两种手术方式重建“恐怖三联征”肘关节稳定性的有限元评价  

Finite element evaluation of the stability of the elbow joint in the “terrible triad injury” by two surgical methods

作　　者：宋超 丁志宏[1] 殷涛 李震时 吴亮[1] 周文超 徐波[1] 刘粤[1] 孔德策 杨铁毅[1] 张岩[1] Song Chao;Ding Zhihong;Yin Tao;Li Zhenshi;Wu Liang;Zhou Wenchao;Xu Bo;Liu Yue;Kong Dece;Yang Tieyi;Zhang Yan(Department of Orthopedics, Shanghai Pudong New Area Gongli Hospital, Shanghai 200135, China;Department of Orthopedics, Xing’an Jieshou Hospital of Integrated Traditional Chinese and Western Medicine, Guilin 541300, Guangxi Zhuang Autonomous Region, China)

机构地区：[1]上海市浦东新区公利医院骨科,上海市200135 [2]广西壮族自治区桂林市兴安界首中西医结合医院骨科,广西壮族自治区桂林市541300

出　　处：《中国组织工程研究》2019年第24期3834-3839,共6页Chinese Journal of Tissue Engineering Research

基　　金：上海市卫生和计划生育委员会科研课题(201640173);项目负责人:张岩;浦东新区卫生和计划生育委员会重点学科资助项目(PWZxk2017-18);项目负责人:杨铁毅;浦东新区医学学科建设项目(PWYts2018-03)~~

摘　　要：背景:肘关节"恐怖三联征"是严重复杂的骨折脱位损伤。能否通过修复内侧副韧带结构替代冠状突骨块的固定来重建肘关节的稳定性值得探讨研究。目的:通过建立肘关节"恐怖三联征"的有限元模型,在肘关节外侧柱稳定性重建的基础上,比较尺骨冠状突骨折固定和内侧副韧带修补两种模式下,肘关节不同屈曲角度的力学值,评价两种手术方法对肘关节稳定性的影响。方法:利用肘关节CT、MRI图片的相关数据,计算机生成命令流文件,建立肘关节实体模型,进行网格划分,去除1/3冠状突,去除桡骨小头及内外侧副韧带即为恐怖三联征模型。模拟内侧副韧带断裂后是否进行修复,冠状突骨块是否固定两种情况,并且对其分别施加纵向载荷,分析各种工况条件下肘关节关节面的应力分布,比较肘关节的稳定性。结果与结论:①肘关节伸直位0°时正常肘关节关节面的最大应力为0.78 MPa。将1/3冠状突骨折模型骨折做固定,内侧副韧带不修补,该模型关节面的最大应力为0.84MPa,而冠状突骨折不做固定,仅修补内侧副韧带的肘关节模型关节面的最大应力也是0.84MPa;②肘关节屈曲30°时正常肘关节模型关节面的最大应力为2.02 MPa,将1/3冠状突骨折模型骨折做固定,内侧副韧带不修补,该模型关节面的最大应力为2.02 MPa,而冠状突骨折不做固定,修补内侧副韧带的肘关节模型关节面的最大应力为2.07 MPa;③肘关节伸直位0°时正常肘关节关节面的最大位移为0.14 mm,将1/3冠状突骨折模型骨折做固定,内侧副韧带不修补,该模型关节面的最大位移为0.15mm,而冠状突骨折不做固定,修补内侧副韧带的肘关节模型关节面的最大位移为0.16 mm;④肘关节屈曲30°时正常肘关节模型关节面的最大位移为0.52 mm,将1/3冠状突骨折做固定,内侧副韧带不修补,该模型关节面的最大位移为0.52 mm,而冠状突骨折不做固定,修补内侧�BACKGROUND: The ‘terrible triad injury” of the elbow joint is a serious complex fracture and dislocation. It is worthwhile to study on stability of the elbow joint by repairing the medial collateral ligament structure instead of the fixation of the coronal process. OBJECTIVE: To compare the mechanical value of different flexion angles of the elbow joint under two modes of fixing ulnar coronoid process and repairing medial collateral ligament based on the stability reconstruction of the lateral column of the elbow joint and to evaluate the effect of two surgical methods on the stability of the elbow joint by establishing a finite element model of the “terrible triad injury” of the elbow joint. METHODS: Using data of the elbow joint CT and MRI, command stream files were generated from the computer. The elbow joint solid model was established and meshed. To compare the elbow joint stability, by simulating whether the medial collateral ligament was repaired or not after fracture, and the coronoid process was fixed or not, longitudinal load was applied to analyze the stress distribution on the elbow joint surface under various working conditions. RESULTS AND CONCLUSION:(1) The maximum stress of the normal elbow joint surface was 0.78 MPa when the elbow joint was extended to 0°. If the 1/3 coronoid process fracture was fixed, and the medial collateral ligament was not repaired, the maximum stress of the articular surface of the model was 0.84 MPa. If the coronoid process fracture was not fixed, the medial collateral ligament was repaired, the maximum stress of the articular surface was also 0.84 MPa.(2) When the elbow joint was flexed 30°, the maximum stress of the articular surface of the normal elbow joint model was 2.02 MPa. If the 1/3 coronoid process fracture was fixed, and the medial collateral ligament was not repaired;the maximum stress of the joint surface was 2.02 MPa. If the coronoid process fracture was not fixed, the medial collateral ligament was repaired, and the maximum stress was 2.07 MPa.(3)

关 键 词：肘关节 恐怖三联征 有限元 冠状突 骨折 内侧副韧带 稳定性 应力 位移 

分 类 号：R459.9[医药卫生—治疗学] R605[医药卫生—临床医学]