经骶2骶骨翼髂骨螺钉与骶1螺钉连接固定治疗DenisⅡ区骶骨骨折的有限元分析  

Finite element analysis of S_(2)AI-S1 in the treatment of Denis type II sacral fracture

作　　者：郑健雄 向杰[2] 冯小仍 刘飞[1] 陈滨[1] Zheng Jianxiong;Xiang Jie;Feng Xiaoreng;Liu Fei;Chen Bin(Division of Orthopaedics and Traumatology,Department of Orthopaedics,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China;Department of Orthopaedics and Traumatology,The First Affiliated Hospital of University of South China,Hengyang 421001,China)

机构地区：[1]南方医科大学南方医院骨科-创伤骨科,广州510515 [2]南华大学附属第一医院创伤骨科,衡阳421001

出　　处：《中华骨科杂志》2021年第20期1500-1508,共9页Chinese Journal of Orthopaedics

基　　金：广东省教育厅高水平建设经费南方医科大学临床研究启动项目(LC2019ZD001);南方医科大学南方医院临床研究专项(2019CR016)。

摘　　要：目的通过有限元分析对比经骶2骶骨翼髂骨(S_(2)-alar-iliac,S_(2)AI)螺钉与骶1螺钉连接固定(S_(2)AI screw and S_(1)screw fixation,S_(2)AI-S_(1))与传统骶髂螺钉治疗DenisⅡ区骶骨骨折的生物力学稳定性。方法对1名骨性结构正常的男性志愿者的腰椎及骨盆行CT扫描及三维重建,采用ANSYS 17.0软件构建右侧DenisⅡ区骶骨骨折及耻骨联合损伤的有限元模型。骨盆前环统一采用五孔钢板固定,骨盆后环分别采用:骶髂螺钉,S_(1)节段半螺纹空心钉;S_(2)AI-S_(1);经骶2骶骨翼髂骨螺钉与对侧骶1螺钉连接固定(S_(2)AI screw and contralateral S_(1)screw fixation,S_(2)AI-CS_(1))。通过约束双侧髋臼软骨并在L4椎体上方施加500 N垂直应力,比较上述三种固定模型骶骨最大位移、最大von Mises应力和垂直刚度。结果在垂直方向和前后方向上骶骨最大位移方面,S_(2)AI-S_(1)模型均最小,分别为1.40 mm、1.40 mm,而S_(2)AI-CS_(1)模型均最大,分别为1.60 mm、1.56 mm;在水平方向上骶骨最大位移方面,S_(2)AI-S_(1)模型最小(0.19 mm),而骶髂螺钉固定模型最大(0.37mm);在内固定最大von Mises应力方面,骶髂螺钉模型的应力最大(216.02 MPa),而S_(2)AI-S_(1)模型应力最小(39.82 MPa);在螺钉周围骨最大von Mises应力方面,骶髂螺钉模型应力最大(39.68 MPa)而S_(2)AI-S_(1)模型应力最小(31.56 MPa);在S_(1)椎体上表面中心点垂直位移方面,骶髂螺钉、S_(2)AI-S_(1)及S_(2)AI-CS_(1)组分别为0.83 mm、0.73 mm及0.93 mm。以S_(1)椎体上表面中心点垂直位移预测三组模型垂直刚度从大到小依次为S_(2)AI-S_(1)、骶髂螺钉及S_(2)AI-CS_(1)。结论S_(2)AI-S_(1)在三维有限元分析中具有良好的生物力学稳定性,可作为骶骨骨折治疗的一种新型内固定方式。Objective Comparison of biomechanical stability of S_(2)-alar-iliac screw and S_(1)pedicle screw fixation(S_(2)AI-S_(1))with conventional sacroiliac screw in the treatment of Denis type II sacral fractures by finite element analysis.Methods The lumbar spine and pelvis of a male volunteer with normal skeletal structure were scanned by CT,followed by three-dimensional reconstruction.The finite element model of right Denis type II sacral fracture and pubic symphysis injury was constructed using ANSYS 17.0 software.The anterior pelvic ring is fixed with a five-hole steel plate,and the posterior pelvic ring is fixed with four different internal fixation methods,namely,sacroiliac screw(S_(1)segment half-thread hollow screw),S_(2)AI-S_(1)and S_(2)AI screw and contralateral S_(1)screw fixation(S_(2)AI-CS_(1)).By restraining the bilateral acetabular and applying 500 N vertical stress above the L4 vertebral body,the maximum displacement,maximum von Mises stress and vertical stiffness of the three groups of internal fixation were compared.Results In terms of the maximum displacement of the sacrum in the vertical and anteroposterior directions,the S_(2)AI-S_(1)model was the smallest(1.40 mm,1.40 mm,respectively),while the S_(2)AI-CS_(1)model was the largest(1.60 mm,1.56 mm,respectively);In terms of the maximum displacement of the sacrum in the horizontal direction,the S_(2)AI-S_(1)model is the smallest(0.19 mm),while the SIS model is the largest(0.37 mm);In terms of the maximum von Mises stress of internal fixation,the stress of the sacroiliac screw model is the largest(216.02 MPa),while the stress of the S_(2)AI-S_(1)model is the smallest(39.82 MPa);In terms of the maximum von Mises stress of the bone around the screw,the stress of the sacroiliac screw model(39.68 MPa)is the largest and that of the S_(2)AI-S_(1)model is the smallest(31.56 MPa);In terms of the vertical displacement of the center point of the upper surface of the S_(1)vertebral body,the sacroiliac screw,S_(2)AI-S_(1)and S_(2)AI-CS_(1)groups were 0.83 mm,0.73

关 键 词：骶骨 骨折固定术 内 有限元分析 对比研究 骨螺丝 

分 类 号：R687.3[医药卫生—骨科学]