双钢板内固定治疗肱骨远1/3骨折的有限元分析及基于肘关节功能和肘关节活动度评估疗效  

Finite element analysis of double-plate internal fixation for distal 1/3 humeral fractures and evaluation of efficacy based on elbow function and elbow range of motion

作　　者：王曦 关鹏飞[2] Wang Xi;Guan Pengfei(Department of Orthopaedics,North China University of Science and Technology Clinical School,Tangshan 063000,China;Department of Traumatology,Second Hospital,Tangshan 063000,China)

机构地区：[1]华北理工大学临床医学院骨科,唐山063000 [2]唐山市第二医院创五科,063000

出　　处：《中华肩肘外科电子杂志》2024年第3期230-237,共8页Chinese Journal of Shoulder and Elbow(Electronic Edition)

摘　　要：目的探讨双钢板内固定治疗肱骨远1/3骨折的生物力学特性及其对肘关节功能和肘关节活动度的影响。方法选取本院2020年1月至2022年12月收治的160例肱骨远1/3骨折患者,随机分为传统内固定组(n=80)和双钢板内固定组(n=80),比较两组患者的手术指标、术后肘关节功能Mayo评分、肘关节评分、并发症发生率以及肩关节功能改善情况。采用人工骨建立肱骨远端C1型骨折模型,分别采用传统内固定和双钢板内固定,通过特定的软件进行建模,模拟生物力学的各种测试,进行有限元分析。依据术后Mayo评分将患者分为优良组(≥75分)和非优良组(<75分),分析两组患者的基本资料,Logistic回归分析影响患者手术疗效的因素。结果双钢板内固定组的切口长度、手术时间、术中出血量、骨折愈合时间均显著低于传统内固定组(P<0.05)。双钢板内固定组的术后肘关节功能Mayo评分、肘关节活动度、肘关节评分、肩关节功能改善情况均显著高于传统内固定组(P<0.05)。双钢板内固定组的并发症发生率(6.25%)显著低于传统内固定组(21.25%,P<0.05)。有限元分析结果显示,双钢板内固定组的应力分布更均匀,应变能量密度更低,骨折稳定性更高,骨折愈合速度更快。Logistic分析结果显示,影响患者手术疗效的因素有年龄、性别、骨折类型、内固定方式、术中出血量、骨折愈合时间、并发症发生率等,其中内固定方式是最重要的影响因素(OR=8.32,95%CI:2.54~27.28,P<0.01)。结论双钢板内固定治疗肱骨远1/3骨折具有良好的生物力学特性,能有效提高骨折稳定性,促进骨折愈合,改善肘关节功能和肘关节活动度,降低并发症发生率,是一种安全、有效、可靠的治疗方法。Background The distal 1/3 fracture of the humeral shaft refers to the fracture from below the middle part to 2 cm above the condyle of the humerus.The structural and anatomical characteristics of the distal 1/3 of the humeral shaft make it a prone site for fracture.As the aging of society progresses,about 85%of the patients occur in people over 50 years of age,with the incidence peaking in the 60-90-year age group.For distal humerus fractures,non-surgical methods such as upper limb suspension fixation usually result in good treatment if there is no significant displacement.However,for severely displaced or comminuted fractures,surgical treatment with locking plate internal fixation is usually more effective.However,there are inconsistent conclusions about the clinical effectiveness of different internal fixation procedures,which increases the difficulty of selecting an appropriate clinical treatment strategy.The efficacy varies,especially in treating distal humerus 1/3 fracture with double plate internal fixation.Therefore,it is essential to analyze the factors affecting the therapeutic effect based on clinical data,evaluate the prognosis of patients accordingly,and provide timely and reasonable treatment to improve the quality of life of patients with distal humerus 1/3 fracture.Objective To investigate the biomechanical characteristics of double plate internal fixation in treating distal humerus 1/3 fracture and its effect on elbow joint function and elbow joint motion.Methods A total of 160 patients with distal 1/3 fracture of the humerus admitted to our hospital from January 2020 to December 2022 were randomly divided into a traditional internal fixation group(80 cases)and a double plate internal fixation group(80 cases).The two groups’surgical indicators,postoperative Mayo score of elbow function,elbow joint score,complication rate,and improvement of shoulder joint function were compared.The C1 fracture model of the distal humerus was established using artificial bone.Traditional internal fixation and doub

关 键 词：肱骨远1/3骨折 双钢板内固定 有限元分析 肘关节功能 生物力学分析 

分 类 号：R687.3[医药卫生—骨科学]