重建钢板与钛制弹性钉两种内固定方式治疗锁骨中段骨折的有限元分析  

Finite element analysis on titanium elastic nail and reconstruction plate fixation for midshaft clavicular fractures

作　　者：曾浪清[1] 陈云丰[1] 张长青[1] 曾炳芳[1] 王磊[1] 宋文奇[1] 张闻[1] 刘燕洁[1] 章伟[1] 

机构地区：[1]上海交通大学附属第六人民医院骨科,上海200233

出　　处：《医用生物力学》2013年第4期441-447,共7页Journal of Medical Biomechanics

基　　金：上海市自然科学基金项目(12ZR1422300)

摘　　要：目的应用有限元方法分析锁骨中段骨折分别采用钛制弹性钉(titanium elastic nail,TEN)髓内固定和重建钢板固定后的应力分布、最大应力。方法利用Mimics软件对锁骨的CT数据进行三维重建,建立无损锁骨、锁骨中段骨折,分别采用TEN髓内固定和重建钢板固定的三维有限元模型。运用Abaqus 6.9软件对建立的模型进行有限元分析,模拟锁骨远端250 N轴向载荷及250 N垂直载荷下,计算三者锁骨远端位移、最大应力及应力分布等情况。结果轴向载荷下锁骨远端轴向位移为TEN固定模型(0.23 mm)>无损锁骨模型(0.14 mm)>重建钢板固定模型(0.11 mm),垂直载荷下锁骨远端垂直位移为TEN固定模型(5.12 mm)>无损锁骨模型(3.71 mm)>重建钢板固定模型(2.25 mm)。轴向载荷锁骨最大应力为TEN固定模型(33.1 MPa)>重建钢板固定模型(18.7 MPa)>无损锁骨模型(15.5 MPa);垂直载荷锁骨最大应力为TEN固定模型(146.3 MPa)>无损锁骨模型(64.1 MPa)>重建钢板固定模型(56.1 MPa)。两种载荷下TEN固定模型锁骨的应力分布均与无损锁骨模型较接近;垂直载荷下重建钢板固定模型锁骨的应力分布与无损锁骨模型明显不同。内植物最大应力,轴向载荷为TEN固定模型(191.5 MPa)>重建钢板固定模型(52.3 MPa),垂直载荷为TEN固定模型(1 248.0 MPa)>重建钢板固定模型(421.7 MPa)。结论 TEN髓内固定治疗简单的锁骨中段骨折,锁骨应力分布更接近于正常锁骨,但其骨折端锁骨及TEN应力均较大。重建钢板固定锁骨中段骨折,其固定效果更稳定,但应力遮挡效应更明显。因此,对于简单移位的锁骨中段骨折,建议采用TEN髓内固定治疗,但术后早期患肩应避免过度锻炼及持重。Objective To analyze the stress distribution and peak stress on midshaft clavicular fractures fixed by titanium elastic nail （TEN） or reconstruction plate, respectively. Methods CT data of the clavicle was adopted to reconstruct the intact clavicle model and the midshaft clavicular fracture models with the TEN and reconstruc- tion plate fixation by using Mimics software. All the three-dimensional finite element models were analyzed using Abaqus 6.9 software. The distal displacement, the peak stress and stress distribution on the distal clavicle under the axial load （250 N） and vertical load （250 N） were calculated for the three models. Results The axial dis- placement of the distal clavicle under the axial load showed TEN （0.23 mm） 〉 intact clavicle （0.14 mm） 〉 recon- struction plate （0.11 ram）, respectively. While the vertical displacement of the distal clavicle under the verticalload was 5.12 mm for TEN, 3.71 mm for intact clavicle and 2.25 mm for reconstruction plate, respectively. But the peak stress of the clavicle under the axial load was 33. 1 MPa for TEN, 18.7 MPa for reconstruction plate, and 15..5 MPa for intact clavicle model, respectively. And the peak stress under the vertical load was 146.3, 64. I, 56. I MPa in the TEN, intact clavicle model, and reconstruction plate model, respectively. The stress dis- tribution in TEN model under both kinds of loads was similar to that in intact clavicle model, while under the verti- cal load, the stress distribution in reconstruction plate model was clearly different with that in intact clavicle model. For the implants under the axial load, the peak stresses were 191.5,52.3 MPa in the TEN model and reconstruc- tion plate model, respectively, and the peak stress on implants under the vertical load was 1 248.0,421.7 MPa in the TEN model and reconstruction plate model, respectively. Conclusions The TEN for treating midshaft clavic- ular fractures showed a stress distribution similar to the intact clavicle, with a higher peak stress and a

关 键 词：锁骨骨折 内固定 钛制弹性钉 重建钢板 有限元分析 

分 类 号：R318.01[医药卫生—生物医学工程]