锁骨骨折的有限元分析:桥接组合式内固定系统与传统钢板螺钉内固定的比较  

Finite element analysis of clavicle fracture:A comparison between bridge-combined fixation system and platescrew fixation

作　　者：李潺 袁利杰 屈路强[1] 顾晓岚 夏聪 Li Chan;Yuan Lijie;Qu Luqiang;Gu Xiaolan;Xia Cong(Department of Orthopedics,Taicang Affiliated Hospital of Soochow University,The First People's Hospital of Taicang,Taicang Jiangsu,215400,China)

机构地区：[1]江苏省太仓市第一人民医院(苏州大学附属太仓医院)骨科,江苏太仓215400

出　　处：《生物骨科材料与临床研究》2024年第6期45-54,62,共11页Orthopaedic Biomechanics Materials and Clinical Study

基　　金：太仓市基础研究计划(TC2021JCYL26)。

摘　　要：目的通过有限元分析比较桥接组合式内固定系统(bridge combined fixation system,BCFS)与传统钢板螺钉固定(plate screw fixation,PSF)在锁骨中段骨折中应用的力学表现,评估BCFS在模拟负载条件下的生物力学稳定性和应力分布特性,以探究其在临床应用中的潜在优势。方法采用1名健康志愿者的正常锁骨三维CT数据,通过相关软件建立锁骨中段横断骨折模型。同时设计了8种内固定配置:BCFS圆棒(直径4 mm)上置及前置、PSF上置及前置、BCFS双棒固定、BCFS扁棒(4 mm×8 mm长圆截面)上置及前置,以及髓内钉固定。对模型施加压缩、扭转、三点弯曲应力测试,评价指标包括固定装置的最大等效应力和骨折端的最大位移,以此来检验各种固定方式下的应力分布和骨折端稳定性。结果桥接扁棒固定方式在参数表现上优于传统PSF,后者又要优于桥接4 mm直径单圆棒固定。在200 N压缩负荷下,桥接扁棒前置固定的最大应力为210.92 MPa,位移为0.15 mm,相较于PSF前置固定的292.46 MPa和0.16 mm,以及桥接4 mm圆棒前置固定的720.6 MPa和0.72 mm表现更为优异。在扭转载荷下,桥接扁棒上置固定的最大应力为27.36 MPa,位移为0.04 mm,不仅低于PSF上置固定的28.62 MPa和0.07 mm,也显著低于桥接4 mm圆棒上置固定的50.97 MPa和0.13 mm。在三点弯曲负荷下,桥接扁棒上置固定的最大应力和位移分别为217.98 MPa和0.37 mm,低于PSF上置固定的253.47 MPa和0.37 mm,同时也显著优于桥接4 mm圆棒上置固定的332.52 MPa和0.41 mm。结论BCFS为锁骨中段骨折提供了多样化的固定选择,使得针对不同骨折类型可以采用相应的BCFS配置。本研究展示了BCFS固定方案在内植物应力和骨折端位移方面的优势,提供了比传统PSF更宽广的选择范围。其避免了PSF的过度固定及髓内钉固定不足,提供了一种生物力学上更为稳健的解决方案。Objective To compare the mechanical performance of the bridge combined fixation system(BCFS)with traditional plate screw fixation(PSF)in midshaft clavicle fractures through finite element analysis.The aim was to evaluate the biomechanical stability and stress distribution characteristics of the BCFS under simulated loading conditions and to explore its potential advantages in clinical application.Methods Using the normal clavicle 3D CT data from a healthy volunteer,a model of a midshaft transverse clavicle fracture was constructed using dedicated software.Eight internal fixation configurations were designed:BCFS round bars(4 mm diameter)placed superiorly and anteriorly,PSF placed superiorly and anteriorly,BCFS double bar fixation,BCFS flat bars(4 mm×8 mm oval cross-section)placed superiorly and anteriorly,and intramedullary nail fixation.The models were subjected to compression,torsion,and three-point bending stress tests.Evaluation indicators included the maximum equivalent stress of the fixation device and the maximum displacement of the fracture end to test the stress distribution and fracture end stability under different fixation methods.Results The flat bar BCFS fixation showed superior parameter performance compared to the traditional PSF,which in turn was superior to the single 4 mm diameter round bar BCFS fixation.Under a compressive load of 200 N,the maximum stress for the anteriorly placed flat bar BCFS fixation was 210.92 MPa with a displacement of 0.15 mm,outperforming the anteriorly placed PSF of 292.46 MPa and 0.16 mm and the anteriorly placed 4 mm round bar BCFS of 720.6 MPa and 0.72 mm.Under torsional loading,the maximum stress for the superiorly placed flat bar BCFS fixation was 27.36 MPa at 0.04 mm displacement,which was not only lower than the superiorly placed PSF's 28.62 MPa at 0.07 mm,but also significantly lower than the superiorly placed 4 mm round bar BCFS's 50.97 MPa at 0.13 mm.Under three-point bending loading,the maximum stress for the superiorly placed flat bar BCFS fixation was 27.

关 键 词：桥接组合式内固定系统 传统钢板螺钉内固定系统 锁骨中段骨折 有限元分析 

分 类 号：R318[医药卫生—生物医学工程]