改良与传统构型髂腰钉棒系统固定垂直不稳定骨盆后环脱位的生物力学特性比较  

Modified and traditional iliolumbar pedicle screw-rod system for the fixation of vertically unstable posterior pelvic ring dislocation:a biomechanical comparative study

作　　者：张俊[1] 厉国定[1] 王健[1] 禹宝庆 Zhang Jun;Li Guoding;Wang Jian;Yu Baoqing(Department of Orthopedics,Pudong New Area People′s Hospital,Shanghai 201299,China;Department of Orthopedics,Seventh People′s Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200137,China)

机构地区：[1]上海市浦东新区人民医院骨科,上海201299 [2]上海中医药大学附属第七人民医院骨科,上海200137

出　　处：《中华创伤杂志》2024年第2期146-153,共8页Chinese Journal of Trauma

基　　金：上海市浦东新区卫健委特色专病(PWZzb2022-15);上海市浦东新区卫健委临床高原学科(PWYgy2021-08);上海市浦东新区卫健委重点学科(PWZxk2022-16)。

摘　　要：目的比较改良与传统构型髂腰钉棒系统固定垂直不稳定骨盆后环脱位的生物力学特性。方法选用1名31岁健康男性志愿者的腰椎、骨盆及股骨CT图像,通过有限元方法利用三维虚拟软件建立骨盆后环脱位模型、改良与传统构型髂腰钉棒系统单侧与双侧固定模型。通过约束双侧股骨下端于L1椎体上施加500 N纵向载荷,评估完整骨盆模型最大应力及骨盆后环脱位模型刚度,以验证模型的可靠性;模型验证完成后,沿L1椎体曲线方向施加400 N跟随载荷模拟上部躯干力量,比较改良与传统构型髂腰钉棒系统模型骶骨最大垂直位移、最大后方位移、最大右侧位移及整体最大位移;比较内固定及骨盆的应力分布情况。结果(1)完整骨盆模型最大应力为22.0 MPa,骨盆后环脱位模型刚度为180.03 N/mm。(2)在骶骨最大垂直位移方面,改良与传统构型髂腰钉棒系统双侧固定基本相当;但在骶骨最大后方位移、最大右侧位移及整体最大位移方面,改良构型髂腰钉棒系统双侧固定分别为0.57 mm、0.19 mm、0.68 mm,传统构型髂腰钉棒系统双侧固定分别为1.38 mm、0.26 mm、1.41 mm,前者均明显小于后者。(3)在骶骨最大垂直位移、最大后方位移、最大右侧位移及整体最大位移方面,改良构型髂腰钉棒系统单侧固定分别为0.70 mm、0.73 mm、0.17 mm、0.88 mm,传统构型髂腰钉棒系统单侧固定分别为1.17 mm、2.21 mm、0.31 mm、2.29 mm,前者均明显小于后者。(4)改良构型髂腰钉棒系统中内固定应力主要集中在髂骨钉棒与腰椎弓根钉棒之间的连接棒上,而传统构型髂腰钉棒系统中内固定应力主要集中在髂骨钉上缘的连接棒上。在内固定最大应力方面,改良构型髂腰钉棒系统双侧固定为340.84 MPa,传统构型髂腰钉棒系统双侧固定为489.77 MPa,前者较后者减小30.4%;改良构型髂腰钉棒系统单侧固定为351.23 MPa,传统构型髂腰钉棒系统单侧固定�Objective To compare the biomechanical properties of the modified and traditional iliolumbar pedicle screw-rod system for the fixation of vertically unstable posterior pelvic ring dislocation.Methods The CT images of the lumbar spine,pelvis,and femur from a 31-year-old healthy male volunteer were used to establish models of posterior pelvic ring dislocation and unilateral and bilateral fixation models of modified and traditional iliolumbar pedicle screw-rod systems with the three-dimensional virtual software using the finite element method.By restraining the distal ends of the femurs of both sides and applying a vertical load of 500 N to the L1 vertebral body,the maximum stress of the intact pelvis model and the stiffness of the posterior pelvic ring dislocation model were evaluated to validate the reliability of the models.After the validation of the models,a follower load of 400 N was applied in the direction of the L1 vertebral curve to simulate the upper body weight;the maximum vertical displacement,the maximum posterior displacement,the maximum right displacement,and the overall maximum displacement of the sacrum of the modified and traditional iliolumbar pedicle screw-rod system models were compared.Additionally,stress distributions of the implant and the pelvis were also compared.Results(1)The maximum stress of the intact pelvis model was 22.0 MPa,with the stiffness of the posterior pelvic ring dislocation model as 180.03 N/mm.(2)In terms of the maximum vertical displacement of the sacrum,the bilateral modified iliolumbar pedicle screw-rod system was similar to the bilateral traditional iliolumbar pedicle screw-rod system.However,the maximum posterior displacement,the maximum right displacement,and the overall maximum displacement of the sacrum in the bilateral modified iliolumbar pedicle screw-rod system were 0.57 mm,0.19 mm and 0.68 mm respectively,which were markedly smaller than those of the bilateral traditional iliolumbar pedicle screw-rod system(1.38 mm,0.26 mm and 1.41 mm respectively).(3)The maxim

关 键 词：骨盆 骨折固定术 内固定器 生物力学 

分 类 号：R687.3[医药卫生—骨科学] R318.01[医药卫生—外科学]