| 双前皮下内固定支架与前皮下内固定支架联合骶髂螺钉固定骨盆C1型骨折的稳定性比较 |
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投稿时间：2024-07-08
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| 作者 | Author | 单位 | Address | E-Mail |
| 崔栋清 |
CUI Dong-qing |
山西医科大学第二临床医学院, 山西 太原 030001 |
The Second Clinical Medical College, Shanxi Medical University, Taiyuan 030001, Shanxi, China |
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| 卫锦杰 |
WEI Jin-jie |
山西医科大学第二临床医学院, 山西 太原 030001 |
The Second Clinical Medical College, Shanxi Medical University, Taiyuan 030001, Shanxi, China |
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| 孙海钰 |
SUN Hai-yu |
山西医科大学第二医院骨科, 山西 太原 030001 |
Department of Orthopaedics, the Second Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi, China |
shy1995@126.com |
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| 期刊信息：《中国骨伤》2024年，第37卷，第11期，第1107-1113页 |
| DOI：10.12200/j.issn.1003-0034.20240300 |
| 基金项目: |
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中文摘要:
目的: 通过有限元分析法评估双前皮下内固定支架(anterior subcutaneous internal fixation,INFIX)在骨盆C1型骨折中的生物力学稳定性,并与INFIX联合骶髂螺钉比较判断其是否足够替代前后环联合固定。
方法: 将1名43岁女性志愿者的骨盆CT数据导入至计算机并使用Mimics、Workbench等软件构建正常骨盆模型和骨盆C1型骨折模型,并对后者分别使用双INFIX和INFIX联合骶髂螺钉进行固定,首先验证正常骨盆模型在解剖标志和应力传导及位移分布上的有效性,然后对两种内固定模型施加500 N垂直向下的载荷力并分别模拟人体站立位和坐位,采集前后环骨折端的位移、内固定的应力及骨质中钉道的应力等数据。
结果: 模型通过了有效性验证。站立位双INFIX组的前环和后环骨折最大移位分别为0.861 mm和4.128 mm,均大于联合固定组的0.152 mm和0.293 mm;坐位双INFIX组的后环骨折移位是3.757 mm,大于联合固定组的0.560 mm,而前环骨折最大位移是0.221 mm与联合固定组的0.194 mm差距不大。站立位双 INFIX组内固定最大应力大于联合固定组,坐位则相反,各内固定最大应力均低于钛合金的屈服强度790 MPa。站立位和坐位双INFIX 组的钉道最大应力均小于联合固定组,所有钉道应力均低于骨质的强度极限290~540 MPa。
结论: 前后环骨折中双INFIX固定的稳定性整体上不如INFIX联合骶髂螺钉固定,单纯的双INFIX固定虽能为后环分担一部分负荷,但后环依旧会产生较大的移位,因此后环的固定很重要。此外,双INFIX在前环的固定强度和稳定性要优于INFIX,当INFIX不能提供足够的强度来稳定前环骨折时,双INFIX将是一种很好的选择。 |
| 【关键词】前后环骨折 前皮下内固定 骶髂螺钉 有限元分析 |
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| Comparison of the stability of dual INFIX and INFIX combined with sacroiliac screw fixation for C1 type pelvic fractures |
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ABSTRACT
Objective To evaluate the biomechanical stability of dual anterior subcutaneous internal fixation (INFIX) in pelvic C1 fractures by finite element analysis,and to compare it with INFIX combined with sacroiliac screws to determine whether it is sufficient to replace the combined fixation of anterior and posterior rings.
Methods The pelvic CT data of a 43-year-old female volunteer were imported into the computer and the normal pelvic model and pelvic C1 fractures model were constructed using Mimics,Workbench and other software. The latter was fixed with dual INFIX and INFIX combined with sacroiliac screws,respectively. First,the effectiveness of the normal pelvic model in anatomical landmarks,stress conduction and displacement distribution was verified. Then,a vertical downward load of 500 N was applied to the two internal fixation models to simulate the standing and sitting positions of the human body,and the displacement of the anterior and posterior ring fractures ends,the stress of the internal fixation and the stress of the nail channel in the bone were collected.
Results The model passed the validity verification. The maximum displacement of the anterior and posterior ring fractures in the standing dual INFIX group were 0.861 mm and 4.128 mm,respectively,which were both smaller than the 0.152 mm and 0.293 mm in the combined fixation group. The displacement of the posterior ring fractures in the sitting dual INFIX group was 3.757 mm,which was larger than the 0.560 mm in the combined fixation group,while the maximum displacement of the anterior ring fractures was 0.221 mm,which was not much different from the 0.194 mm in the combined fixation group. The maximum stress of internal fixation in the standing dual INFIX group was greater than that in the combined fixation group,while the opposite was true in the sitting position. The maximum stress of each internal fixation was lower than the yield strength of titanium alloy 790 MPa. The maximum stress of the nail channel in the standing and sitting daul INFIX groups was lower than that in the combined fixation group,and the stress of all nail channels was lower than the strength limit of bone 290 to 540 MPa.
Conclusion The stability of dual INFIX fixation in anterior and posterior ring fractures is generally inferior to that of INFIX combined with sacroiliac screw fixation. Although simple dual INFIX fixation can share part of the load for the posterior ring,the posterior ring will still have a large displacement,so the fixation of the posterior ring is very important. In addition,the fixation strength and stability of dual INFIX in the anterior ring are better than INFIX. When INFIX cannot provide sufficient strength to stabilize the anterior ring fractures,dual INFIX will be a good choice. |
| KEY WORDS Anterior and posterior ring fractures Anterior subcutaneous internal fixation Sacroiliac screws Finite element analysis |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 崔栋清,卫锦杰,孙海钰.双前皮下内固定支架与前皮下内固定支架联合骶髂螺钉固定骨盆C1型骨折的稳定性比较[J].中国骨伤,2024,37(11):1107~1113 |
| 英文格式: | CUI Dong-qing,WEI Jin-jie,SUN Hai-yu.Comparison of the stability of dual INFIX and INFIX combined with sacroiliac screw fixation for C1 type pelvic fractures[J].zhongguo gu shang / China J Orthop Trauma ,2024,37(11):1107~1113 |
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