首页|术中塑形与锁钉分布及术后愈合状态对接骨板生物力学的影响

术中塑形与锁钉分布及术后愈合状态对接骨板生物力学的影响

Effect of Intraoperative Shaping,Screw Distribution,and Postoperative Healing on Plate Biomechanics

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目的 分析塑形对接骨板弯曲强度以及不同锁钉分布情况对接骨板受力的影响,为临床上对接骨板进行塑形与选择不同的锁钉分布方式提供生物力学依据.方法 根据YY/T 0342-2020 标准对接骨板四点弯曲强度进行有限元仿真分析,并应用理论分析及有限元仿真方法 对不同锁钉分布的假体模型进行受力分析.结果 在 30°折弯时,3.7 mm厚接骨板比 2.7 mm厚接骨板的等效塑性应变高 28%;3.7、2.7 mm厚接骨板的极限折弯角度分别为 55°、67°.折痕对接骨板受力影响较小,未塑形结构四点弯曲强度为 2.64 N·m,等效弯曲刚度为 1.12 N·m2;带折痕四点弯曲强度为 2.63 N·m,等效弯曲刚度为1.10 N·m2;正反折弯后接骨板四点弯曲强度由2.64 N·m降低至2.45 N·m,降低约7.72%,等效弯曲刚度由 1.12 N·m2降低至0.98 N·m2,降低了12%,影响较为明显.植入填塞螺钉后单孔接骨板四点弯曲强度改善较为明显,由 2.64 N·m提升至3.15 N·m,提升约 19.32%,等效弯曲刚度由1.12 N·m2提升至 1.14 N·m2,提升幅度为 2.1%.骨折线两侧至少各留出两个锁定孔不植入锁钉比打满锁钉应力降低约 50%.在未形成骨痂的情况下,术后 16 周下地行走,TC4 材质应力达到 852.7 MPa,出现屈服.结论 在需要进行较大塑形的临床场景下,不适合厚度过大的接骨板,厚度大塑形后更易出现接骨板断裂问题,可指导临床基于塑形角度选择合适厚度接骨板,极端情况可选择植入填塞螺钉.建议临床固定锁钉时,避免打满螺钉的固定锁钉方式;骨折线两端各保留两个锁定孔不固定锁钉,生物力学效果最好.
Objective To analyze the influence of shaping on the bending strength of bone plates and the influence of different locking nail distributions on plate force to provide biomechanical references for shaping plates and selecting different locking nail distributions.Methods Finite element simulation analysis of the four-point bending strength of a plate was performed according to the YY/T 0342-2020 standard.Theoretical analysis and finite element simulation method were used to analyze the force on prosthesis models with different lock-nail distributions.Results At 30° bending,the 3.7 mm-thick plate had 28%higher equivalent plastic strain than the 2.7 mm-thick plate.The 3.7 and 2.7 mm-thick plates had ultimate bending angles of 55° and 67°,respectively.The crease had little impact on the plate stress.The four-point bending strength and equivalent bending stiffness of the unshapeed structure were 2.64 N·m and 1.12 N·m2,respectively.The four-point bending strength and equivalent bending stiffness with the crease were 2.63 N·m and 1.10 N·m2,respectively.After forward and backward bending,the four-point bending strength of the plate decreased from 2.64 to 2.45 N·m by approximately 7.72%,and the equivalent bending stiffness decreased from 1.12 to 0.98 N·m2 by approximately 12%.The impact was obvious.After implantation of tamponade screws,the four-point bending strength of the single-hole plate improved significantly from 2.64 to 3.15 N·m,by approximately 19.32%and the equivalent bending stiffness increased from 1.12 to 1.14 N·m2,by approximately 2.1%.At least two locking holes were reserved on both sides of the fracture line.Not inserting the locking screw reduced the stress by approximately 50%compared with the full insertion of the locking screw.During 15-week postoperative walking without bone callus formation,the material stress of TC4 reached 852.7 MPa and yielding occurred.Conclusions In a clinical scenario where larger shaping is required,it is not suitable for plates with larger thicknesses and plate fractures are more likely to occur after large-thickness shaping.This can guide the clinical selection of plates with appropriate thickness based on the shaping angle,and tamponade screws can be implanted in extreme cases.Fixing locking screws clinically is recommended;however,a method of fixing the locking screws with full screws is not recommended.The biomechanical effect is best when two locking holes at both ends of the fracture line are maintained without fixing the locking screws.

shapingbone platelocking nail distributionfour-point bending strengthfinite element analysis

周望、徐剑晴、何思渊、张述、王俊文、焦竞、米博斌、刘国辉、朱威威、何智圣、张柳云、刘梦星

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武汉迈瑞科技有限公司,武汉 430065

东南大学 生物科学与医学工程学院,南京 210096

天津市医疗器械质量监督检验中心,天津 300384

武汉市第四医院 骨科,武汉 430030

华中科技大学同济医学院附属协和医院,武汉 430022

深圳迈瑞生物医疗电子股份有限公司,广东 深圳 518057

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塑形 接骨板 锁钉分布 四点弯曲强度 有限元分析

湖北省重点研发计划武汉市重点研发计划

2022BAD1752023020402010591

2024

医用生物力学
上海第二医科大学

医用生物力学

CSTPCD北大核心
影响因子:0.858
ISSN:1004-7220
年,卷(期):2024.39(4)
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