的构建 课题组前期基于Mimics软件已经建立了包含骨骼、韧带、关节软骨及软组织的正常腕关节有限元仿真模型(图1),并进行了有效性的验证[4]。现对该基础模型进行了增加尺桡骨髓腔的优化设计(图2左图),优化后模型单元数量为 859 409,节点数量为324 534。对模型轴向施加100 N载荷后计算出桡腕关节面接触应力最大值为10.6 MPa,获得的桡骨远端关节面应力分布云图(图2右图)与尸体实验报道得出的应力分布图基本吻合[5],证实了优化后模型的有效性。相关技术成果获得国家版权局计算机软件著作权登记(一种桡骨远端骨折的有限元建模系统,2019-7-10,登记号:2019SR1037684.)。 "
1.4.3 夹板有限元模型的构建及与骨折模型的组装 利用游标卡尺对小夹板进行尺寸测量,并在SolidWorks2016软件中对小夹板进行三维绘制,然后对小夹板进行分网,构建小夹板的三维有限元模型。以成人桡骨远端夹板的实物为参照,在软件中按照1∶1比例建立夹板仿真模型,严格按照尚天裕著《中国接骨学》中制定的标准位置组装。夹板固定骨折的力学机制是通过布带的约束力将力均匀分配传导到肢体上的,李想[6]对桡骨远端骨折中夹板束缚力进行了量化研究,参照其研究结果对每块夹板上均匀施加28 N载荷模拟绷带约束力,方向垂直于夹板表面,夹板与皮肤接触后开始计算,直至夹板与皮肤达到力学稳定,如此建立出实验所需夹板固定骨折的模型,用于模拟仿真夹板固定后的状态(图4)。夹板固定桡骨远端FrykmanⅧ型骨折模型(合并尺骨茎突Ⅰ型骨折)单元数量为866 384,节点数量为334 886(以下简称为Ⅰ型-夹板固定);合并尺骨茎突Ⅱ型骨折单元数量为866 312,节点数量为334 779(以下简称为Ⅱ型-夹板固定)。相关技术成果获得国家版权局计算机软件著作权登记(一种中医小夹板对桡骨远端骨折干预的有限元建模及分析系统,2019-7-10,登记号:2019SR1037948.)。 "
1.4.4 钢板螺钉系统有限元模型的构建及与骨折模型组装 在参考AO辛迪思公司桡骨远端2.4 mm锁定钢板螺丝钉系统手册所描述特征的基础上,利用游标卡尺对钢板及螺钉进行实际测量,根据所得数据在SolidWorks2016软件中进行钢板螺钉系统1∶1比例的三维绘制,绘制过程中对钢板的边缘倒角及螺钉螺纹进行简化处理,构建桡骨远端2.4 mm斜T型锁定钢板螺丝钉内固定系统的三维有限元模型。通过查阅有关内固定钢板参数的文献对不同位置的钢板、螺钉进行赋值后进行组装[7-8](图5)。据此建立出实验所需钢板固定骨折的模型,用于模拟仿真钢板固定后状态。钢板固定桡骨远端FrykmanⅧ型骨折合并尺骨茎突Ⅰ型骨折模型(以下简称为Ⅰ型-钢板固定)单元数量为875 765,节点数量为346 288;合并尺骨茎突Ⅱ型骨折(以下简称为Ⅱ型-钢板固定)单元数量为875 693,节点数量为346 181。 "
2.2 下尺桡关节在旋转工况下的相对位移变化 提取模型中立位时下尺桡关节内部尺、桡骨关节软骨部分,选取尺骨头几何中心在桡骨乙状切迹上的投影点为原始标志点。通过软件测量各模型在不同工况下标志点的位移变化值,就可以得出下尺桡关节内部尺、桡骨关节软骨部分相对位置变化,完成各模型下尺桡关节在不同工况中相对位移变化的采集[4]。结果显示在旋转工况下,夹板干预桡骨远端FrykmanⅧ型骨折合并尺骨茎突Ⅰ型及Ⅱ型骨折模型下尺桡关节发生的相对位移小于钢板干预的相对应骨折模型,见表2及图6,7,表明前者下尺桡关节比后者稳定,即夹板干预能增加尺骨茎突骨折后下尺桡关节的稳定性。在横向拉伸、旋前及旋后工况中,夹板干预桡骨远端FrykmanⅧ型骨折合并尺骨茎突Ⅰ型及Ⅱ型骨折模型尺骨茎突骨折端位移值小于钢板干预的相对应骨折模型,表明夹板干预可以增加尺骨茎突骨折端的稳定性,也可以再次佐证夹板作为弹性固定治疗桡骨远端骨折合并尺骨茎突骨折时能够提供尺侧柱的相对稳定性。 "
2.2 下尺桡关节在旋转工况下的相对位移变化 提取模型中立位时下尺桡关节内部尺、桡骨关节软骨部分,选取尺骨头几何中心在桡骨乙状切迹上的投影点为原始标志点。通过软件测量各模型在不同工况下标志点的位移变化值,就可以得出下尺桡关节内部尺、桡骨关节软骨部分相对位置变化,完成各模型下尺桡关节在不同工况中相对位移变化的采集[4]。结果显示在旋转工况下,夹板干预桡骨远端FrykmanⅧ型骨折合并尺骨茎突Ⅰ型及Ⅱ型骨折模型下尺桡关节发生的相对位移小于钢板干预的相对应骨折模型,见表2及图6,7,表明前者下尺桡关节比后者稳定,即夹板干预能增加尺骨茎突骨折后下尺桡关节的稳定性。在横向拉伸、旋前及旋后工况中,夹板干预桡骨远端FrykmanⅧ型骨折合并尺骨茎突Ⅰ型及Ⅱ型骨折模型尺骨茎突骨折端位移值小于钢板干预的相对应骨折模型,表明夹板干预可以增加尺骨茎突骨折端的稳定性,也可以再次佐证夹板作为弹性固定治疗桡骨远端骨折合并尺骨茎突骨折时能够提供尺侧柱的相对稳定性。 "
2.2 下尺桡关节在旋转工况下的相对位移变化 提取模型中立位时下尺桡关节内部尺、桡骨关节软骨部分,选取尺骨头几何中心在桡骨乙状切迹上的投影点为原始标志点。通过软件测量各模型在不同工况下标志点的位移变化值,就可以得出下尺桡关节内部尺、桡骨关节软骨部分相对位置变化,完成各模型下尺桡关节在不同工况中相对位移变化的采集[4]。结果显示在旋转工况下,夹板干预桡骨远端FrykmanⅧ型骨折合并尺骨茎突Ⅰ型及Ⅱ型骨折模型下尺桡关节发生的相对位移小于钢板干预的相对应骨折模型,见表2及图6,7,表明前者下尺桡关节比后者稳定,即夹板干预能增加尺骨茎突骨折后下尺桡关节的稳定性。在横向拉伸、旋前及旋后工况中,夹板干预桡骨远端FrykmanⅧ型骨折合并尺骨茎突Ⅰ型及Ⅱ型骨折模型尺骨茎突骨折端位移值小于钢板干预的相对应骨折模型,表明夹板干预可以增加尺骨茎突骨折端的稳定性,也可以再次佐证夹板作为弹性固定治疗桡骨远端骨折合并尺骨茎突骨折时能够提供尺侧柱的相对稳定性。 "
2.3 骨折模型中尺骨茎突骨折端位移的变化情况 在轴向压缩工况下,因为桡腕关节面承担了绝大部分的轴向应力,夹板及钢板固定干预的骨折模型中尺骨茎突骨折端相对位移无明显变化,但在横向拉伸及旋转工况下,骨折模型中尺骨茎突骨折端相对位移均出现了明显变化,具体数值见表3。结果可见在横向拉伸及旋转工况下,Ⅰ型骨折模型的尺骨茎突骨折端相对位移小于Ⅱ型骨折模型,表明前者骨折端相对稳定;夹板干预后骨折模型中尺骨茎突骨折端相对位移均变小,在旋后工况中为著,表明夹板干预可以增加尺骨茎突骨折端的稳定性。另外在旋后工况中,钢板干预模型尺骨茎突骨折端位移值随载荷变化波动较大;夹板干预模型骨折端位移值随载荷大致呈线性变化,见图8,这说明夹板能较好地维持骨折断端稳定,能减少在康复中因旋转运动造成的进一步损伤。 "
2.3 骨折模型中尺骨茎突骨折端位移的变化情况 在轴向压缩工况下,因为桡腕关节面承担了绝大部分的轴向应力,夹板及钢板固定干预的骨折模型中尺骨茎突骨折端相对位移无明显变化,但在横向拉伸及旋转工况下,骨折模型中尺骨茎突骨折端相对位移均出现了明显变化,具体数值见表3。结果可见在横向拉伸及旋转工况下,Ⅰ型骨折模型的尺骨茎突骨折端相对位移小于Ⅱ型骨折模型,表明前者骨折端相对稳定;夹板干预后骨折模型中尺骨茎突骨折端相对位移均变小,在旋后工况中为著,表明夹板干预可以增加尺骨茎突骨折端的稳定性。另外在旋后工况中,钢板干预模型尺骨茎突骨折端位移值随载荷变化波动较大;夹板干预模型骨折端位移值随载荷大致呈线性变化,见图8,这说明夹板能较好地维持骨折断端稳定,能减少在康复中因旋转运动造成的进一步损伤。 "
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