Ilizarov胫骨横向搬移术4种截骨方式的有限元分析  

Finite element analysis of four osteotomy methodsin Ilizarov tibial transverse transport

作　　者：涂振阳 蓝常贡[2] 唐盛斐 王治国 曾敬 吴冬冬 魏洁莹 廖秋姣 唐强[3] TU Zhenyang;LAN Changgong;TANG Shengfei;WANG Zhiguo;ZENG Jing;WU Dongdong;WEI Jieying;LIAO Qiujiao;TANG Qiang(Department of Orthopedics,Guangzhou Liwan Central Hospital,Guangzhou 510000,Guangdong,China;Department of Joint Surgery,Affiliated Hospital of Youjiang Medical University for Nationalities,Baise 533000,Guangxi,China;Department of Burn Plastic and Wound Repair Surgery,Affiliated Hospital of Youjiang Medical University for Nationalities,Baise 533000,Guangxi,China;Department of Ultrasound Diagnosis,Guangzhou Red Cross Hospital,Guangzhou 510000,Guangdong,China)

机构地区：[1]广东省广州市荔湾区中心医院骨外科,广东广州510000 [2]右江民族医学院附属医院关节外科,广西百色533000 [3]右江民族医学院附属医院烧伤整形与创面修复外科,广西百色533000 [4]广东省广州市红十字会医院超声诊断科,广东广州510000

出　　处：《右江医学》2024年第12期1079-1084,共6页Chinese Youjiang Medical Journal

基　　金：国家自然科学基金(82160907)。

摘　　要：目的 基于胫腓骨CT建立Ilizarov胫骨横向搬移术(TTT)三维有限元模型,研究不同术式的生物力学特征。方法 通过有限元建立TTT不同骨瓣形态和位置的模型。选择胫骨结节50 mm以远,胫骨内侧截骨宽15 mm、长50 mm窗口,截骨深度为20 mm设为A组;在A组的基础上将截骨上端改为圆弧形设为B组;在A组的基础上将截骨位置改为胫骨内侧中段设置为C组;在A组的基础上将截骨位置改为胫骨结节50 mm以远,胫骨外侧截骨设置为D组;未截骨设为完整胫骨实体组。研究各组截骨方式对截骨术后胫骨生物力学的影响。结果 (1)Von Mises应力:A组、B组、C组、D组和完整胫骨实体组Von Mises应力分别为37.808 MPa、39.153 MPa、57.072 MPa、37.384 MPa、37.334 MPa;最大主应力:A组、B组、C组、D组和完整胫骨实体组最大主应力分别为30.823 MPa、30.879 MPa、59.270 MPa、30.825 MPa、30.819 MPa。完整胫骨实体组的Von Mises应力、最大主应力小于其他四组;A组Von Mises应力小于B组及C组,最大主应力小于B组、C组及D组。(2)总体位移:A组、B组、C组、D组和完整胫骨实体组分别为7.1514 mm、7.1573 mm、7.3762 mm、7.2639 mm、7.0624 mm;单方向位移:A组、B组、C组、D组和完整胫骨实体组分别为7.1063 mm、7.1124 mm、7.3335 mm、7.2154 mm、7.0155 mm。完整胫骨实体组的总体位移、单方向位移小于其他四组,A组总体位移、单方向位移小于B组、C组及D组。结论 在胫骨结节50 mm以远,胫骨内侧截骨宽15 mm、长50 mm窗口,截骨深度为20 mm的截骨方式稳定性较强,具有生物力学优势,可降低胫骨的骨折风险,对临床有一定指导意义。Objective To establish the three-dimensional finite element model of Ilizarov tibial transverse transport based on the CT of tibia and fibula,so as to study the biomechanical characteristics of different surgical types.Methods The models of different bone flap shapes and positions were established by finite element method.Group A were selected with distal tibial tubercle of 50 mm,vtibia internal osteotomy window of 15 mm in width and 50 mm in length,and a osteotomy depth of 20 mm.On the basis of group A,group B changed the upper end of the osteotomy to a circular arc,group C changed osteotomy position to the middle part of internal tibia.In addition,group D changed osteotomy position to be 50 mm away from the tibial tubercle,and implemented lateral tibial osteotomy on the basis of group A.No osteotomy was set as intact tibial solid group.And then,the effects of osteotomy methods on the biomechanics of tibia after osteotomy were studied.Results(1)Von Mises stress:the Von Mises stress in the group A,the group B,the group C,the group D,and the intact tibial solid group were 37.808 MPa,39.153 MPa,57.072 MPa,37.384 MPa,and 37.334 MPa,respectively;maximum principal stresses:maximum principal stresses in the group A,the group B,the group C,the group D,and the intact tibial solid group were 30.823 MPa,30.879 MPa,59.270 MPa,30.825 MPa,and 30.819 MPa,respectively.The Von Mises stress and maximum principal stress in the intact tibial solid group were lower than those in the other four groups;the Von Mises stress in the group A was lower than that in the group B and the group C,and the maximum principal stress was lower than that in the group B,the group C and the group D.(2)Overall displacement:overall displancement in the group A,the group B,the group C,the group D,and the intact tibial solid group were 7.1514 mm,7.1573 mm,7.3762 mm,7.2639 mm,and 7.0624 mm,respectively;unidirectional displacement:unidirectional displacement in the group A,the group B,the group C,the group D,and the intact tibial solid group were 7.1063 mm,

关 键 词：胫骨横向搬移术 有限元建模 胫骨 

分 类 号：R683.42[医药卫生—骨科学]