有限元法分析不同固定方式在胫骨远端粉碎性骨折骨愈合中的生物力学差异  

Biomechanical difference of different fixation methods in bone healing of distal tibial comminuted fractures analyzed by finite element method

作　　者：颜华东 张中[1] 赵刚[2,3] 李杰 宋华[1] 孙建华 刘志 王明明 Yan Huadong;Zhang Zhong;Zhao Gang;Li Jie;Song Hua;Sun Jianhua;Liu Zhi;Wang Mingming(Department of Orthopedics,Tengzhou Central People’s Hospital Affiliated to Jining Medical University,Tengzhou 277599,Shandong Province,China;Shandong University,Jinan 250100,Shandong Province,China;Department of Orthopedics,Jinan Central Hospital,Jinan 250013,Shandong Province,China)

机构地区：[1]济宁医学院附属滕州市中心人民医院骨科,山东省滕州市277599 [2]山东大学,山东省济南市250100 [3]济南市中心医院骨科,山东省济南市250013

出　　处：《中国组织工程研究》2024年第24期3814-3821,共8页Chinese Journal of Tissue Engineering Research

基　　金：枣庄市科技发展计划项目(2022NS34),项目负责人:王明明;枣庄市科技发展计划项目(2022NS33),项目负责人:宋华。

摘　　要：背景:胫骨远端粉碎性骨折伴软组织损伤的治疗具有挑战性,新型逆行胫骨髓内钉、外置接骨板是重要的治疗手段,但其在骨折愈合不同时期、不同负重情况时的骨折端应变、应力遮挡情况未见报道。目的:通过有限元分析法探讨骨折愈合不同时期逆行髓内钉及外置接骨板的生物力学差异,为临床应用及康复锻炼提供科学参考。方法:利用1名40岁健康男性的胫骨CT数据,建立胫骨远端粉碎骨折的有限元模型,构建胫骨逆行髓内钉、外置接骨板固定模型及骨痂模型并根据骨折的固定原则进行装配。使用ANSYS软件进行有限元分析,比较骨折愈合不同时期时逆行髓内钉及外置接骨板2种固定方式的骨折端位移、胫骨应力遮挡、骨痂应力、胫骨及固定装置应力分布情况。结果与结论:①胫骨骨折端相对位移随着骨折愈合的进行逐渐减小,在术后3个月后位移明显减少;术后0,1个月,外置接骨板组的垂直位移及总位移均大于逆行髓内钉组,2种固定方式的Z轴位移(水平内外侧位移)均较X、Y轴位移明显,且接骨板模型的Z轴位移差异最明显;2种固定方式的Z轴位移最大位置均位于胫骨外侧,位移最小位置均位于胫骨内侧;②骨折愈合的应力遮挡率随骨折时间延长而逐渐降低;逆行髓内钉的应力遮挡率在骨折愈合不同时期均高于外置接骨板;术后3个月后外置接骨板的应力遮挡率降低到4%左右,逆行髓内钉的应力遮挡率降低到40%左右;③2种固定方式骨痂应力集中部位的应力随着载荷的增大而增加,外置接骨板组骨痂的应力始终大于逆行髓内钉组;2种固定方式中,骨痂最大应力大致分布一致,均位于胫骨外侧部分;④随着骨折愈合2种固定方式的胫骨最大应力逐渐降低,外置接骨板组的应力始终大于逆行髓内钉组;1500 N载荷下外置接骨板组胫骨最大应力区域平均应力为285 MPa,而逆行髓内钉组为26 MBACKGROUND:The treatment of distal tibial comminuted fractures with soft tissue injury has always been challenging.The new retrograde tibial nailing and supercutaneous locking plate are important treatment methods,but their strain and stress shielding at the fracture end during different periods of fracture healing and different load conditions have not been reported.OBJECTIVE:To explore the biomechanical stability of retrograde tibial nailing and supercutaneous locking plate in different periods of fracture healing by finite element analysis to offer a scientific foundation for clinical application and rehabilitation exercise.METHODS:The finite element model of distal tibial comminuted fracture was established by utilizing the CT data of the tibia from a 40-year-old healthy male.Retrograde tibial nailing,supercutaneous locking plate,and callus models were assembled in accordance with the principle of fracture fixation.The finite element analysis was performed using ANSYS software to compare the displacement of the fracture end,the stress shielding of the tibia,the stress of the callus,and the stress distribution of the tibia and the fixation device during different periods of fracture healing.RESULTS AND CONCLUSION:(1)The relative displacement of the tibial fracture decreased gradually with the healing of the fracture,and the displacement decreased significantly after 3 months.At 0 and 1 months after operation,the vertical displacement and total displacement of the supercutaneous locking plate group were higher than those in the retrograde intramedullary nail group.The Z-axis displacement(horizontal medial and lateral displacement)of the two fixation methods was more obvious than the X-axis and Y-axis,and the Z-axis displacement of supercutaneous locking plate group was the most obvious.The maximum Z-axis displacement of the two fixation methods was located on the outside of the tibia,and the minimum displacement was located on the inside of the tibia.(2)The stress shielding rate at different periods of fracture

关 键 词：胫骨远端骨折 骨痂 骨折愈合 逆行髓内钉 外置接骨板 有限元分析 生物力学 应力遮挡 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] R683