四爪接骨板内固定治疗多发性肋骨骨折和连枷胸的有限元建模和临床分析  

Finite Element Modeling and Clinical Analysis of Internal Fixation of Multiple Rib Fractures and Flail Chest Using Four-claw Ti-planes

作　　者：王长涛[1,2] 王盛章[3] 王伟中[1,4] 许咏冬[1,2] 王冬冬[1,2] 李智成[1,2] 熊健[1,2] 

机构地区：[1]上海市浦东医院 [2]复旦大学附属浦东医院胸外科,上海201399 [3]复旦大学力学与工程科学系,上海200433 [4]复旦大学附属浦东医院放射科,上海201399

出　　处：《中国胸心血管外科临床杂志》2013年第5期551-554,共4页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的评价四爪接骨板行多发性肋骨骨折和连枷胸内固定术的临床疗效。方法回顾性分析上海市浦东医院2011年12月至2012年11月93例多发性肋骨骨折和连枷胸患者的临床资料,其中男78例、女15例;年龄20～80岁。均采用四爪接骨板内固定治疗,对固定后的四爪接骨板进行有限元建模分析。结果 93例患者平均肋骨骨折数(5.9±2.1)根,内固定数(3.8±1.3)根,入院后手术时间(6.3±3.2)d。患者经四爪接骨板内固定治疗后,骨折错位的肋骨及连枷胸胸壁塌陷得到矫正,患者疼痛缓解。术后胸部CT三维重建显示四爪肋骨接骨板内固定区无松脱移位,肋骨骨折复位好,胸廓恢复正常;通过有限元分析发现四爪接骨板内固定后能承受的最大应力是正常肋骨的两倍。结论四爪肋骨接骨板内固定治疗肋骨骨折效果好,并且切口小,胸壁肌肉损伤小,有较高的实用价值。Objective To evaluate clinical efficacy of four-claw Ti-planes for internal fixation of multiple rib fractures and flail chest. Methods Clinical data of 93 patients with multiple rib fractures and flail chest who were admitted to Shanghai Pudong Hospital from December 2011 to November 2012 were retrospectively analyzed. There were 78 male and 15 female patients with their age of 20-80 years. All the patients received internal fixation of rib fractures using four-claw Ti-planes. Finite element modeling and analysis were performed to investigate biomechanical behaviors of rib fractures after internal fixation with four-claw Ti-planes. Results The average number of rib fractures of the 93 patients was 5.9 ＋ 2.1, and each patient received 3.8 ＋ 1.3 four-claw Ti-planes for internal fixation. The operations were performed 6.3 ＋ 3.2 days after admission. After the rib fractures were fixed with four-claw Ti-planes, rib dislocations and chest-wall collapse of flail chest were restored, and patients＇ pain was relieved. Postoperative CT image reconstruction of the chest showed no dislocation or displacement at the fixation areas of the four-claw Ti-planes. Rib fractures were stabilized well, and normal contours of the chest were restored. Finite element analysis showed that the maximum bearable stress of the rib fractures after internal fixation with four-claw Ti-planes was twice as large as normal ribs. Conclusion Clinical outcomes of four-claw Ti-planes for internal fixation of rib fractures are satisfactory with small incisions and less muscle injury of the chest wall, so this technique deserves wide clinical use.

关 键 词：四爪接骨板 多发性肋骨骨折 连枷胸 内固定 有限元建模 

分 类 号：R687.3[医药卫生—骨科学]