目的 比较定制式内侧 Y 形接骨板与传统 T 形接骨板在治疗 Wahlquist 不同亚型内侧胫骨平台骨折中的生物力学效益.方法 采集 1 名健康成年女性膝关节 CT 断层扫描数据,重建胫骨几何形态,基于 Wahlquist 分型建立内侧胫骨平台骨折模型,矢状骨折线分别位于髁间内侧(A 型)、经髁间嵴(B 型)、髁间嵴外侧(C 型),代表 3 种骨折亚型,分别使用定制 Y 形接骨板与传统 T 形接骨板固定.使用 Ansys 2021 软件进行有限元分析,输出两种固定方式下各成分所有节点的应力与位移.基于 Mann-Whitney 非参数检验对输出结果进行统计学分析.结果 对于 A、B、C 3 种骨折类型,无论使用 T 形接骨板或 Y 形接骨板固定,最大应力点均位于最远端钉孔处;Y 形接骨板固定组的骨应力均显著高于 T 形接骨板组,差异均有统计学意义(P<0.0001);Y形接骨板组内侧骨折块的内-外方向位移显著高于 T形接骨板组,前-后方向及上-下方向位移显著低于 T形接骨板组,差异均有统计学意义(P<0.0001).结论 定制式内侧 Y形接骨板较 T形接骨板显著降低应力屏蔽效应,同时能够为内侧骨折块提供更强的抗轴向、抗前后方向滑移能力,在治疗 Wahlquist 不同亚型内侧胫骨平台骨折时具有更佳的综合力学表现.
Finite element analysis of T-Plate and customized Y-Plate in the treatment of medial tibial plateau fractures
Objective To compare the biomechanical behavior of customized medial Y-plate with conventional T-plate in the treatment of different Wahlquist subtypes of medial tibial plateau fractures.Methods CT scan data from a healthy adult female knee were used to recreate the tibia's geometry and model a medial tibial plateau fracture according to the Wahlquist classification.The fracture was categorized into three subtypes:type A with sagittal fracture lines positioned in the medial intercondylar region,type B with sagittal fracture lines passing through the intercondylar crest,and type C with sagittal fracture lines situated laterally to the intercondylar crest.Each subtype was fixed using either a customized Y-shaped plate or a conventional T-shaped plate.Finite element analysis was conducted via Ansys 2021 software to generate stress and displacement outputs for all nodes within each component utilizing both fixation methods.The data were then analyzed statistically using the Mann-Whitney nonparametric test.Results The maximum stress location for the three fracture types A,B,and C was at the distal nail hole,regardless of T-or Y-plate fixation.The bone stress in the Y-plate fixation group was significantly higher than that in the T-plate group(P<0.0001);and the displacement of the medial fracture fragment in the medial-lateral direction in the Y-plate group was significantly higher than that in the T-plate group(P<0.0001);The Y-plate group showed a significantly higher medial-lateral displacement of the medial fracture fragment compared to the T-plate group(P<0.0001),whereas significantly lower displacement than the T-plate group in the anteroposterior and superior-inferior directions(P<0.0001).Conclusions In treating various types of medial tibial plateau fractures in Wahlquist,customized medial Y-plates have been found to significantly reduce the stress-shielding effect when compared to T-plates.Furthermore,Y-plates provide greater resistance to axial and anteroposterior sliding of the medial fracture fragment,as well as better overall mechanical performance.
Tibial fracturesBone platesBiomechanical phenomenaFinite element analysis
NETL
NSTL
万方数据
