生物可吸收板与微型钛板在不同骨质下颌骨骨折固定中的有限元分析  

Finite element analysis of bioabsorbable plates versus miniature titanium plates in mandibular fracture fixation in different bone qualities

作　　者：周宗昊 罗思阳 陈佳文 陈光能 冯红超 Zhou Zonghao;Luo Siyang;Chen Jiawen;Chen Guangneng;Feng Hongchao(School of Stomatology of Guizhou Medical University,Guiyang 550004,Guizhou Province,China;Guiyang Hospital of Stomatology,Guiyang 550000,Guizhou Province,China)

机构地区：[1]贵州医科大学口腔医学院,贵州省贵阳市550004 [2]贵阳市口腔医院,贵州省贵阳市550000

出　　处：《中国组织工程研究》2025年第4期818-826,共9页Chinese Journal of Tissue Engineering Research

基　　金：贵州省卫生健康委科学技术基金项目(gzwkj2022-431),项目名称:基因重组人生长激素对人牙髓细胞增殖及成骨分化研究,项目负责人:冯红超;观山湖区科技计划项目(观科合同[2021]01号),项目名称:人工智能技术在口腔颌面医学影像中的应用研究,项目负责人:冯红超。

摘　　要：背景:下颌骨骨折在坚强内固定后的愈合受多种因素影响,包括接骨板的材料、骨折部位以及患者骨密度等,然而,目前对于不同骨质下下颌骨骨折固定稳定性关系的研究相对较少,并且缺乏科学的依据。目的:利用有限元法分析生物可吸收板和微型钛板固定不同骨质条件下颌骨骨折的稳定性。方法:根据ZARB和LEKHOLM提出的骨质分类方法,分别建立Ⅰ-Ⅳ类下颌骨骨折三维有限元模型,每类骨质条件下分别模拟下颌骨正中、体部和下颌角3个部位的骨折模型,采用生物可吸收板(或微型钛板)对上述骨折进行内固定,模拟健侧咬合状态,利用有限元分析骨折段的相对位移与内固定物应力分布情况。结果与结论:①随着骨质等级的增加,内固定物的最大应力值基本呈逐渐增加趋势,微型钛板组、生物可吸收板组下颌体部Ⅳ类骨质下的内固定物最大应力值最高,分别为382.74,96.11 MPa;在相同骨质条件下,钛板组各部位骨折模型的内固定物最大应力值均高于生物可吸收板组。②对于Ⅲ和Ⅳ类下颌骨正中部骨折,微型钛板组、可吸收板固定组骨折断端位移较大,超过了骨愈合极限值(大于150μm);对于Ⅳ类骨质下颌骨体部骨折,生物可吸收板组骨折断端位移超过了愈合极限值,微型钛板组骨折断端位移接近愈合极限值;在相同骨质条件与骨折部位下,微型钛板组骨折断端位移要小于生物可吸收板组。③结果显示,两种内固定物的强度和刚度均足以支持Ⅰ-Ⅳ类骨质下颌骨3种部位骨折的骨愈合,并且生物可吸收板的固定稳定性与微型钛板几乎相同,可以提供骨折早期的愈合条件。在治疗下颌骨骨折时应将下颌骨骨质类型纳入考虑因素,下颌骨骨质等级越高,骨折固定的稳定性越差,术后更易发生骨愈合不良等并发症。BACKGROUND:The healing of mandibular fractures after rigid internal fixation is influenced by many factors,including the material of the bone plate,fracture site,and bone density of the patient.However,there are relatively few studies on the relationship between the stability of mandibular fracture fixation in different bone qualities and they lack a scientific basis.OBJECTIVE:To analyze the stability of fixation of mandibular fractures with different bone qualities with bioabsorbable plates and miniature titanium plates by finite element analysis.METHODS:Three-dimensional finite element models of class I-IV mandibular fractures were developed according to the bone quality classification method proposed by ZARB and LEKHOLM.The fractures at the median mandibular symphysis,mandibular body,and mandibular angle were simulated under different bone qualities.Bioabsorbable bone grafting plates(or miniature titanium plates)were placed at each fracture site for fixation and to simulate the state of healthy side occlusion.Finite element analysis on the model was used to analyze the relative displacement of the fracture segments and the stress distribution of fixators.RESULTS AND CONCLUSION:(1)The maximum stress value during fixation with titanium plates increased gradually with the increase of bone class,in which the maximum stress value of titanium plates was the highest in the mandibular body class IV bone group,which was 382.74 MPa and 96.11 MPa in the miniature titanium plate and bioabsorbable plate groups.The results for mandibles of the same bone type showed that the maximum stress value of titanium plates was much higher than that of bioabsorbable plates.(2)For fractures of the median middle of the mandible in types III and IV,the displacement of the fracture breaks at the fixation site was large and exceeded the limiting value of bone healing(>150μm),regardless of whether the fixation was performed with a miniature titanium plate or a bioabsorbable plate.For type IV mandibular fractures,the fracture end displaceme

关 键 词：生物可吸收板 微型钛板 三维有限元分析 下颌骨骨折 固定方法 骨质 

分 类 号：R496[医药卫生—康复医学] R318[医药卫生—临床医学] R782