新型组合式锁定加压钢板不同滑槽钢板方案治疗股骨粉碎性骨折的三维有限元分析  

A new assembly of locking compression plate for treatment of comminuted femoral fracture： a three-dimensional finite element analysis

作　　者：周江军[1] 易蕊[2] 赵敏[1] 肖春林[1] 刘达[3] 吕仁发[1] 杨俊[1] 付美清[1] 史柏娜[1] 余专一 程球新 雷雪[1] 

机构地区：[1]解放军第一八四医院骨科,江西省鹰潭市335000 [2]北京军区总医院医务部 [3]成都军区总医院骨科

出　　处：《中华创伤骨科杂志》2015年第8期725-729,共5页Chinese Journal of Orthopaedic Trauma

基　　金：江西省科技支撑计划（20132BBG70092）;全军后勤科研重点项目（BNJ13J003）

摘　　要：目的通过有限元分析方法观察3种不同滑槽方案的新型组合式锁定加压钢板固定股骨粉碎性骨折的应力分布情况。方法采用64排螺旋CT对1名健康成年男性志愿者的股骨进行扫描（层厚为0．625mm），获得股骨cT数据，通过Mimics10．0、Geomagic Studio12．0等逆向工程软件获得股骨有限元模型，模拟股骨中段粉碎性骨折，分别采用A、B、C方案钢板模拟手术固定，A方案：滑槽钢板与主钢板以“微弧面”接触，B方案：滑槽钢板以内侧卡槽与主钢板接触，C方案：滑槽钢板以中间卡槽与主钢板接触。加以缓慢行走单侧股骨载荷及扭转载荷，分析3种不同固定方案钢板及股骨的应力分布情况。结果在缓慢行走载荷及扭转载荷下，3种固定方案钢板应力分布变化趋势均匀，骨折断端周围为应力集中区域，主钢板最大应力集中点均位于钢板近端第5钉孔外侧缘，A方案主钢板最大应力均最小（529．20、617．20MPa）；C方案滑槽钢板最大应力均最小（372．10、814．70MPa），A方案次之（938．80、1059．00MPa）。A方案骨折块最大应力及最大位移均最小（缓慢行走载荷下分别为28．68MPa、2．411mm，扭转载荷下分别为34．52MPa、3．209mm）。结论滑槽钢板与主钢板以“微弧面”接触方案既能为股骨干粉碎性骨折提供坚强的力学稳定性，又能减小钢板应力集中，较其他2种方案更方便固定骨碎块，有利于骨愈合。Objective To explore the stress distributions on a new assembly of locking compression plate （NALCP） in 3 schemes of sliding plate by finite element analysis （FEA） in the treatment of comminuted femoral fracture. Methods A male volunteer received CT scanning with a slice thickness of 0. 625 mm. The CT data were converted to FEA models of comminuted femoral fracture by software Mimics 10. 0 and Geomagic Studio 12.0. The femoral fracture was fixated by NALCP in 3 schemes of sliding plate respectively. The sliding plate contacted the main plate by a mini arc plane in scheme A, by an inside groove in scheme B, and by a middle groove in scheme C. Loads were applied on NALCP in the 3 schemes when a person slowly walking by one leg and torsion were simulated. The stress distributions on NALCP and the femur were analyzed in the 3 schemes. Results Under the slowly walking and torsion loads, the 3 schemes led to similar change tendency in the stress distribution. The stress centered around the fracture ends. The maximum stress was situated at the lateral border of NO. 5 countersink of the plate. The maximum stress of the main plate was the smallest in scheme A（529. 20 MPa ＆ 617.20 MPa）. The maximum stress of the sliding plate was the smallest in scheme C （372.10 MPa ＆ 814.70 MPa） and the second in scheme A （938.80 MPa ＆ 1, 059.00 MPa） . The maximum stress and the maximum displacement of bone blocks were the smallest in scheme A （28.68 MPa ＆ 2.411 mm under slowly walking load; 34. 52 MPa ＆ 3. 209 mm under torsion load）. Conclusions Scheme A of NALCP in which the sliding plate contacts the main plate by a mini arc plane may provide adequate mechanical stability for comminuted femoral fracture and reduce stress concentration on plates, promoting fixation and thus bone union.

关 键 词：股骨骨折 骨折固定术 内 骨板 有限元分析 生物力学 

分 类 号：R687.3[医药卫生—骨科学]