不同载荷下3种固定方式治疗胫骨平台后外侧骨折的有限元分析  

Finite element analysis on three internal fixations for posterolateral tibial plateau fracture under different loads

作　　者：张岩[1] 范鑫斌[1] 梁旭[1] 杨铁毅[1] 叶维光 邵进[1] 龚璐璐[2] 

机构地区：[1]上海市浦东新区公利医院骨科,上海200135 [2]同济大学生命科学与技术学院,上海200092

出　　处：《医用生物力学》2015年第1期62-67,共6页Journal of Medical Biomechanics

基　　金：上海市浦东新区科技发展基金创新资金项目(PKJ2011-Y09);上海市浦东新区卫生系统学科带头人资助项目(PWRd2012-16)

摘　　要：目的探索不同轴向载荷下3种固定方式(外侧钢板螺钉组、后侧钢板螺钉组、前后拉力螺钉组)治疗胫骨平台后外侧骨折的生物力学特性差异。方法利用胫骨平台CT图片的相关数据建立胫骨平台后外侧1/2和1/4骨折3种固定方式的实体模型,进行网格划分。分析不同轴向载荷作用下,3种固定方式治疗胫骨平台后外侧1/2和1/4骨折模型的受力状况。结果 1 k N轴向载荷下,对于1/2骨折固定模型,外侧钢板螺钉组、后侧钢板螺钉组、前后拉力螺钉组骨折块的位移分别为552.082、67.964、54.085μm,内固定物的应力分别为306.745、231.844、73.047 MPa;对于1/4骨折固定模型,外侧钢板螺钉组、后侧钢板螺钉组、前后拉力螺钉组骨折块的位移分别为416.072、302.107、150.639μm,内固定的应力分别为306.673、208.467、73.607 MPa。1.5 k N轴向载荷下,各种固定方式下骨折块的位移和内固定物的应力都相应增加,数据的变化趋势同1 k N载荷情况相似。结论两种载荷下,不同骨折模型均显示前后拉力螺钉组的生物力学稳定性最具优势,后侧钢板螺钉亦可以获得相近的力学特性。在临床工作中,对于移位不明显的胫骨平台后外侧骨折,前后拉力螺钉固定方式可以作为首选。Objective To investigate the differences in biomechanical properties of 3 internal fixation patterns（ the lateral plate and screw group,the rear plate and screw group,and the front and rear lag screw group） for treating posterolateral tibial plateau fracture under different axial loads. Methods Based on CT data of the tibial plateau,the entity model of 1 /2 and 1 /4 posterolateral tibial plateau fracture with 3 internal fixations were established and meshed to analyze force status of the fracture models with 3 internal fixations under different axial loads. Results Under the axial load of 1 kN,for the 1 /2 posterolateral tibial plateau fracture model,the displacements of the fracture fragments in the lateral plate and screw group,the rear plate and screw group,and the front and rear lag screw were 552. 082,67. 964,54. 085 μm,respectively,and the stresses on the fixation device were 306. 745,231. 844,73. 047 MPa,respectively. For the 1 /4 posterolateral tibial plateau fracture model,the displacements in the three groups above were 416. 072,302. 107,150. 639 μm,respectively,and the stresses on the fixation device were 306. 673,208. 467,73. 607 MPa,respectively. Both the displacements of the fracture fragments and the stresses on the fixation device increased correspondingly under the axial load of 1. 5 kN,and the trend of the data was similar to that under the axial load of 1 kN. Conclusions The results from the fracture models with 3 internal fixation patterns show that the front and rear lag screw group has a superior biomechanical stability under two different axial loads,and the similar mechanical properties can be achieved in the rear plate and screw group.Therefore,the front and rear lag screws will be preferred to treat posterolateral tibial plateau fracture with less obvious displacement in clinic.

关 键 词：胫骨平台 后外侧骨折 固定 有限元分析 

分 类 号：R318.01[医药卫生—生物医学工程]