新型锁定钢板与AO-PHILOS钢板固定肱骨近端四部分骨折的三维有限元分析  

Three-dimensional finite element analysis on the novel locking plate and AO-PHILOS plate for fixing four-part proximal humeral fractures

作　　者：章伟[1] 芮碧宇[2] 潘垚[2] 傅士平[1] 张明[3] 张云龙[2] 薛培璘 陈云丰[2] ZHANG Wei RUI Bi-yu PAN Yao FU Shi-ping ZHANG Ming ZHANG Yun-long XUE Pei-lin CHEN Yun-feng(Department of Orthopaedics, the Eighth People＇ s Hospital, Shanghai200235, China Department of Orthopaedics, the Sixth People＇ s Hospital, Shanghai Jiao Tong University, Shanghai 200233, China Department of Orthopaedics, Puai Hospital, Wuhan 430033, China)

机构地区：[1]上海市第八人民医院骨科,上海200235 [2]上海交通大学附属第六人民医院骨科,上海200233 [3]武汉市普爱医院骨科,武汉430033

出　　处：《医用生物力学》2016年第6期548-555,共8页Journal of Medical Biomechanics

基　　金：上海市自然科学基金项目(13DZ940702)

摘　　要：目的比较分别使用新型锁定钢板固定和AO-PHILOS钢板固定肱骨近端四部分骨折的生物力学表现。方法建立肩关节、肱骨近端四部分及骨折内固定三维有限元模型。通过有限元分析,比较两种骨折内固定模型在肩关节4种外展不同功能位置时应力、位移分布情况。结果肩关节外展0°、30°、60°、90°时,新型锁定钢板的最大位移分别为6.644、7.079、5.850、3.005 mm,而AO-PHILOS钢板的最大位移分别为6.293、6.826、5.774、3.023 mm。两种内固定的最大位移在变化中接近,表明在固定肱骨近端骨折中的稳定性无明显差别。肩关节外展0°、30°、60°、90°时,新型锁定钢板的最大Von Misses应力分别为1 033.0、904.1、888.1、1 062.0 MPa,而AO-PHILOS钢板的最大Von Misses应力分别为743.1、692.4、486.4、393.5 MPa。在不同肩关节外展位过程中,两者总体应力都在逐渐减小,但新型锁定钢板应力减小的范围较大,相对来说,应力分散传递明显。结论新型锁定钢板和AO-PHILOS钢板内固定治疗肱骨近端四部分骨折时,应力分布差异不明显,都表现出稳定的固定效果。但对于有骨质疏松且同时合并大、小结节的肱骨近端骨折时,新型锁定钢板独特的解剖设计及固定效果更具有优势。Objective To compare biomechanical performance of four-part proximal humeral fractures fixed by novel locking plate or by AO-PHILOS plate. Methods The finite element fixation models of both the novel locking plate and AO-PHILOS plate for four-part proximal humeral fractures were established, respectively. The maximum Von Mises stress and displacement under 4 different functional positions of shoulder abduction in the two fixation models were compared by finite element analysis. Results The maximum displacement in shoulder abduction of 0° ,30° ,60° ,90° were 6.644, 7.079, 5. 850, 3.005 mm, respectively, in novel locking plate fixation model, and 6. 293, 6. 826, 5. 774, 3. 023 mm, respectively, in AO-PHILOS plate fixation model. Since the maximum displacements in both fracture fixation models were similar, it indicated that there was no significant difference in the stability for fixing proximal humeral fracture. The maximum Von Mises stress in shoulder abduction of 0° ,30° ,60°, 90°were 1 033. 0, 904.1,888.1, 1062.0 MPa in novel locking plate fixation model, while in AO-PHILOS plate fixation model, it showed 743. 1, 692.4,486.4,393.5 MPa, respectively. During the process of shoulder abduction, the total stress in both fracture fixation models gradually decreased, but the new locking plate decreased in a larger range, showing an obvious stress dispersion. Cenclusiens Both the novel locking plate and AO-PHILOS plate can be used as internal fixation treatment for complex four-part proximal humeral fractures with no significant difference in stress distribution, and both showing a stable fixation effect. For fixing proximal humeral fractures with osteoporosis combined with the great and less tuberosity, the novel locking plate has an advantage over AO- PHILOS plate due to its unique anatomical wings and better fixing effect.

关 键 词：肱骨近端骨折 内固定 锁定钢板 AO—PHILOS钢板 有限元分析 

分 类 号：R318.01[医药卫生—生物医学工程]