非锁定加压钢板与锁定加压钢板固定肱骨干骨折的有限元分析  

Finite element analysis of locking and non-locking compression plate fixation for humeral shaft fracture

作　　者：王鉴顺[1] 吴信雷[2] 郭晓山[1] 

机构地区：[1]温州医科大学附属第二医院创伤骨科,325027 [2]温州医科大学数字化医学研究所,325035

出　　处：《中华创伤骨科杂志》2016年第4期336-340,共5页Chinese Journal of Orthopaedic Trauma

基　　金：国家自然基金（81472146）;浙江省温州市科技计划项目（Y20130092）

摘　　要：目的采用有限元分析方法探讨非锁定加压钢板（DCP）与锁定加压钢板（LCP）固定治疗肱骨干骨折的生物力学异同性。方法模拟DCP和LCP治疗肱骨干横形骨折，建立相应三维有限元模型。研究在4种基础载荷（弯曲、剪切、扭转和压缩）作用下，两种内固定下的肱骨骨折块、应力峰值与分布、整体位移峰值及趋势，进而分析骨折固定后的生物力学稳定性。结果DCP的钢板螺孔连接处应力易于集中并且分布均匀；LCP的多个螺孔应力呈梯度分布，应力集中于LCP中央螺孔处。在弯曲、剪切和扭转载荷作用下，DCP固定的肱骨骨折块和钢板螺钉应力峰值均大于LCP固定；但在压缩载荷下，DCP固定的肱骨骨折块和钢板螺钉应力峰值均小于LCP固定。DCP与LCP具有相似的位移趋势。在弯曲、剪切和扭转载荷作用下，LCP固定整体位移峰值均较小；而压缩载荷下，DCP固定的整体位移峰值较小。结论DCP与LCP在一定程度上具有相似的抗弯、抗剪、抗扭和抗压生物力学效果。但LCP螺孔之间应力成梯度分布，比较适用于粉碎及骨质疏松患者；而DCP的应力分布更为均匀，需要综合考虑，将二者的优势结合起来提高内固定的疗效。Objective To compare the biomechanical properties of non-locking compression plate （DCP） and locking compression plate （LCP） in the internal fixation of humeral shaft fracture by means of finite element analysis. Methods Three-dimensional finite element models were constructed to simulate DCP and LCP internal fixation of humeral transverse fracture. The DCP and LCP groups were compared in terms of peak stress on the humeral fracture fragments （MPa）, peak stress on the screws （MPa）, and overall displacement peak value （ram） under 4 basic loads （bending, shear, torsion and compression）. The biome- chanical stability was analyzed after fracture fixation. Results The stress tended to concentrate at the connection sites of plate and screws and distributed evenly on DCP. The stress distributed in a gradient manner at the multiple screw holes and tended to concentrated on the central screws on LCP. Under the bending, shear and torsion loadings, the peak stresses on the fracture fragments and screws in the DCP fixation were larger than in the LCP fixation. However, under the compression loading, the peak stresses on the fracture fragments and screws in the DCP fixation were smaller than in the LCP fixation. DCP and LCP had similar trends in displacement. Under the bending, shear and torsion loadings, the overall displacement peak values in LCP fixation were smaller. However, under the compression loading, the overall displacement peak values in DCP fixation were smaller. Conclusions DCP and LCP have similar biomechanical properties to resist bend- ing, shear, torsion and compression. Due to the gradient distribution of stress among the screw holes, LCP is more suitable for patients with comminuted fracture or osteoporosis. Stress distribution is more even in DCP. Surgeons should consider the advantages of both DCP and LCP to achieve better stability.

关 键 词：肱骨 骨折固定术 内 骨板 有限元分析 

分 类 号：R687.3[医药卫生—骨科学]