三种固定方式治疗胫骨平台后外侧1/2骨折的生物力学分析  

Biomechanical analysis on three internal fixations for posterolateral 1/2 tibial plateau fracture

作　　者：刘世军[1] 李治国[1] 马治国[1] 冯志伟[1] 索海军[1] 娄宏亮[1] LIU Shi-jun LI Zhi-guo MA Zhi-guo FENC Zhi-wei SUO Hai-jun LOU Hong-liang(Jizhong Energy Fengfeng Group Hospital, Handan 055200, Chin)

机构地区：[1]冀中能源峰峰集团总医院创伤骨二科,河北邯郸056200

出　　处：《创伤外科杂志》2017年第5期338-342,共5页Journal of Traumatic Surgery

摘　　要：目的通过尸体标本及有限元模型对前侧拉力螺钉固定、外侧L型钢板固定和后侧T型钢板固定治疗胫骨平台后外侧1/2骨折行生物力学分析,为临床工作提供基础数据。方法选取上海交通大学医学院解剖教研室提供的新鲜成人尸体胫骨标本24个,用电动摆锯制备胫骨平台后外侧1/2骨折模型,将模型随机等分为前侧拉力螺钉固定组、外侧L型钢板固定组及后侧T型钢板固定组各8具。另选取1名健康男性志愿者,对其膝关节行螺旋CT后将数据导入Mimics14.0等软件后得到三维胫骨平台实体,经分割等操作后获得胫骨平台后外侧1/2骨折模型,而后结合三维解剖数据,通过Solidworks2013软件制作相应的拉力螺钉及钢板,模拟前侧拉力螺钉固定、外侧L型钢板固定及后侧T型钢板固定三种胫骨平台后外侧1/2骨折内固定有限元模型。对各骨折内固定实体标本和有限元模型分别施加250、500、1000、1500N的轴向载荷,比较各组骨折块移位及受力情况。结果实验生物力学结果表明,250N、500N和1000N载荷下前侧拉力螺钉固定组、外侧L型钢板固定组及后侧T型钢板固定组内固定实体标本骨折块移位值[250N:(0.14±0.02)mm vs.(0.13±0.02)mm vs.(0.14±0.13)mm;500N:(0.27±0.05)mm vs.(0.29±0.06)mm vs.(0.28±0.07)mm;1000N:(0.49±0.12)mm vs.(0.53±0.10)mm vs(0.50±0.09)mm],差异均无统计学意义(P>0.05),1500N载荷下前侧拉力螺钉固定组骨折块位移值(0.57±0.14mm)小于外侧L型钢板固定组(0.72±0.10mm)和后侧T型钢板固定组(0.76±0.13mm),差异均有统计学意义(P<0.05),外侧L型钢板固定组和后侧T型钢板固定组骨折块位移值差异无统计学意义(P>0.05)。有限元分析结果表明,在各载荷下前侧拉力螺钉固定模型的骨折块位移值及内固定最大应力均小于外侧L型钢板固定模型和后侧T型钢板固定模型。两种实验方法所得最大位移值分布区域均为近侧胫腓关节交界区。结论�Objective To analyze three internal fixations for posterolateral 1/2 tibial plateau fracture through hiomechanical and finite element analysis methods. Methods Twenty-four fresh adult cadaver tibia speci- mens were selected and made into posterolateral 1/2 tibia1 plateau fracture models by electric saw. They were divided into anterior screw fixation group （8 cases）, lateral L type plate fixation group （8 cases ） and posterior T type plate fixation group （8 cases）. A healthy male volunteer was selected, who was given CT on knee joint and the data was imported into Mimics 14. 0 software to make tibia] plateau and fracture model. Axial load was given on solid specimen and finite element model. The displacement and stress of fracture mass were compared among groups. Results There was no significant difference in displaced fragment of bone on 250N ,500N and 1000N axial load a- mong 3 internal fixations models[ 250N： （0. 14±0. 02）mm vs. （0. 13 ± 0. 02）mm vs. （0. 14± 0. 13 ）mm ;500N： （ 0. 27 ± 0. 05 ） mm vs. （ 0. 29± 0. 06 ） mm vs. （0.28±0.07）mm;1000N：（0,49±0.12）mmvs. （0.53±0.10） mm vs. （0. 50± 0. 09） mm; P 〉 0. 05 1. The bone displaced distance of fragment of anterior screw fixation group （0. 57±0. 14） mm was lower than that of other groups [ （ 0. 72 ±0. 10） mm, （ 0. 76 ± 0. 13 ） mm ] on 1500N axial load （ P 〈 O. 05 ）. In finite element, the bone displaced distance of fragments of anterior screw fixation were less than those of other two groups on all axial loads （ P 〈 O. 05 ） ; the maximum displacement distribution regions were all lo-catt＇d into proxi,nal tibial joint junction. Conclusion For poslerolateral I/2 tibial plateau fracture,all three fixation methods can provide early stability,while the stability＇ of anterior screw fixation is better than lateral L type plate fix- atiou and posterior T type plate fixation.

关 键 词：胫骨平台骨折 内固定 有限元模型 生物力学 

分 类 号：R683.42[医药卫生—骨科学]