空心螺钉固定骶髂关节脱位的有限元分析  

Finite element analysis of hollow screw fixation for sacroiliac dislocation

作　　者：叶海民 邹华春 丁凌华 游木荣 Ye Haimin;Zou Huachun;Ding Linghua;You Murong(Department of Orthopedics,Jiangxi Provincial People’s Hospital,Nanchang 330006,Jiangxi Province,China;Department of Imaging,Jiangxi Provincial People’s Hospital,Nanchang 330006,Jiangxi Province,China)

机构地区：[1]江西省人民医院骨科,江西省南昌市330006 [2]江西省人民医院影像科,江西省南昌市330006

出　　处：《中国组织工程研究》2023年第13期1993-1998,共6页Chinese Journal of Tissue Engineering Research

基　　金：江西省自然科学基金项目(20181BAB205021),项目负责人:游木荣。

摘　　要：背景:骶髂关节对稳定骨盆环有重要作用,其骨折或脱位在手术上具有挑战性,尽管各种置钉方法不断改进,但是螺钉误置、神经血管损伤等并发症依旧存在。如何准确地将螺钉置入骶骨内及确认螺钉位置,并且保证良好的稳定性是一个急需解决的问题。目的:利用有限元法分析两种不同组合方式螺钉固定骶髂关节脱位的生物力学差异。方法:以人尸体标本数据为资料,采用ABAQUS有限元分析系统构建全骨盆三维有限元模型,在此基础上建立骶髂关节脱位有限元模型,分别进行两种组合的螺钉固定,一种为S_(1)置入2枚直径6.0 mm的螺钉+S_(2)置入1枚直径6.0 mm的螺钉(命名为S_(1)2枚+S_(2)1枚组),另一种S_(1)置入1枚直径7.3 mm的螺钉+S_(2)置入1枚直径6.0 mm的螺钉(命名为S_(1)1枚+S_(2)1枚组)。在S_(1)上终板施加600 N的垂直方向力,分析骨盆最大应力、螺钉最大应力(抗疲劳程度)、模型整体位移值及螺钉形变量。结果与结论:①两组螺钉固定骨盆后能够有效恢复骨盆生物力学的传导方向,骨盆应力都小于双节段螺钉固定应力,且最大应力都位于骨折端皮质骨上;②正常骨盆的最大位移为0.0809 mm,最大应力为9.39 MPa;S_(1)2枚+S_(2)1枚组的骨盆最大位移为0.0978mm,最大应力为11.59 MPa;S_(1)1枚+S_(2)1枚组骨盆的最大位移为0.1118 mm,最大应力为13.51 MPa;③S_(1)2枚+S_(2)1枚组螺钉的最大应力为12.35 MPa,形变量为0.08111mm;S_(1)1枚+S_(2)1枚组螺钉的最大应力为14.53MPa,形变量为0.0882mm;④结果显示,与正常骨盆相比,两种不同组合方式螺钉的稳定性无实质性变化,其中3枚螺钉固定的抗疲劳程度优于2枚螺钉,因此首选3枚螺钉固定法,若无条件进行S_(1)双螺钉固定时,最佳固定方法是在双节段均选择1枚螺钉进行固定。BACKGROUND:The sacroiliac joint plays an important role in stabilizing the pelvic ring,and its fracture or dislocation is challenging in surgery.Despite the continuous improvement of various screw placement methods,complications still exist such as screw misplacement and neurovascular injury.How to accurately place the screw into the sacrum,confirm the position of the screw,and ensure good stability is an urgent problem to be solved.OBJECTIVE:To analyze biomechanical differences of two different combinations of screw fixation for sacroiliac dislocation by finite element analysis.METHODS:Human corpse specimens were used as data.The three-dimensional finite element model of the whole pelvis was constructed by the ABAQUS finite element analysis system.Finite element models of sacroiliac dislocation were established,and two combinations of screw fixation were performed.One is that S_(1)was treated with 2 screws of 6.0 mm in diameter+S_(2)was treated with 1 screw of 6.0 mm in diameter(named as S_(1)2+S_(2)1 group),and the other is that S_(1)was treated with a screw of 7.3 mm in diameter+S_(2)was treated with a screw of 6.0 mm in diameter(named as S_(1)1+S_(2)1 group).A vertical force of 600 N was applied to the end plate on S_(1),and the maximum stress of the pelvis,the maximum stress of the screw(fatigue resistance),the overall displacement value of the model and the deformation of the screw were analyzed.RESULTS AND CONCLUSION:(1)Pelvis fixation with screws in the two groups could effectively restore the conduction direction of pelvic biomechanics.The pelvic stress was less than the double-segment screw fixation stress,and the maximum stress was located on the cortical bone at the fracture end.(2)The maximum displacement of the normal pelvis was 0.0809 mm and the maximum stress of the pelvis was 9.39 MPa.The maximum displacement of the pelvis was 0.0978 mm and the maximum stress was 11.59 MPa in the S_(1)2+S_(2)1 group.The maximum displacement of the pelvis was 0.1118 mm and the maximum stress was 13.51 MPa in the S

关 键 词：骶髂关节 骶髂关节脱位 螺钉固定 有限元分析 骨盆 

分 类 号：R459.9[医药卫生—治疗学] R394.2[医药卫生—临床医学] R542.2