| 肱骨距螺钉尖顶距对肱骨近端骨折接骨板固定稳定性影响的有限元分析 |
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投稿时间：2023-10-10
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| 作者 | Author | 单位 | Address | E-Mail |
| 周晨 |
ZHOU Chen |
泰州市姜堰中医院骨伤科, 江苏 泰州 225599 |
Department of Orthopaedics, Jiangyan Hospital of Traditional Chinese Medicine, Taizhou 225599, Jiangsu, China |
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| 陈成 |
CHEN Cheng |
泰州市姜堰中医院骨伤科, 江苏 泰州 225599 |
Department of Orthopaedics, Jiangyan Hospital of Traditional Chinese Medicine, Taizhou 225599, Jiangsu, China |
ccorthopaedics@163.com |
| 曹瑞 |
CAO Rui |
泰州市姜堰中医院骨伤科, 江苏 泰州 225599 |
Department of Orthopaedics, Jiangyan Hospital of Traditional Chinese Medicine, Taizhou 225599, Jiangsu, China |
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| 郭宏网 |
GUO Hong-wang |
泰州市姜堰中医院骨伤科, 江苏 泰州 225599 |
Department of Orthopaedics, Jiangyan Hospital of Traditional Chinese Medicine, Taizhou 225599, Jiangsu, China |
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| 黄陈翼 |
HUANG Chen-yi |
西南医科大学附属中医医院骨伤科, 四川 泸州 646000 |
Department of Orthopaedics and Traumatology, Affiliated Hospital of Traditional Chinese Medicine, Southwest Medical University, Luzhou 646000, Sichuan, China |
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| 严亮 |
YAN Liang |
泰州市姜堰中医院骨伤科, 江苏 泰州 225599 |
Department of Orthopaedics, Jiangyan Hospital of Traditional Chinese Medicine, Taizhou 225599, Jiangsu, China |
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| 薛卫华 |
XUE Wei-hua |
泰州市姜堰中医院骨伤科, 江苏 泰州 225599 |
Department of Orthopaedics, Jiangyan Hospital of Traditional Chinese Medicine, Taizhou 225599, Jiangsu, China |
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| 期刊信息：《中国骨伤》2024年，第37卷，第12期，第1202-1207页 |
| DOI：10.12200/j.issn.1003-0034.20230590 |
| 基金项目:泰州市科技局项目(编号:TS202227) |
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中文摘要:
目的: 通过有限元分析距螺钉尖顶距变化对肱骨近端骨折模型肱骨近端锁定钢板(proximal humeral internal locking system,PHILOS)固定稳定性的影响,以期为术中内植物尺寸的选择提供参考。
方法: 在三维工程制图软件中基于Synbone人工骨模型构建肱骨近端三维模型,并基于PHILOS钢板轮廓构建相应三维模型。通过修改模型模拟肱骨近端粉碎性骨折,并对骨折后模型进行术式模拟,完成固定手术模型装配,分别将肱骨距螺钉的尖顶距设定为4、8、12、16 mm。在垂直向下和20°外展条件下分别加载轴向载荷和扭转载荷完成分析求解,在相应工况下分别计算不同模型的肱骨头最大位移、肱骨头皮质骨及松质骨的峰值应力,以评估螺钉尖顶距变化对PHILOS钢板固定术后肱骨头内翻风险的影响。
结果: 肱骨头的峰值位移未随距螺钉尖顶距增大而普遍上升。相反,随着距螺钉尖顶距的逐渐增大,各工况下肱骨头的峰值位移均出现了轻度的下降。在20°外展的情况下,各模型肱骨头最大位移均明显高于垂直加载时的肱骨头最大位移。同时,距螺钉尖顶距的延长未导致术后肱骨头的显著应力集中。松质骨峰值应力随着肱骨距螺钉尖顶距的延长而逐渐降低,皮质骨的峰值应力呈先上升后下降的趋势,在尖顶距为12 mm时,皮质骨在各工况下的峰值应力最大,后随着尖顶距进一步延长而降低。
结论: 在肱骨头交叉锁定螺钉尖顶距<4 mm的情况下,增大肱骨距螺钉尖顶距不会导致PHILOS钢板固定术后稳定性的显著丢失和术后并发症发病风险的明显上升。 |
| 【关键词】肱骨近端锁定钢板 尖顶距 肱骨头交叉螺钉 肱骨距螺钉 |
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| Finite element analysis of influence of humerus torque screw tip distance on stability of proximal humeral fracture plate fixation |
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ABSTRACT
Objective To explore changes of humerus torque screw tip distance on stability of proximal humeral internal locking system (PHILOS) by finite element analysis,in order to provide reference for selection of intraoperative plant size.
Methods The proximal humerus 3D model was constructed based on Synbone artificial bone model in 3D engineering drawing software,and the corresponding 3D model was constructed based on PHILOS bone plate contour. The model was modified to simulate comminuted proximal humerus fracture,and the operation model was simulated after fracture,and the fixed operation model was assembled,the apex distance of humerus moment screw was set as 4,8,12 and 16 mm respectively. The axial and torsional loads were applied under the conditions of vertical downward and 20° abduction respectively,and the maximum displacement of humeral head and the peak stress of cortical bone and cancellous bone of humeral head were calculated under the corresponding working conditions,respectively,to evaluate influence of screw tip distance change on the risk of humeral head varus after PHILOS plate fixation.
Results The peak displacement of humerus head did not generally increase with the increase of torque screw tip distance. On the contrary,the peak displacement of humerus head decreased slightly in all working conditions with the gradual increase of torque screw tip distance. At 20° abduction,the maximum displacement of humerus head was significantly higher in all models than that under vertical loading. At the same time,the lengthening of tip distance of torque screw did not lead to significant stress concentration of the humerus head after operation. The peak stress of cancellous bone decreased gradually with the extension of the peak distance of humerus moment screw,while the peak stress of cortical bone increased first and then decreased. When the peak distance was 12 mm,the peak stress of cortical bone was the largest under all working conditions,and then decreased with the further extension of the peak distance.
Conclusion In the case of a small humeral head interlocking screw tip distance(less than 4 mm),increasing the humeral torque screw tip distance does not lead to a significant loss of stability after PHILOS plate fixation and a significant increase in the risk of postoperative complications. |
| KEY WORDS Proximal humeral internal locking systerm Tip-apex distance Humeral calcar screw Humerus torque screw |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 周晨,陈成,曹瑞,郭宏网,黄陈翼,严亮,薛卫华.肱骨距螺钉尖顶距对肱骨近端骨折接骨板固定稳定性影响的有限元分析[J].中国骨伤,2024,37(12):1202~1207 |
| 英文格式: | ZHOU Chen,CHEN Cheng,CAO Rui,GUO Hong-wang,HUANG Chen-yi,YAN Liang,XUE Wei-hua.Finite element analysis of influence of humerus torque screw tip distance on stability of proximal humeral fracture plate fixation[J].zhongguo gu shang / China J Orthop Trauma ,2024,37(12):1202~1207 |
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