摘要
[目的]以有限元分析方法探讨钢板固定Sanders Ⅳ型跟骨骨折的力学效果,并比较解剖型钢板与锁定钢板固定关节内跟骨骨折的效果。[方法]建立SandersⅣ型跟骨骨折模型分别以解剖型加压钢板和锁定钢板内固定三维有限元模型,研究不同内固定的von Mises应力分布、跟骨的von Mises应力分布、位移并比较跟骨及内固定模型应力峰值,分析骨折固定后生物力学稳定性。[结果]解剖型加压钢板固定的有限元模型骨端应力分布均匀,各部分最大应力值小于锁定钢板;解剖型钢板应力集中部位为钢板中后部,锁定钢板应力集中于钢板螺钉连接处;骨折端各部分位移差异较大,其中载距突位移最大。[结论]切开复位钢板内固定治疗SandersⅣ型跟骨骨折,关节内碎骨快可随足部负重而产生不同程度移位,存在较高创伤性关节炎的风险,建议采用一期外固定二期关节融合治疗;锁定钢板与解剖型加压钢板治疗关节内跟骨骨折各具优势,需要将二者的优势结合起来提高内固定的疗效。
[ Objective ] To explore the biomechanical properties of Sanders type 4 calcaneus fracture fixed with conventional or locking plates through finite element analysis （ FEA ） , and therefore to compare the biomechanical characteristics between these two plates. [ Method] Three-dimentional FE model of the Sanders type 4 calcaneus fracture with different fixations were developed. The different fixations were compared for Von Mises distribution, and the von Mises distribution of the calcaneus and the maxim stress and displacement on the plate and bone respectly. [ Result] The stress distribution on the bone was well-pro- portioned with fracture fixed with conventional plate compared with locking plate. The highest stress concentration area was in posterior segment of conventional plate and screw locking hole of locking plate. There was a significant difference of displacement between each bone fragment and highest in sustentaculum tali. [ Conclusion] Due to the significant difference in the displacement between each bone fragment fixed with plate and screws,it is suggested that primary external fixation followed by subtalar fusion is a good choice in treating patients with Sanders type 4 calcaneus fractures. It is necessary to combine the benefit of both plate together to achieve better clinical outcome.
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2013年第6期602-607,共6页
Orthopedic Journal of China
基金
国家自然科学基金资助项目(编号:81071233)
