单一前路与前后联合入路治疗髋臼双柱骨折的力学分布差异  

Mechanical difference between anterior approach and anterior combined with posterior approach in the treatment of acetabular both-column fractures

作　　者：古金山 杨朝晖[1] 栗树伟[1] Gu Jinshan;Yang Chaohui;Li Shuwei(Department of Orthopedics,Second Affiliated Hospital of Shanxi Medical University,Taiyuan 030001,Shanxi Province,China)

机构地区：[1]山西医科大学第二医院骨科,山西省太原市030001

出　　处：《中国组织工程研究》2021年第33期5254-5258,共5页Chinese Journal of Tissue Engineering Research

摘　　要：背景:对于移位较大的髋臼双柱骨折,手术是其治疗的金标准,但目前针对髋臼双柱骨折的手术治疗方式存在较大争议,尚无一致定论。目的:利用有限元方法建立髋臼双柱骨折内固定有限元模型,分析比较单一前路与前后联合入路治疗髋臼双柱骨折时力学分布差异性,从力学角度为临床治疗提供新思路。方法:选取1名成年男性志愿者进行骨盆CT扫描,将CT扫描得到的骨盆髋臼数据导入Mimics,Geomagics和Hypermesh等软件对其进行处理,并在ABAQUS中分别建立髋臼双柱骨折模型、单一前路固定髋臼双柱骨折及前后联合入路治疗髋臼双柱骨折内固定有限元模型,比较在两种不同内固定方式时,髋臼双柱骨折内固定系统的生物力学差异性。结果与结论:①在两种髋臼双柱骨折内固定模型中,髋臼的应变位移量无显著差异;②单一前路固定髋臼双柱骨折模型中,最大应力集中在髋臼前柱、髋臼顶及四方区;③前后联合入路固定髋臼双柱骨折模型中,应力均匀分布,最大应力集中在髋臼顶,四方区应力明显减小;④单一前路固定髋臼双柱骨折模型的股骨颈最大应力大于前后联合入路固定髋臼双柱骨折模型;⑤结果表明,在单一前路固定髋臼双柱骨折模型中,后柱未产生额外应力,但在四方区及股骨颈应力更加集中,且大于前后联合入路固定模型;因此对于经前路固定稳定的髋臼双柱骨折,不需要额外经后路固定髋臼后柱,但对于有创伤性股骨头坏死倾向、下肢力线畸形、骨质疏松老年患者或极度肥胖患者,采用前后联合入路方式为佳。BACKGROUND:Surgery is the gold standard for the treatment of both-column acetabular fractures with large displacement,but the surgical treatment for both-column acetabular fractures is controversial and there is no consensus.OBJECTIVE:The finite element model of acetabular both-column internal fixation was established by using the finite element method to analyze and compare the difference of mechanical distribution between anterior approach and anterior combined with posterior approach in the treatment of acetabular bothcolumn fractures,and to provide new ideas for clinical treatment from the perspective of mechanics.METHODS:An adult male was selected to undergo pelvic CT scan.The CT scan data of pelvic acetabulum were imported into Mimics,Geomagics and Hypermesh software for processing.Acetabular both-column fracture model and finite element models of single fixed anterior acetabular both-column fractures and anterior combined with posterior approach in the treatment of acetabular both-column fractures were established in the ABAQUS.The biomechanical differences of the internal fixation system for acetabular both-column fractures under two different internal fixation methods were compared.RESULTS AND CONCLUSION:(1)There was no significant difference in the amount of acetabular strain displacement between the two types of acetabular both-column fracture internal fixation models.(2)In the model of acetabular both-column fracture with single anterior fixation,the maximum stress was concentrated in the anterior acetabular column,the top of the acetabulum and the quadripartite area.(3)In the model of acetabular both-column fracture fixed by anterior combined with posterior approach,the stress was evenly distributed;the maximum stress was concentrated at the top of the acetabulum,and the stress in the quadripartite area was significantly reduced.(4)The maximum stress of femoral neck in the model of acetabular both-column fracture fixed by a single anterior approach was greater than that in the model of acetabular bot

关 键 词：髋臼 骨折 骨折固定术 内 生物力学 有限元分析 双柱 前入路 联合入路 

分 类 号：R459.9[医药卫生—治疗学] R319[医药卫生—临床医学]