Lisfranc韧带损伤钉板固定与实心螺钉固定的三维有限元分析  

Screw-plate fixation versus non-cannulated screw fixation for Lisfranc ligament injury:a 3-D finite element analysis

作　　者：张宏波 黄爱军 蔡汉周 黄醒中 林方思宇 王一民 Zhang Hongbo;Huang Aijun;Cai Hanzhou;Huang Xingzhong;Lin Fangsiyu;Wang Yimin(Department of Orthopaedics and Traumatology,The Eighth Affiliated Hospital,Sun Yat-Sen University,Shenzhen 518000,China)

机构地区：[1]中山大学附属第八医院(深圳福田)创伤骨科,深圳518000

出　　处：《中华创伤骨科杂志》2022年第10期898-904,共7页Chinese Journal of Orthopaedic Trauma

基　　金：深圳市福田区卫生公益性科研项目资助(FTWS2019022)。

摘　　要：目的建立Lisfranc韧带损伤三维有限元模型,比较钉板内固定与实心螺钉固定后的生物力学稳定性。方法采集正常人体足部的CT断层扫描数据,重建足部几何形态,截断Lisfranc韧带、第1、2跖骨跖跗韧带,模拟单纯韧带断裂的Lisfranc损伤。应用Abaqus6.14软件分别在钉板固定模型(共2块锁定钢板+8颗锁定螺钉+1枚实心螺钉)及螺钉固定模型(3枚实心螺钉)上加载载荷后进行有限元分析,比较两种模型整体的应力应变情况、足骨的应力分布和位移以及内固定系统自身的应力分布。结果在相同载荷下,钉板固定模型整体的应力分布集中在钉板系统上,螺钉固定时内固定应力同样明显高于骨质;两种固定下整个足部模型的形变均为足弓下榻,内侧柱明显。钉板固定模型内中柱的钉孔应力最大为39.91 MPa,小于螺钉固定模型的53.13 MPa。钉板固定模型内侧楔骨与第1跖骨相对位移为8.515×10^(-1)mm,大于螺钉固定模型的3.893×10^(-1)mm。二者内固定自身均有应力集中现象,钉板固定应力集中于固定第1跖跗关节的钢板中段偏腓侧,两端应力分布较小,螺钉固定应力峰值位于固定第1跖跗关节的内侧柱螺钉中部,明显高于钉尖和钉尾。钉板系统应力峰值为239.5 MPa,小于螺钉系统的256.8 MPa。结论实心螺钉内固定Lisfranc损伤中表现出的生物力学稳定性强于背侧钢板,但其自身承受应力更多,发生断钉的风险也更高。Objective To compare biomechanical stabilities between screw-plate fixation and non-cannulated screw fixation for Lisfranc ligament injury by a 3-D finite element analysis.Methods A 3-D model of a healthy foot was developed from computed tomography images.The 1st and the 2nd dorsal tarsometatarsal ligaments and Lisfranc ligament were cut in the 3-D model of a healthy foot to establish a Lisfranc ligament injury model,in which screw-plate fixation(with 2 locking plates and 8 standard screws and one non-cannulated screw)and non-cannulated screw fixation(with 3 non-cannulated screws)for Lisfranc ligament injury were simulated respectively.Finite element analyses were carried out by Abaqus 6.14 software after loads were added in the 3-D models of screw-plate fixation and non-cannulated screw fixation for Lisfranc ligament injury.The overall stress-strain nephogram,the stress distribution and displacement of the foot bone,and the stress distribution on the internal fixation system were compared between the 2 kinds of models.Results Under the same load,the stress of the whole screw-plate fixation was concentrated on the fixators,and the stress of the non-cannulated screws was also greater than that of the bones.In both models,the strain of the whole foot led to arch collapse,especially in the medial column.The maximum stress on the screw holes in the medial and middle columns in the screw-plate fixation model was 39.91 MPa,smaller than that in the non-cannulated screw fixation model(53.13 MPa).The relative displacement of the first metatarsal joint in the screw-plate fixation model was 8.515×10^(-1)mm,much greater than that in the non-cannulated screw fixation model(3.893×10^(-1)mm).Stress concentration was observed in both models.The stress of the screw-plate system was concentrated on the fibular side of the middle section of the plate used to fix the first tarsometatarsal joint,decreasing towards both ends.The maximum stress of the non-cannulated screws was located in the middle of the medial column screw for fixa

关 键 词：有限元分析 生物力学 内固定器 LISFRANC损伤 

分 类 号：R687.3[医药卫生—骨科学]