CAJ | 학술논문

目的使用有限元法分析比较螺钉、管型钢板、3孔T型钢板固定治疗后踝骨折的生物力学稳定性.方法取1名23岁男性健康志愿者的足踝CT数据进行三维重建,建立带有周围韧带的踝关节有限元模型并进行有效性验证,将模型导入Solidworks软件中根据相关文献的方法制作后踝骨折三维模型.根据临床上常用的后踝骨折内固定方式建立螺钉、1/4管型钢板、3孔T型钢板的内固定模型,相同条件下分别对内固定模型行中立位负载加载、外旋负载加载和跖屈负载加载,计算各模型的骨折块移位程度和内固定系统Von Mises应力分布等情况.结果中立负载和外旋负载作用下,与1/4管型钢板和螺钉固定相比,3孔T型钢板固定时骨折块移位程度最小;且与螺钉固定相比,1/4管型钢板与3孔T型钢板钉固定能明显减小骨折块的垂直方向移位.跖屈负载下,3种固定方式的骨折块移位程度相似.在所有负载方式下,3种固定方式的内固定模型和内固定周围骨质峰值VonMises应力接近.结论相比于螺钉和1/4管型钢板,3孔 T型钢板固定后踝骨折模型的稳定性指标更好,1/4管型钢板和3孔T型钢板比螺钉能更好地防止骨折块向上移位.
목적 사용유한원법분석비교라정、관형강판、3공T형강판고정치료후과골절적생물역학은정성.방법 취1명23세남성건강지원자적족과CT수거진행삼유중건,건립대유주위인대적과관절유한원모형병진행유효성험증,장모형도입Solidworks연건중근거상관문헌적방법제작후과골절삼유모형.근거림상상상용적후과골절내고정방식건립라정、1/4관형강판、3공T형강판적내고정모형,상동조건하분별대내고정모형행중립위부재가재、외선부재가재화척굴부재가재,계산각모형적골절괴이위정도화내고정계통Von Mises응력분포등정황.결과 중립부재화외선부재작용하,여1/4관형강판화라정고정상비,3공T형강판고정시골절괴이위정도최소;차여라정고정상비,1/4관형강판여3공T형강판정고정능명현감소골절괴적수직방향이위.척굴부재하,3충고정방식적골절괴이위정도상사.재소유부재방식하,3충고정방식적내고정모형화내고정주위골질봉치VonMises응력접근.결론 상비우라정화1/4관형강판,3공 T형강판고정후과골절모형적은정성지표경호,1/4관형강판화3공T형강판비라정능경호지방지골절괴향상이위.
Objective To compare the tube plate,T-plate and screws in fixation of posterior malleolar fracture in terms of biomechanical stability.Methods The CT data of the ankle obtained from a normal male volunteer was used to make a three-dimensional reconstruction by software mimics 14.0 and geomagic 2012.After we built a three-dimensional finite element model of the ankle along with its stimulated ligaments in software ANSYS,the validity of the model was verified.The model of posterior malleolar fracture was cut from the posteromedial point of the tibia to the one-fourth point of the distance from the posterior to the anterior margin in the software Solidworks 2012.Models of screws,1/4 tube plate and T-plate were also constructed in Solidworks 2012.According to the established method in the literature,2 screws,a 1/4 tube plate and a T-plate were applied respectively.Under the same neutral weight bearing,the flexion and external loadings,the fragmental displacement,the stresses of fracture and fixation were calculated by finite element analysis.Results Under neutral or external loading,T-plate fixation caused the smallest fragmental displacement compared with the other 2 fixations and the 2 plate fixations caused a smaller displacement in Z-axis under neutral loading than screws fixation.However,similar displacements were identified in all fixations under flexion loading.Under all loading conditions,excessive concentration of the stress was not observed.Conclusions T-plate shows a better biomechanical stability than 1/4 tube-plate and screws while plating reduces the upward displacement than screws.All the 3 fixations show no obvious excessive concentration of the stress.