螺钉空间编织与钢板固定跟骨骨折的生物力学及有限元研究  

Biomechanical comparison of spatial weaving and conventional calcaneal plate fixation for calcaneal fracture

作　　者：张勇[1] 翁秋燕 张雁儒 陈剑明[1] 杨云峰 Zhang Yong;Weng Qiuyan;Zhang Yanru;Chen Jianming;Yang Yunfeng(Department of Traumatic Orthopaedics,Ningbo No.6 Hospital,Ningbo 315040,China;Medical School,Ningbo University,Ningbo 315211,China;Department of Foot and Ankle Surgery,Tongji University School of Medicine,Shanghai 200065,China)

机构地区：[1]宁波市第六医院创伤骨科,宁波200065 [2]宁波大学医学院,宁波315211 [3]上海同济医院足踝外科,上海200065

出　　处：《中华骨科杂志》2023年第15期1041-1049,共9页Chinese Journal of Orthopaedics

基　　金：上海市科技计划项目(21ZR1458500,22S31900300);浙江省医药卫生项目(2021PY072);宁波市鄞州区科技计划项目(20200432)。

摘　　要：目的比较跟骨骨折采用螺钉空间编织固定和跟骨钢板固定的生物力学特性.方法采用跟骨模型标本建立SandersⅢ型跟骨骨折模型:生理模型组,为正常跟骨模型;钢板组,为常规钢板固定骨折模型;金属螺钉组,为金属螺钉编织固定骨折模型;7枚和9枚可吸收螺钉空间编织组(可吸收7钉组和可吸收9钉组),为分别用7枚或9枚可吸收钉编织固定骨折模型.进行循环测试和力学压缩试验,记录载荷-位移曲线.复制金属螺钉空间编织及跟骨解剖钢板系统材料属性,建立有限元骨折模型,逆向处理完成钢板螺钉组、编织螺钉组的跟骨内固定模型;模拟人体(70 kg)单足站立状态下的跟骨生物力学特性变化,以Von Mises等效应力云图、位移云图分析结构强度分布规律.结果20~200N载荷的循环测试中生理模型组、钢板组、金属螺钉组、可吸收7钉组、可吸收9钉组的模型间隙分别为(0.87±0.22)、(0.82±0.08)、(0.70±0.12)、(1.04±0.13)和(0.83±1.76)mm,模型间隙的差异有统计学意义(F=3.16,P=0.037);其中可吸收7钉组大于金属螺钉组,差异有统计学意义(t=4.28,P=0.003).五组变形量分别为(0.37±0.06)、(0.38±0.07)、(0.38±0.06)、(0.52±0.07)和(0.42±0.07)mm,差异有统计学意义(F=4.39,P=0.010);其中可吸收7钉组变形量大于生理模型组、钢板组及金属螺钉组(t=3.69,P=0.006;t=3.25,P=0.012;t=3.51,P=0.008).静力测试中压缩位移分别为(7.14±0.79)、(7.30±0.66)、(6.95±0.28)、(8.19±0.61)和(7.16±0.55)mm,差异有统计学意义(F=3.28,P=0.032),其中可吸收7钉组位移大于金属螺钉组(t=4.13,P=0.003);刚度分别为(570.60±122.62)、(512.86±80.77)、(497.40±66.50)、(456.21±58.19)和(560.39±94.40)N/mm,差异无统计学意义(F=1.44,P=0.258).有限元分析结果示3500 N轴向压力载荷下钢板螺钉组压缩最大位移为6.47 mm、刚度为540.96 N/mm、钢板和螺钉Von Mises等效应力峰值分别为450.31、353.15 MPa,编织螺钉组压缩最大�Objective To compare the biomechanical characteristics of screw only spatial weaving fixation and calcaneal plate fixation in calcaneal fractures.Methods Sanders type III calcaneus fracture model was established by using calcaneus model specimens:the physiological model group were the normal calcaneal models;the steel plate group were conventional steel plate fixation fracture models;the metal screw group were fracture models with only metal screw weaving fixation;seven and nine absorbable screw spatial weaving groups(seven absorbable screw group,nine absorbable screw group)were used to weave and fix fracture models with seven and nine absorbable screws.Cyclic test and mechanical compression test were carried out,and load-displacement curves were recorded.The material properties of metal screw spatial weaving and calcaneal anatomical plate system were replicated,finite element fracture models were established,and the calcaneal internal fixation models of plate screw group and spatial weaving screw group were completed by reverse processing.The changes of biomechanical characteristics of calcaneal bone in human(70 kg)standing on one foot were simulated,and the distribution of structural strength was analyzed by Von Mises equivalent stress cloud diagram and displacement cloud diagram.Results In the cyclic test of 20-200 N load,the physiological model group,the plate group,the metal screw group,the absorbable 7 screw group,the absorbable 9 screw group were 0.87±0.22,0.82±0.08,0.70±0.12,1.04±0.13 and 0.83±1.76 mm,the difference in model gap was statistically significant(F=3.16,P=0.037).Among them,the absorbable 7 screws group was larger than the metal screws group(t=4.28,P=0.003),and the other pin-two comparisons were not statistically significant(P>0.05).The deformation of the five groups was 0.37±0.06,0.38±0.07,0.38±0.06,0.52±0.07 and 0.42±0.07 mm,and the difference was statistically significant(F=4.39,P=0.010).The deformation of absorbable 7 screws group was greater than that of physiological model group

关 键 词：跟骨 骨折固定术 内 有限元分析 生物力学 

分 类 号：R318.01[医药卫生—生物医学工程] R683[医药卫生—基础医学]