CAJ | 학술논문

目的比较髋臼双柱骨折4种内固定方法在不同载荷下的生物力学特点.方法利用CT图像,建立左侧髋臼双柱骨折三维有限元模型.比较四边区十字钢板、后路双重建钢板、髋臼三柱空心螺钉、新型解剖钢板固定,模拟上半身重量约60 kg坐位、向左转身、向右转身时的受力,施加600N的垂直载荷,向左旋转及向右旋转方向分别施加8 N/M的扭矩,时长1 s,Von Mises应力公式分析内固定的受力.结果 (1)垂直载荷及向左旋转工况下,应力峰值为:解剖板＞十字板＞后路双板＞三柱钉,向右旋转工况为:十字板＞解剖板＞后路双板＞三柱钉.(2)坐位向右转身,四边区十字板位于髂窝臼顶区域的位移最大,耻骨结节处的螺钉应力最大.(3)坐位向左转身,臼顶区域的后路双板内侧钢板近端应力及位移最大,臼顶内上方区域的髋臼后柱螺钉应力最大,髂后上嵴区域的横向双柱钉位移最大.位移峰值为:十字板＞解剖板＞后路双板＞三柱钉.结论三柱钉固定最稳定,解剖板应力分布较均匀,稳定性与后路双重建钢板相似.钢板固定时,应避免与拧人螺钉反方向的转身动作,减少内植物变形、松动滑脱、断裂、复位丢失等并发症.
목적 비교관구쌍주골절4충내고정방법재불동재하하적생물역학특점.방법 이용CT도상,건립좌측관구쌍주골절삼유유한원모형.비교사변구십자강판、후로쌍중건강판、관구삼주공심라정、신형해부강판고정,모의상반신중량약60 kg좌위、향좌전신、향우전신시적수력,시가600N적수직재하,향좌선전급향우선전방향분별시가8 N/M적뉴구,시장1 s,Von Mises응력공식분석내고정적수력.결과 (1)수직재하급향좌선전공황하,응력봉치위:해부판＞십자판＞후로쌍판＞삼주정,향우선전공황위:십자판＞해부판＞후로쌍판＞삼주정.(2)좌위향우전신,사변구십자판위우가와구정구역적위이최대,치골결절처적라정응력최대.(3)좌위향좌전신,구정구역적후로쌍판내측강판근단응력급위이최대,구정내상방구역적관구후주라정응력최대,가후상척구역적횡향쌍주정위이최대.위이봉치위:십자판＞해부판＞후로쌍판＞삼주정.결론 삼주정고정최은정,해부판응력분포교균균,은정성여후로쌍중건강판상사.강판고정시,응피면여녕인라정반방향적전신동작,감소내식물변형、송동활탈、단렬、복위주실등병발증.
Objective To compare the biomechanical properties of four kinds of internal fixation techniques for acetabular both columns fractures.Methods A three-dimensional finite element model of left acetabular both-column fracture was established according to pelvic computed tomography (CT) images and photo software.Four kinds of internal fixation techniques,including quadrilateral double plates,posterior double reconstruction plates,acetabular three-column canulated screws,new anatomical plate were performed separately by the three-dimensional finite element model.These four models were put into Abaqus finite element program,axial load 600 N on vertical compression,and 8 N/M (1 S) torque were loaded on left rotation,right rotation respectively to study the corresponding stress and displacement using the Von Mises stress formula,in order to simulate the force conditions of human body seated positions,turning left and turning right.Results (1) Under vertical compression and left rotation,the peak value of stress concentration were:new anatomical plate ＞ quadrilateral double plates ＞ posterior double reconstruction plates ＞ three cannulated screws.Under vertical compression and right rotation,the peak value of stress concentration were:quadrilateral double plates ＞ new anatomical plate ＞ posterior double reconstruction plates ＞ three cannulated screws.(2) When turing right,anterior plates located at acetabular dome region had the maximal displacement,with the screws located at pubic symphsis had the maximal stress.(3) When turing left,posterior medial plate located at acetabular dome region had the maximal stress and displacement.When turing left,posterior acetabular screw located at acetabular dome region had the maximum stress,both-column screw located at posterior superior iliac spine region had the maximum displacement.Conclusion Among these four types of internal fixation,the most stable technique is acetabular three-column cannulated screws fixation.With plate fixation,either anterior or posterior fixation,turning action in the opposite orientation of inserting screws should be avoided in order to lower the stress stimulation on the plate and screws,reduce the complication of implantation distortion,loosening,slippage,disruption and reduction loss.