CAJ | 학술논문

目的探讨载距突螺钉内固定在SandersⅡ型跟骨骨折治疗中的作用及必要性.方法将跟骨CT扫描后的Dicom数据输入Mimics 12.0软件及Ansys 13.0软件中构建跟骨三维有限元数字模型.而后,将此模型导人Solidworks 2010软件中,根据Sanders分型切割跟骨,建立SandersⅡ型跟骨骨折模型.将AO跟骨钢板及螺钉的几何参数输入Solidworks 2010软件中,在跟骨模型的基础上建立两种内固定模拟,一种为钢板放于跟骨外侧面,在钢板后关节面下方2枚螺钉孔、钢板后方2枚螺钉孔、钢板下方1枚螺钉孔、钢板前方2枚螺钉孔分别垂直跟骨打入松质骨螺钉；另一种为在前一种固定方式的基础上再在钢板后关节面最下方螺钉孔向载距突打入1枚皮质骨螺钉.在相同条件下分别对两种内固定模型加载,行非线性有限元分析,分别计算两种内固定模型的应力分布情况.结果在相同条件的加载下两种内固定跟骨模型的最大主应力均集中于载距突皮质骨,载距突螺钉内固定模型在骨缝间位移值、跟骨最大主应力值、钢板螺钉内固定系统的最大主应力值方面均较无载距突螺钉内固定模型小,且应力更分散.结论载距突螺钉内固定治疗跟骨骨折符合生物力学稳定性,可很好地用于临床.
목적 탐토재거돌라정내고정재SandersⅡ형근골골절치료중적작용급필요성.방법 장근골CT소묘후적Dicom수거수입Mimics 12.0연건급Ansys 13.0연건중구건근골삼유유한원수자모형.이후,장차모형도인Solidworks 2010연건중,근거Sanders분형절할근골,건립SandersⅡ형근골골절모형.장AO근골강판급라정적궤하삼수수입Solidworks 2010연건중,재근골모형적기출상건립량충내고정모의,일충위강판방우근골외측면,재강판후관절면하방2매라정공、강판후방2매라정공、강판하방1매라정공、강판전방2매라정공분별수직근골타입송질골라정；령일충위재전일충고정방식적기출상재재강판후관절면최하방라정공향재거돌타입1매피질골라정.재상동조건하분별대량충내고정모형가재,행비선성유한원분석,분별계산량충내고정모형적응력분포정황.결과 재상동조건적가재하량충내고정근골모형적최대주응력균집중우재거돌피질골,재거돌라정내고정모형재골봉간위이치、근골최대주응력치、강판라정내고정계통적최대주응력치방면균교무재거돌라정내고정모형소,차응력경분산.결론 재거돌라정내고정치료근골골절부합생물역학은정성,가흔호지용우림상.
Objective To explore the necessity and function of the sustentaculum tali screw placement for the treatment of Sanders type Ⅱ calcaneal fracture.Methods The data of Dicom that CT scan with bone was input into Mimics 12.0 software and Ansys 13.0 software for construction of calcaneus three-dimensional finite element model.Then,this model was imported into Solidworks 2010 software.Type Ⅱ calcaneal fracture model was established according to Sanders type cutting of calcaneus.Geometric parameters of AO calcaneal plate and screws were imported to the Solidworks 2010 software.Two internal fixation simulations were established based on the calcaneal model.In one model,the steel was placed on the outside with bone and the cancellous' bone screws were infiltrated respectively into the vertical bone since two screw holes which under the articular surface behind the steel plate,two screw holes which rear of the steel plate,a screw hole of the below calcaneus,two screw holes which in front of steel plate.In another model,a cortical bone screw was infiltrated into the sustentaculum tali through the bottom screw hole of articular surface of the steel plate.The two internal fixation models were loaded under the same condition,and non linear finite element analysis was carried out.The stress distribution in the two internal fixation models was calculated respectively.Results The maximum principal stress focused on the cortical bone of sustentaculum tali in both of the models under the same condition of loading.Bone joint displacement,maximum principal stress of calcaneal and internal fixation system in the model with sustentaculum screw fixation were smaller than that in the model without sustentaculum screw fixation.The stress in the model with sustentaculum screw fixation was more dispersed.Conclusion The placement of sustentaculum tali screw is essential for fixation of type Ⅱ calcaneal fracture to achieve the biomechanical stability and can be used in clinical.