锁定板外置治疗胫骨中下段骨折的有限元分析及临床近中期随访

发布时间：2018-02-02 22:06

本文关键词： 胫骨中下段骨折有限元分析锁定接骨板外固定随访　出处：《南华大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的:1、构建成人胫骨中下段骨折的三维有限元模型,我们通过三维有限元法对胫骨中下段骨折锁定接骨板内固定、锁定接骨板外固定、单边外固定架三种不同固定方式的固定效果进行比较分析,判断锁定接骨板外置固定胫骨中下段骨折的效果,为临床采用锁定接骨板外置治疗胫骨中下段骨折提供生物力学理论依据。2、随访我院行锁定接骨板外置治疗胫骨中下段骨折的患者,评估其近中期疗效。方法:1、选取健康28岁女性患者,对其右膝关节髌骨最上缘以上1.0cm开始,至胫骨踝关节下5.0cm进行128排螺旋CT扫描,获取薄层CT扫描数据,利用Mimics10.0数字化三维医学影像交互式处理软件和Abaqus6.10有限元处理软件建立胫骨中下段骨折的三维有限元模型,并将锁定接骨板、单边外固定架与骨折模型装配,通过设定边界和加载负荷,对装配后的胫骨骨折三维有限元模型进行轴向压缩、扭转加载和四点弯曲加载生物力学分析得出相应的应力分布、应力值、位移值、固定系统的刚度值。2、回顾性分析我院2011年6月~2014年8月采用解剖锁定板外置治疗胫骨中下段骨折7例,其中,男3例,女4例;手术时平均年龄37.6岁,平均随访22.8个月(7~36个月)。于术后及骨折愈合时、末次随访时复查正位及侧位X线片及进行临床评估。结果:1、通过有限元分析,不同加载方式下,锁定板外固定系统胫骨骨折端总位移及X、Y、Z轴分位移大于锁定板内固定系统,小于单边外固定架系统;各固定系统的刚度值比较:锁定板内固定系统平均轴向刚度值(2066.9259+0.0494)、锁定板外固定系统平均轴向刚度值(256.7541+0.0011)及单边外固定架系统平均轴向刚度值(188.6585+0.0005)多重两两比较结果,P值0.05,有统计学意义。锁定板内固定系统平均扭转刚度值(225.3137+0.0003)、锁定板外固定系统平均扭转刚度值(103.3419+0.0001)及单边外固定架系统平均扭转刚度值(97.7292+0.00006)多重两两比较结果,P值0.05,有统计学意义。锁定板内固定系统平均弯曲刚度值(225.3137+0.0003)、锁定板外固定系统平均弯曲刚度值(109.0122+0.0002)及单边外固定架系统平均弯曲刚度值(34.6815+0.00002)多重两两比较结果,P值0.05,有统计学意义。2、临床随访结果:本组所有患者骨折愈合后均对位对线良好,未出现肢体畸形,肢体功能恢复均优良。结论:1、锁定接骨板外置固定胫骨中下段骨折的稳定性小于锁定接骨板内固定,大于半针单边外固定架;锁定接骨板外置固定胫骨中下段骨折的系统刚度值比单边外固定架要大,小于锁定接骨板内固定。2、锁定接骨板外置治疗胫骨中下段骨折可获得较满意的近中期临床疗效。
[Abstract]:Objective to construct a three-dimensional finite element model of middle and lower tibial fractures in adults. We used three-dimensional finite element method to fix the fractures of middle and lower tibia with locking plate and external fixation. The results of three different fixation methods of unilateral external fixator were compared and analyzed to judge the effect of locking plate external fixation for the middle and lower tibial fractures. In order to provide biomechanical theoretical basis for the treatment of middle and lower tibial fractures by locking plate external placement, we followed up the patients who were treated with locking plate external placement for the fracture of the middle and lower tibia. Methods: to evaluate the efficacy in the near and medium term. Methods 1: 1 was selected from a healthy 28-year-old female patient, and 1.0 cm above the upper edge of the patella of the right knee joint was selected. From 5.0cm below the ankle joint of tibia, 128 slice spiral CT scanning was performed, and thin slice CT scanning data were obtained. The 3D finite element model of middle and lower tibia fracture was established by Mimics10.0 digital 3D medical image interactive processing software and Abaqus6.10 finite element processing software. The locking plate, unilateral external fixator and fracture model were assembled, and the three-dimensional finite element model of tibial fracture was subjected to axial compression by setting the boundary and loading load. The corresponding stress distribution, stress value, displacement value and stiffness value of the fixed system are obtained by the biomechanical analysis of torsional loading and four-point bending loading. From June 2011 to August 2014, 7 cases of middle and lower tibial fractures were treated by anatomic locking plate placement, including 3 males and 4 females. The mean age at the time of operation was 37.6 years, and the average follow-up was 22.8 months, ranging from 7 to 36 months. At the time of postoperative and fracture healing, X-ray films of positive and lateral position and clinical evaluation were reexamined at the last follow-up. Results: 1. According to the finite element analysis, the total displacement of tibial fracture end and the axial branch displacement of XMY Z in the locking plate external fixation system were larger than those in the locking plate internal fixation system and were smaller than those in the unilateral external fixation system under different loading modes. Comparison of the stiffness of each fixed system: the average axial stiffness of the locking plate fixation system is 2066.9259 0.0494). The average axial stiffness of the locking plate external fixation system is 256.7541 0.0011) and the average axial stiffness value of the unilateral external fixator system is 188.6585 0.0005). Multiple pairwise comparison results. The mean torsional stiffness of the locking plate fixation system was 225.3137 0.0003). The average torsional stiffness of the locked plate external fixation system is 103.3419 0.0001) and the mean torsional stiffness of the unilateral external fixator system is 97.7292 0.00006). Multiple pairwise comparison results. P value was 0.05, there was statistical significance. The average bending stiffness of locking plate fixation system was 225.3137 0.0003). The average bending stiffness of the locking plate external fixation system is 109.0122 0.0002) and the average bending stiffness value of the unilateral external fixator system is 34.6815 0.00002). Multiple pairwise comparison results. P value was 0.05, with statistical significance. 2. The clinical follow-up results showed that all the patients had good alignment after fracture healing, no limb deformity and good recovery of limb function. Conclusion: 1. The stability of external fixation of middle and lower tibial fractures with locking plate was less than that with locking plate, and the stability was greater than that of unilateral external fixator with half needle. The system stiffness value of locking plate external fixation for middle and lower tibial fractures was larger than that of unilateral external fixation frame, and less than that of locking plate internal fixation .2. Locking plate external placement for middle and lower tibial fractures can obtain satisfactory clinical results in the near and medium term.
【学位授予单位】：南华大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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