五种内固定方式固定髋臼后柱骨折的三维有限元对比研究

发布时间：2019-01-14 08:09

【摘要】：背景:随着现代社会交通事故、高处坠落伤等的增加,使髋臼骨折的发生与日俱增。髋臼解剖位置深在,结构复杂,保守治疗效果差,手术治疗难度大,若治疗方式选择不当,术后发生并发症的概率较高。因此,髋臼骨折的治疗异常重要。目前临床上主张积极手术治疗,切开复位内固定的方式已成为治疗髋臼骨折的首选方案。髋臼结构复杂,有学者将其领近结构分为前柱和后柱,后柱为髋臼骨折常累及的部位。临床上单纯的髋臼后柱骨折不常见,多为伴有前柱骨折的双柱骨折,手术中使用前后联合入路治疗髋臼双柱骨折无外乎会增加患者的创伤,不利于术后恢复。近年来,改良Stoppa入路作为传统髂腹股沟入路的良好补充得到广泛应用,有学者采用改良Stoppa入路治疗前柱骨折的同时,在后柱骨盆内面坐骨大切迹移形处及与坐骨相连的髂骨部分放置预弯的接骨板来固定后柱,效果良好。因其一端固定于髂骨,一端固定于坐骨,且钢板位于后柱前方,为与后髂坐钢板(常规后柱钢板)区分,本文使用内髂坐钢板将其命名,但目前国际社会上对于内髂坐钢板尚无生物力学分析评价其稳定性。目的:利用计算机分析软件,建立骨盆三维有限元模型并验证其有效性。在有限元模型基础上,建立包括内髂坐钢板在内共5种内固定方式模型,模拟站立及坐位下,其对髋臼后柱骨折固定的生物力学特点,为临床提供依据。方法:1、选取1例健康女性志愿者行CT扫描,将数据以DICOM格式导入Mimics15.0软件生成骨盆三维模型,经有限元前处理软件处理后导入有限元分析软件ANSYS中,添加韧带附属结构,建立骨盆三维有限元模型并验证其有效性。2、应用软件生成后柱骨折模型,建立5种内固定模型,对模型行应力加载,分析评价其应力位移分布、关节面骨折线的位移、髋臼整体刚度等。3、使用t检验行统计学处理,P0.05表示结果有统计学差异。结果:站立位时后髂坐钢板、内髂坐钢板、顺行拉力螺钉、经坐骨结节逆行拉力螺钉和经坐骨小切迹逆行拉力螺钉的骨折线位点平均位移为(6.13± 1.04)m、(7.08±0.24)μm、(7.85±0.88)μm、(6.85±0.42)μm、(7.07±0.49)μm;坐位其平均位移分别为(7.77±1.0)μm、(9.65±0.83)μm、(9.69±1.12)μm、(10.2±0.37)μm、(10.1 ±0.51)μm。钢板固定和螺钉固定的结果之间有统计学差异(P0.05),而坐位时,内髂坐钢板与螺钉内固定结果无统计学差异,但其平均位移明显小于螺钉内固定。结论:内髂坐钢板及后髂坐钢板固定后柱骨折稳定性较空心螺钉具有优势,可应用于临床,具体情况需结合临床及个体情况而定。
[Abstract]:Background: with the increase of traffic accidents and falling injuries in modern society, the incidence of acetabular fractures is increasing day by day. The acetabular anatomical position is deep, the structure is complex, the conservative treatment effect is poor, the surgical treatment is difficult, if the treatment method is not proper, the probability of postoperative complications is higher. Therefore, the treatment of acetabular fractures is extremely important. At present, active surgical treatment and open reduction and internal fixation have become the first choice in the treatment of acetabular fractures. The acetabular structure is complex. The proximal structure of acetabular is divided into anterior column and posterior column, and the posterior column is often involved in acetabular fracture. Clinical simple acetabular posterior column fractures are uncommon, most of them are double-column fractures with anterior column fractures. The use of combined anterior and posterior approach in the treatment of acetabular double-column fractures will increase the trauma of patients, which is not conducive to postoperative recovery. In recent years, the modified Stoppa approach has been widely used as a good supplement to the traditional ilioinguinal approach. Some scholars have used the modified Stoppa approach to treat anterior column fractures. The posterior column was fixed with precurved plates at the position of the great notch of the ischium on the inner side of the posterior column and the iliac bone associated with the ischium. Because its one end is fixed in the iliac bone and the other in the ischium, and the steel plate is located in the front of the posterior column, in order to distinguish it from the posterior iliac plate (conventional posterior column plate), this paper uses the internal iliac plate to name it. However, there is no biomechanical analysis to evaluate the stability of the internal iliac plate in the international community. Objective: to establish a three-dimensional finite element model of pelvis by computer software and verify its validity. Based on the finite element model, five internal fixation models, including internal iliac plate, were established to simulate the biomechanical characteristics of acetabular posterior column fracture fixation under standing and sitting position. Methods: 1. A healthy female volunteer was selected to perform CT scanning. The data were imported into Mimics15.0 software to generate three dimensional model of pelvis in DICOM format. The data were processed by finite element preprocessing software and imported into the finite element analysis software ANSYS to add ligamentum appendage structure. The three-dimensional finite element model of pelvis was established and its validity was verified. 2. The posterior column fracture model was created by software. Five kinds of internal fixation models were established, and the stress displacement distribution of the model was analyzed and evaluated, and the displacement of the fracture line of the articular surface was analyzed and evaluated. Acetabular stiffness, etc. 3, using t test for statistical processing, P0.05 indicated that the results were statistically different. Results: the average displacement of the fracture line of the posterior iliac plate, the internal iliac plate, the anterograde pull screw, the retrograde lag screw through the ischium tubercle and the retrograde lag screw through the small notch of the ischium was (6.13 卤1.04) m, when standing, the average displacement of the fracture line was (6.13 卤1.04) m. (7.08 卤0.24) 渭 m, (7.85 卤0.88) 渭 m, (6.85 卤0.42) 渭 m, (7.07 卤0.49) 渭 m; The average displacement in sitting position was (7.77 卤1.0) 渭 m, (9.65 卤0.83) 渭 m, (9.69 卤1.12) 渭 m, (10.2 卤0.37) 渭 m, (10.1 卤0.51) 渭 m respectively. There was statistical difference between the results of plate fixation and screw fixation (P0.05), but there was no significant difference between the results of internal fixation of internal iliac plate and screw in sitting position, but the average displacement was significantly smaller than that of screw fixation. Conclusion: internal iliac plate and posterior iliac plate are superior to hollow screw in the stability of posterior column fracture.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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