有限元生物力学分析对眶颧颌骨折不同内固定方式稳定性的评价  

Stability evaluation of different internal fixation methods for zygomaticomaxillary complex fractures by finite element biomechanical analysis

作　　者：李岩[1] 吴鹏森[1] 马越 唐美婷 曾薛颖 唐媛媛[2] 于申[3] 卢苇[1] Li Yan;Wu Pengsen;Ma Yue;Tang Meiting;Zeng Xueying;Tang Yuanyuan;Yu Shen;Lu Wei(Department of Ophthalmology,The Second Hospital of Dalian Medical University,Dalian 116027,China;Department of Otorhinolaryngology,The Second Hospital of Dalian Medical University,Dalian 116027,China;Department of State Key Laboratory of Structural Analysis for Industrial Equipment,Dalian University of Technology,Dalian 116024,China)

机构地区：[1]大连医科大学附属第二医院眼科,116027 [2]大连医科大学附属第二医院耳鼻喉科,116027 [3]大连理工大学工业装备结构分析国家重点实验室,116024

出　　处：《中华实验眼科杂志》2020年第11期916-922,共7页Chinese Journal Of Experimental Ophthalmology

基　　金：国家自然科学基金项目(81700874、11572079);辽宁省自然科学基金指导计划项目(20170540278)。

摘　　要：目的通过有限元生物力学分析方法评价眶颧颌骨折不同内固定方式的稳定性,为选择最佳内固定方式提供新的研究方法和客观的量化依据。方法选择2016年10月于大连医科大学附属第二医院确诊为眶颧颌骨折(Zingg B型)的患者1例,术中固定颧额缝、眶下缘,术后功能恢复良好,无张口受限、咬合功能正常、无复视、无内固定植入物移位、面部外观对称。收集术前眼眶CT图像,利用Mimics、Geomagic、Solidworks、Abaqus软件对健侧镜像处理模拟构建正常的颅面部骨骼有限元模型(FEM/intact)并进行验证,在此基础上根据骨折位置进行分割、装配,结合临床手术固定位点构建骨折内固定模型,分别为固定颧额缝有限元模型(FEM/ZFS)、固定眶下缘有限元模型(FEM/IOR)、固定颧额缝及眶下缘有限元模型(FEM/ZFS+IOR)和固定颧额缝、眶下缘及颧上颌缝有限元模型(FEM/ZFS+IOR+ZMS)。对不同内固定模型加载咬肌牵拉力,分析材料与骨折段的应力及位移、计算颧骨的旋转角度。并根据患者实际的手术情况建立术后模型(FEM/Post),与术前模拟的FEM/ZFS+IOR分析结果进行对比。结果建立的FEM/intact外观逼真,几何相似性好,模型通过准确性验证。FEM/ZFS+IOR与FEM/ZFS+IOR+ZMS内固定钛板的最大应力分别为396 MPa和426 MPa,均低于其屈服强度483 MPa,骨折线最大位移分别为0.10 mm和0.06 mm,均≤0.1 mm,颧骨旋转角度均<2°;FEM/ZFS与FEM/IOR内固定钛板的最大应力分别为730 MPa和501 MPa,均高于其屈服强度,骨折线最大位移分别为0.27 mm和0.15 mm,均>0.1 mm,颧骨旋转角度均<2°。FEM/Post应力及位移情况与FEM/ZFS+IOR分析结果一致。结论有限元生物力学分析方法可以在术前对眶颧颌骨折不同内固定方式的稳定性进行数字化分析评价从而选择出最佳固定方式,为眶颧颌骨折的精准治疗提供新的研究方法和客观的量化依据。Objective To analyze the stability of different internal fixation methods for zygomaticomaxillary complex fracture using finite element biomechanical analysis and to provide a quantitative basis for the option of optimal internal fixation methods.Methods One patient with zygomaticomaxillary complex ZMC fracture(Zingg B type)was enrolled from the Second Hospital of Dalian Medical University in October 2016.The zygomaticofrontal suture and the inferior orbital rim were fixed during the surgery,and the postoperative function was well recovered with no mouth opening restriction,diplopia or implant displacement,and had a symmetrical facial appearance.The preoperative orbital CT images were collected.The normal craniofacial bones finite element model(FEM/intact)was reconstructed through Mimics,Geomagic,Solidworks and Abaqus softwares based on the non-fractured side and verified.Based on the verified model,the segmentation and assembling was performed according to the fracture location,and the internal fixation models were established according to the methods of surgery,including fixed zygomaticofrontal suture model(FEM/ZFS),fixed inferior orbital rim model(FEM/IOR),fixed zygomaticofrontal suture and inferior orbital rim model(FEM/ZFS+IOR),fixed ZFS and IOR and zygomaticomaxillary suture model(FEM/ZFS+IOR+ZMS).The masseter muscle strength was applied to the model.The stress and displacement were analyzed and the rotation angle of zygoma was calculated to compare the stability of different operative methods.The postoperative model(FEM/post)was established according to the actual operative method and was compared with FEM/ZFS+IOR.This study protocol was approved by the Ethic Committee of The Second Hospital of Dalian Medical University(2020-33),and written informed consent was obtained from the subject before entering the study.Results The established FEM/intact had a realistic appearance and good geometric similarity,and the validity and accuracy of model was verified.In the FEM/ZFS+IOR and FEM/ZFS+IOR+ZMS,the maximal st

关 键 词：颧骨骨折 眶骨折 骨折内固定 生物力学 有限元分析 

分 类 号：R782.4[医药卫生—口腔医学]