有限元分析不同内固定方式治疗肱骨近端骨折的力学差异  

Finite element analysis of mechanical differences between different internal fixation modalities for proximal humerus fractures

作　　者：王磊 王清[2] 张申申 Wang Lei;Wang Qing;Zhang Shenshen(Mindong Hospital Affiliated to Fujian Medical University,Fuan 355000,Fujian Province,China;Fujian Medical University,Fuzhou 350108,Fujian Province,China)

机构地区：[1]福建医科大学附属闽东医院,福建省福安市355000 [2]福建医科大学,福建省福州市350108

出　　处：《中国组织工程研究》2025年第15期3101-3109,共9页Chinese Journal of Tissue Engineering Research

摘　　要：背景:目前临床中治疗肱骨近端骨折的钢板内固定方式仍无绝对标准,但重建内侧肱骨距并有效抵抗肱骨头内翻移位是实现肱骨近端骨折坚强固定的要点。目的:利用有限元分析技术获得3种内固定方式作用于肱骨近端骨折的力学差异,对比何种内固定方法可以提供更加稳定的固定支撑。方法:选择一名健康女性志愿者进行左肩关节的CT扫描,通过有限元分析软件构建肱骨近端骨折伴内侧柱支撑缺损模型。根据钢板内固定方式将模型划分为3组:A组仅在外侧应用Philos钢板固定;B组外侧应用Philos钢板联合内侧微型直行锁定加压板固定;C组外侧Philos钢板联合前内侧微型直行锁定加压板固定。在相同的固定支撑和约束条件下,采用ANSYS分析软件评估3组内固定模型的生物力学稳定性。结果与结论:①3组内固定模型的内固定物应力均未超过450 MPa;②不同载荷条件下,A组肱骨和内固定物的应力较高于B、C两组,而C组的肱骨和内固定物的应力均为最小值;③在屈曲载荷条件下,C组的相对位移对比A、B两组数值较小;④所有载荷条件下,B组的骨折端相对位移是最小的;在内收、外展以及轴向压缩的载荷条件下,B组的相对位移大约只有A组的一半;⑤C组与B组之间的相对位移并没有显著的差异,且C组的相对位移也均小于A组;⑥结果发现,相较于仅应用外侧Philos钢板,外侧Philos钢板与内侧微型直行锁定加压板的联合应用,以及外侧Philos钢板与前内侧微型直行锁定加压板的联合应用,均展现出显著的内固定系统稳定性,后两种组合在内固定系统稳定性上并未呈现出明显差异;综合考虑临床实践中的操作难易程度,外侧Philos钢板与前内侧微型直行锁定加压板的联合内固定方式治疗肱骨近端骨折可能更具优势。BACKGROUND:There is currently still no absolute standard for internal fixation of plates in the treatment of proximal humerus fractures in clinical practice,but reconstruction of the medial humeral distance and effective resistance to inversion displacement of the humeral head are the key points in achieving strong fixation of proximal humerus fractures.OBJECTIVE:Finite element analysis techniques were used to obtain the mechanical differences between these three internal fixation modalities acting on proximal humerus fractures and to compare which internal fixation method provides more stable fixation support.METHODS:A healthy female volunteer was selected to undergo CT scanning of the left shoulder joint,and finite element analysis software was used to construct a model of proximal humerus fracture with medial column support defect.The model was categorized into three groups based on different internal fixation methods.In group A,Philos plate fixation was applied only on the lateral side.In group B,Philos plate fixation was applied on the lateral side combined with miniature straight-locking compression plate fixation on the medial side.In group C,Philos plate fixation was applied on the lateral side combined with miniature straight-locking compression plate fixation on the anterior medial side.The biomechanical stability of these three groups of internal fixation models was evaluated using ANSYS analysis software under the same fixation support and constraint conditions.RESULTS AND CONCLUSION:(1)The stress of the internal fixation in the three groups of internal fixation models did not exceed 450 MPa.(2)The stress of the humerus and internal fixation in group A was higher than that in groups B and C under different loading conditions,whereas the stress of the humerus and internal fixation in group C was the minimum.(3)Under the flexion loading condition,the relative displacement in group C had a smaller value than that in groups A and B.(4)The relative displacement of the fracture end in group B was the smalle

关 键 词：肱骨近端骨折 内侧柱重建 Philos钢板 双钢板 有限元分析 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] R687.3