有限元分析与快速成型技术在涉及四边体的髋臼骨折治疗中的应用

发布时间：2018-03-28 19:23

本文选题：髋臼骨折　切入点：四边体　出处：《山东大学》2016年硕士论文

【摘要】：第一部分不同内固定方式治疗涉及四边体的髋臼骨折的有限元分析目的：通过有限元分析,探讨不同内固定方式对涉及四边体的髋臼骨折的固定效果。方法：建立涉及四边体的髋臼骨折三维有限元模型,使用髋臼前柱重建钢板结合四边体长螺钉、骨盆缘下重建钢板、L型钢板、髋臼前后柱联合锁定钢板、髋臼前柱重建钢板结合四边体阻挡钉、空心拉力螺钉等6种不同内固定技术对骨折模型进行固定。对三维有限元模型分别施加垂直载荷300N。为进行生物力学分析,记录髋臼四边体的位移量、髋臼整体结构刚度、内固定物的应力分布进行分析,并探讨6种内固定方式在正常骨量、轻度骨质疏松性骨量、重度骨质疏松性骨量情况下的生物力学变化情况。结果：髋臼前柱重建钢板结合四边体长螺钉和髋臼前后柱联合锁定钢板固定方式可以提供最少的四边体位移量和最佳髋臼整体结构刚度。L型钢板固定方式承受最大应力。随着骨量的减少,四边体的位移量逐渐增加、髋臼结构刚度迅速下降、内固定物所承受的应力峰值不断增大。结论：从有限元分析角度,髋臼前柱重建钢板结合四边体长螺钉技术对涉及四边体的髋臼骨折进行固定表现出较好的生物力学特性。第二部分快速成型技术在涉及四边体的复杂髋臼骨折治疗中的应用目的：探讨快速成型技术在涉及四边体的复杂髋臼骨折手术治疗中的价值。方法：回顾性分析2009年1月至2013年12月,使用快速成型技术规划涉及四边体的复杂髋臼骨折的术前计划,行手术治疗并获完整随访的患者资料,其中18例应用快速成型技术在术前模拟手术,进行手术计划(快速成型组),23例未使用快速成型技术辅助手术(常规组)。快速成型组29例,男12例,女6例；平均年龄36.7岁；髋臼骨折Judet-Letournel分型：T形骨折2例,后柱伴后壁骨折1例,横行伴后壁骨折6例,前方伴后半横行骨折2例,双柱骨折7例。常规组23例,男14例,女9例；平均年龄39.4岁；髋臼骨折Judet-Letournel分型：T形骨折3例,后柱伴后壁骨折2例,横行伴后壁骨折8例,前方伴后半横行骨折2例,双柱骨折8例。观察两组末次随访Merle D' Aubigne Postel评分、Matta评分、手术时间、术中出血量、围手术期输血量、术中透视次数、医原性损伤、并发症等指标。使用t检验、卡方检验等进行统计学分析,p0.05认为具有统计学意义。结果：快速成型组手术时间为2.5-8.0 h,术中出血量为600-1800 ml,围手术期输血量为6-16 U,术中透视次数为4-18次,末次随访Merle D' Aubigne Postel评分优良率为72.2%,末次随访Matta评分优良率为77.8%。常规组手术时间为3.0-8.5 h,术中出血量为800-2000 ml,围手术期输血量为6-18 U,术中透视次数为5-18次,末次随访Merle D' Aubigne Postel评分优良率为73.9%,末次随访Matta评分优良率为69.6%。两组间手术时间、术中出血量、围手术期输血量、术中透视次数差异具有统计学意义(p0.05),末次随访Matta评分、Merle D' Aubigne Postel评分差异无统计学意义(p0.05)。结论：快速成型技术可在术前对涉及四边体的复杂髋臼骨折进行充分规划,使复位固定操作更加准确有效、减少手术创伤、提高围手术期安全性。
[Abstract]:The finite element analysis to the first part of different internal fixation methods for treatment of acetabular fractures involving four body: by finite element analysis, the fixed effect of different methods of internal fixation of acetabular fractures involving four body. Methods: four body acetabular fractures involving the establishment of three-dimensional finite element model, the use of the acetabular anterior column reconstruction plate combined with four body length screw, pelvic margin reconstruction plate, L plate, locking plate in anterior or posterior column joint, anterior column reconstruction plate combined with four block screw, hollow screw 6 different internal fixation of fracture model was fixed. The three-dimensional finite element model were applied for biomechanical analysis of vertical load of 300N., record the displacement the amount of the acetabular acetabular quadrilateral, the rigidity of the whole structure, internal stress distribution analysis, and discusses 6 kinds of internal fixation methods in normal bone mass, mild osteoporosis Song of bone mass and biomechanical changes in severe osteoporotic bone cases. Results: acetabular anterior column reconstruction plate combined with body length and acetabular screws before and after the four column combined with locking plate fixation can provide at least four displacement and optimal acetabular stiffness.L plate fixation with bone under stress. Reduce the displacement of four body increases gradually, rapid decline of acetabular structural stiffness, internal stress peak increased. Conclusion: finite element analysis from the angle of acetabular anterior column acetabular reconstruction plate combined with four body length screw on the fixed body involved four showed better biomechanical properties of bone fractures. The second part of the rapid prototyping technology applied to fracture in the treatment of complicated acetabular quadrilateral involving body: To explore the rapid prototyping technology in the complex involving four Surgical treatment of complex acetabular fractures. Methods: a retrospective analysis from January 2009 to December 2013, plans to use the rapid prototyping technology planning of complex acetabular fractures involving four body before operation, patients underwent surgical treatment and followed up, including 18 cases of application of rapid forming technology in surgical simulation before operation. The operation plan (the rapid prototyping group) 23 cases, without the use of rapid prototyping technology assisted surgery (conventional group). Rapid prototyping group 29 cases, 12 cases were male, 6 were female; the average age is 36.7 years old; acetabular fracture Judet-Letournel type T fracture in 2 cases, 1 cases of posterior column and posterior wall fractures, 6 transverse wall fracture with posterior anterior and posterior hemitransverse, 2 cases of transverse fracture, double column fractures in 7 cases. 23 cases of normal group, 14 cases were male, 9 were female; the average age is 39.4 years old; acetabular fracture Judet-Letournel type T fracture in 3 cases, 2 cases of posterior column and posterior wall fractures, 8 transverse and posterior wall fractures. Before The second party with 2 cases of transverse fracture, double column fractures in 8 cases. The two groups at the end of the follow-up Merle D'Aubigne Postel score, the Matta score, operative time, intraoperative blood loss, perioperative blood transfusion, intraoperative fluoroscopy times, iatrogenic injury, complications and other indicators. Using t test, Chi square test for statistical analysis, P0.05 is considered to be statistically significant. Results: RP group operation time was 2.5-8.0 h, the amount of bleeding was 600-1800 ml, the volume of blood transfusion during perioperative period was 6-16 U, intraoperative fluoroscopy times is 4-18, the excellent rate of score at the last follow-up Merle D' Aubigne Postel was 72.2%, the excellent rate of score at the end Matta 77.8%. for routine follow-up group operation time was 3.0-8.5 h, the amount of bleeding was 800-2000 ml, the volume of blood transfusion during perioperative period was 6-18 U, intraoperative fluoroscopy times is 5-18, the excellent rate of score at the last follow-up Merle D'Aubigne Postel 73.9%, Matta score of the final follow up The excellent rate of 69.6%. between the two groups in operation time, bleeding during operation, perioperative blood transfusion, intraoperative fluoroscopy times had significant difference (P0.05), Matta score of the final follow up, there was no significant difference in the score of Postel Merle D'Aubigne (P0.05). Conclusion: the rapid prototyping technique in preoperative acetabular complex four body fractures were fully involved in planning, the reduction and fixation operation more accurately and effectively, reduce the surgical trauma, improve the perioperative safety.

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R687.3

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