| 118 | 2 | 14 |
| 下载次数 | 被引频次 | 阅读次数 |
目的:探讨自行设计的一种新型带侧翼双平面锁定钢板治疗锁骨中段骨折的力学性能。方法:基于1名健康成年男性志愿者锁骨CT数据,通过数字化三维重建技术构建锁骨中段骨折的三维有限元模型,模拟了单平面锁定钢板(SP)、侧翼钢板(WP)的两种固定方式,采用轴向压缩、轴向扭转、悬臂弯曲以及拔出的四种载荷工况分别对两组模型进行分析。结果:WP在轴向压缩、轴向扭转、悬臂弯曲和拔出工况下,相对于SP,其刚度分别提高1.47%、5.82%、1.51%和3.96%,应变能分别下降1.50%、5.39%、1.48%和3.49%,具有更好的内固定稳定性;WP在各种载荷条件下的应力分布特点与SP相似,高应力区位于骨折区上方的钢板钉孔周围;WP在拔出工况下,钉孔表面应力峰值相对于SP有较大幅度的降低,尤其体现在侧翼螺钉两侧钉孔,具有更高的抗拔出能力。结论:侧翼锁定钢板在各种载荷条件下的承载模式与单平面锁定钢板相似,而稳定性略高于单平面锁定钢板;而在抗拔出性能方面,侧翼钢板优势更为明显。双平面固定的带侧翼锁定钢板有望成为锁骨中段粉碎性骨折或合并骨质疏松的患者内固定治疗更为理想的选择。
Abstract：Objective:To investigate the mechanical properties of a new type of biplane locking plate with wings in the treatment of middle clavicle fractures. Methods:Based on the CT data of a healthy adult male volunteer's clavicle,a three-dimensional finite element model of the middle clavicle fracture was constructed through digital three-dimensional reconstruction technology,and the two kinds of fixation methods of single-plane locking plate(SP)and wing plate(WP)were simulated. Four load cases of axial compression,axial torsion,cantilever bending and pull-out were used to analyze the models. Results:Under axial compression,axial torsion,cantilever bending and pull-out conditions,compared with SP,the stiffness of WP increased by 1.47%,5.82%,1.51% and 3.96%,respectively,and the strain energy decreased by 1.50%,5.39%,1.48% and 3.49%,respectively.The stress distribution characteristics of WP under various load conditions were similar to SP,and the high stress area was located around the screw hole of the steel plate above the fracture gap. Under the pull-out condition,the peak value of screw hole surface stress of WP was greatly reduced compared with SP,especially in the screw hole on both sides of the wing screws,which had higher resistance to pulling out. Conclusion:The load-bearing mode of WP under various load conditions is similar to that of SP,and the stability is slightly higher than that of SP and in terms of pull-out resistance,WP has more obvious advantages. The biplane locking plate with wings is expected to be a more ideal choice for patients with comminuted fracture of the middle clavicle or with osteoporosis.
1 Qiu XS,Wang XB,Zhang Y,et al.Anatomical study of the clavicles in a Chinese population[J].Biomed Res Int,2016,2016:6219761.
2 van der Linde RA,Beetz I,van Helden SH.Plating for midshaft clavicular fractures:The impact on quality of life and functional outcome[J].Injury,2017,48(12):2778-2783.
3 Wiesel B,Nagda S,Mehta S,et,al.Management of midshaft clavicle fractures in adults[J].J Am Acad Orthop Surg,2018,26(22):e468-e476.
4 Campbell DH,McKee MD.Operative fixation of a displaced midshaft clavicle fracture[J].J Orthop Trauma,2020,34(Suppl 2):S3-S4.
5 Ropars M,Thomazeau H,Huten D.Clavicle fractures[J].Orthop Traumatol Surg Res,2017,103(1S):S53-S59.
6 Hoogervorst P,van Dam T,Verdonschot N,et al.Functional outcomes and complications of intramedullary fixation devices for Midshaft clavicle fractures:A systematic review and meta-analysis[J].BMC Musculoskelet Disord,2020,21(1):395.
7 Bhardwaj A,Sharma G,Patil A,et al.Comparison of plate osteosynthesis versus non-operative management for mid-shaft clavicle fractures-A prospective study[J].Injury,2018,49(6):1104-1107.
8 Celestre P,Roberston C,Mahar A,et al.Biomechanical evaluation of clavicle fracture plating techniques:Does a locking plate provide improved stability[J].J Orthopaed Trauma,2008,22(4):241-247.
9 Yaacobi E,Sanchez D,Maniar H,et al.Surgical treatment of osteoporotic fractures:An update on the principles of management[J].Injury,2017,48(Suppl 7):S34-S40.
10 Zhuang Y,Zhang Y,Zhou L,et al.Management of comminuted mid-shaft clavicular fractures:Comparison between dual-plate fixation treatment and single-plate fixation[J].J Orthop Surg(Hong Kong),2020,28(2):2309499020915797.
11 Marinescu R,Antoniac VI,Stoia DI,et al.Clavicle anatomical osteosynthesis plate breakage-failure analysis report based on patient morphological parameters[J].Rom J Morphol Embryol,2017,58(2):593-598.
12 Strauss EJ,Schwarzkopf R,Kummer F,et al.The current status of locked plating:The good,the bad,and the ugly[J].J Orthop Trauma,2008,22(7):479-486.
13 Zhang F,Chen F,Qi Y,et al.Finite element analysis of dual small platefixation and single plate fixation for treatment of midshaft clavicle fractures[J].J Orthop Surg Res,2020,15(1):148.
14 Li ZP,Kindig MW,Kerrigan JR,et al.Development and validation of a subject-specific finite element model of a human clavicle[J].Comput Methods Biomech Biomed Engin,2013,16(8):819-829.
15 Zhang X,Cheng X,Yin B,et al.Finite element analysis of spiral plate and Herbert screw fixation for treatment of midshaft clavicle fractures[J].Medicine(Baltimore),2019,98(34):e16898.
16 Sakai R,Matsuura T,et al.Comparison of internal fixations for distal clavicular fractures based on loading tests and finite element analyses[J].Sci World J,2014,2014:817321.
17 Chen Y,Yang Y,Ma X,et al.A biomechanical comparison of four different fixation methods for midshaft clavicle fractures[J].Proc Inst Mech Eng H,2016,230(1):13-19.
18 Nourian A,Dhaliwal S,Vangala S,et al.Midshaft fractures of the clavicle:A meta-analysis comparing surgical fixation using anteroinferior plating versus superior plating[J].J Orthop Trauma,2017,31(9):461-467.
19 Ziegler CG,Aman ZS,Storaci HW,et al.Low-profile dual small plate fixation is biomechanically similar to larger superior or anteroinferior single plate fixation of midshaft clavicle fractures[J].Am J Sports Med,2019,47(11):2678-2685.
20 Prasarn ML,Meyers KN,Wilkin G,et al.Dual minifragment plating for midshaft clavicle fractures:A clinical and biomechanical investigation[J].Arch Orthop Trauma Surg,2015,135(12):1655-1662.
21 Michel PA,Katthagen JC,Heilmann LF,et al.Biomechanics of upper extremity double plating[J].Z Orthop Unfall,2020,158(2):238-244.
22 Uzer G,Yildiz F,Batar S,et al.Biomechanical comparison of three different plate configurations for comminuted clavicle midshaft fracture fixation[J].J Shoulder Elbow Surg,2017,26,2200-2205.
23 Huang TL,Chen WC,Lin KJ,et al.Conceptual finite element study for comparison among superior,anterior,and spiral clavicle plate fixations for midshaft clavicle fracture[J].Med Eng Phys,2016,38(10):1070-1075.
24 Niinomi M.Mechanical properties of biomedical titanium alloys[J].Materials Ence Eng A,1998,243(1-2):231-236.
25 Marie C.Strength analysis of clavicle fracture fixation devices and fixation techniques using finite element analysis with musculoskeletal force input[J].Med Biol Eng Comput,2015,53(8):759-769.
26 Brouwer KM,Wright TC,Ring DC.Failure of superior locking clavicle plate by axial pull-out of the lateral screws:A report of four cases[J].J Shoulder Elbow Surg,2009,18:e22-e25.
27 Osterhoff G,Morgan EF,Shefelbine SJ,et al.Bone mechanical properties and changes with osteoporosis[J].Injury,2016,47(Suppl 2):S11-S20.
28 DeKeyser GJ,Kellam PJ,Haller JM.Locked plating and advanced augmentation techniques in osteoporotic fractures[J].Orthop Clin North Am,2019,50(2):159-169.
29 Gardner MJ,Collinge C.Management principles of osteoporotic fractures[J].Injury,2016,47 (Suppl 2):S33-S35.
基本信息:
DOI：10.13210/j.cnki.jhmu.20210413.001
中图分类号:R687.3
引用信息:
[1]黄解元,陈琦翔,许定拔,等.侧翼钢板内固定治疗锁骨中段骨折的有限元分析[J].海南医学院学报,2021,27(22):1709-1715.DOI:10.13210/j.cnki.jhmu.20210413.001.
基金信息:
湛江市非资助科技攻关计划项目（2019B01067）; 湛江市科技发展专项资金竞争性分配项目（2019A01029）~~
2021-04-13
2021-04-13
2021-04-13