双钢板治疗股骨干骨不连的有限元分析及临床疗效初步观察

发布时间：2018-05-26 05:34

本文选题：有限元 + 股骨骨折　；参考：《中国人民解放军医学院》2017年硕士论文

【摘要】：背景股骨干骨折是临床常见骨折之一,经过正确治疗大部分能够治愈,但仍有部分患者因为种种原因导致骨不连的发生。骨不连是股骨干骨折的主要并发症,会导致疼痛、功能缺失、畸形及其他一系列并发症。目前临床上针对股骨干骨折术后骨不连的治疗方法较多,主要包括:髓内钉动力化、扩髓更换髓内钉、保留原髓内钉附加钢板、双钢板以及Ilizarov外固定架等。但仍存在血供破坏严重、下肢易短缩、成功率低、适应症狭窄等问题。目的本课题利用有限元模拟生物力学分析的研究方法,从生物力学角度对比单外侧钢板、两种不同角度双钢板(180°、90°)以及髓内钉附加钢板治疗股骨干骨折骨不连的力学稳定性,从而为临床上治疗股骨干骨折及术后骨不连提供生物力学证据,指导临床治疗和术后康复。方法1、重建人工股骨的三维模型,建立股骨干骨折骨不连模型。2、建立单外侧钢板、两种不同角度双钢板(180°、90°)以及髓内钉附加钢板模型。3、将骨折模型和内固定模型进行匹配、三角面片网格划分、材料赋值等有限元前处理过程。4、模型装配、接触面定义、设置边界条件和载荷,进行有限元模拟生物力学分析。5、对有限元分析数据进行解读。6、临床初步观察结果1、四种固定模型下最大应力值从大到小排序:单外侧钢板模型髓内钉附加钢板模型90°双钢板模型180°双钢板模型。单外侧钢板模型最大应力值为2506Mpa,髓内钉附加钢板模型最大应力值为1945Mpa,90°双钢板模型最大应力值为1001Mpa, 180°双钢板模型最大应力值为324Mpa。 2、四种固定模型下内翻成角稳定性比较从大到小依次为:180°双钢板模型髓内钉附加钢板模型 90°双钢板模型单外侧钢板模型。180°双钢板模型下骨折块角度为0.4°,内固定角度为0.8°;髓内钉附加钢板模型下骨折块角度为0.9°,内固定角度为0.8°; 90°双钢板模型下骨折块角度为2.7°,内固定角度为3.2°;单外侧钢板模型下骨折块角度为11.3°,内固定角度为14.6°。3、四种固定模型下旋转成角稳定性比较从大到小依次为:180°双钢板模型90°双钢板模型髓内钉附加钢板模型=单外侧钢板模型。180°双钢板模型下旋转成角0.2°,90°双钢板模型下旋转成角0.9°,髓内钉附加钢板模型下旋转成角1.2°,单外侧钢板模型下旋转成角1.2°。结论1、180°双钢板模型与其他内固定方法相比具有更强的稳定性。在应力大小及旋转成角稳定性上90°双钢板优于髓内钉附加钢板;在内翻成角稳定性方面,髓内钉附加钢板强于90°双钢板,因此我们推断二者在股骨干骨不连的治疗上效果相似。2、双钢板结合植骨治疗股骨干骨不连具有高愈合率及低并发症率的特点,尤其适用于缺乏内侧支撑蝶形骨块的患者,有助于患者早期下地活动,最大限度恢复患肢正常功能,疗效满意,值得推广。
[Abstract]:Background femoral shaft fracture is one of the common clinical fractures, most of them can be cured by correct treatment, but some patients still have nonunion due to various reasons. Nonunion is a major complication of femoral shaft fractures, leading to pain, loss of function, deformities, and a range of other complications. At present, there are many clinical treatment methods for nonunion after femoral shaft fracture, including: intramedullary nail dynamics, reaming and replacement of intramedullary nail, retaining the original intramedullary nail attached plate, double plate and Ilizarov external fixator, etc. However, there are still some problems, such as serious blood supply destruction, easy shortening of lower extremities, low success rate and narrow indications. Objective to compare the biomechanical stability of single lateral plate, two different angles of double plate (180 掳~ 90 掳) and intramedullary nail plus plate in the treatment of femoral shaft fracture nonunion by means of finite element simulation biomechanical analysis. It can provide biomechanical evidence for the treatment of femoral shaft fracture and postoperative nonunion, and guide clinical treatment and postoperative rehabilitation. Methods 1. The 3D model of artificial femur was reconstructed, and the fracture nonunion model was established. The single lateral plate, two different angles of double plate with 180 掳or 90 掳) and the intramedullary nail plus plate model were established. The fracture model and the internal fixation model were matched. Pre-processing process of finite element, such as triangulation, material assignment, etc., model assembly, interface definition, boundary condition and load setting, Do finite element simulation biomechanical analysis .5, analyze the data of finite element analysis .6. clinical preliminary observation results 1, the maximum stress value of four fixed models from large to small order: single lateral steel plate model intramedullary nail attached steel plate mold Type 90 掳double steel plate model 180 掳double plate model. The maximum stress value of single-lateral steel plate model was 2506Mpa. the maximum stress value of intramedullary nail attached plate model was 1945Mpa90 掳double plate model was 1001Mpa. the maximum stress value of 180 掳double-plate model was 324Mpa. Comparison of the stability of inversion angle under four fixation models: 1: 180 掳double plate model intramedullary nail additional plate model 90 掳double plate model single lateral steel plate model .180 掳double plate model fracture block angle 0.4 掳, internal fixation The angle is 0.8 掳, the angle of fracture block is 0.9 掳and the angle of internal fixation is 0.8 掳under the model of intramedullary nail plus plate, the angle of fracture block is 2.7 掳and the angle of internal fixation is 3.2 掳under 90 掳double plate model, the angle of fracture block is 11.3 掳and the angle of internal fixation is 11.3 掳under the model of single lateral plate. Comparison of rotation angular stability under four fixed models: 180 掳double plate model 90 掳double plate model intramedullary nail additional plate model = single lateral plate model .180 掳double plate model rotation 0.2 掳angle 90 掳double plate model The angle of rotation was 0.9 掳under the model of intramedullary nail, 1.2 掳in the model of intramedullary nail and 1.2 掳in the model of single lateral plate. Conclusion 1180 掳double plate model is more stable than other internal fixation methods. The stability of 90 掳double plate is better than that of intramedullary nail plate in stress magnitude and rotation angle stability, and that of intramedullary nail attached plate is stronger than that of 90 掳double plate. Therefore, we infer that the results of treatment of femoral shaft nonunion are similar. The double plate combined with bone graft has the characteristics of high healing rate and low complication rate, especially for patients lacking medial support butterfly bone mass. It is helpful for the patients to get down early and restore the normal function of the affected limb to the maximum extent, and the curative effect is satisfactory, which is worth popularizing.
【学位授予单位】：中国人民解放军医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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