摘要
目的 通过有限元分析比较肱骨远端后外侧钢板、前方肱骨近端锁定内固定系统(PHILOS)倒置、前方重建钢板固定治疗肱骨干下段骨折的生物力学特性.方法 选取1名健康成年男性志愿者,年龄27岁,身高171 cm,体重70 kg.应用有限元法建立肱骨干下段骨折仿真模型,比较肱骨远端后外侧钢板(A组)、前方PHILOS钢板倒置(B组)、前方重建钢板(C组)固定治疗肱骨干下段骨折最大应力和最大位移.结果 A、B、C三组模型整体应力峰值分别为409.07、217.04、370.64 MPa;扭转载荷下整体应力峰值分别为234.55、348.80、458.17 MPa;弯曲载荷下整体应力峰值分别为250.22、466.76、582.32 MPa.应力越小说明其疲劳断裂的风险越小.A、B、C三组模型整体位移峰值分别为5.18、3.04、3.75 mm;扭转载荷下整体位移峰值分别为1.20、1.02、2.05 mm;弯曲载荷下整体位移峰值分别为3.85、5.28、9.04mm.位移越小说明其固定稳定性越好.结论 三种内固定比较,PHILOS钢板倒置固定肱骨干下段骨折在轴向压缩、扭转应力下力学稳定性最好,而在弯曲应力下后外侧钢板力学稳定性最好.
Abstract
Objective To compare the biomechanical properties of posterolateral distal humeral plate,inverted anterior proximal humerus internal locking system(PHILOS),and anterior reconstruction plate in the treatment of distal humeral shaft fractures by a finite element analysis.Methods One healthy adult male volunteer,aged 27 years,with a height of 171 cm and a weight of 70 kg,was recruited for this study.The finite element method was used to establish a simulation model of distal humeral shaft fracture.The maximum displacement and maximum stress were compared between fixation with posterolateral distal humeral plate(group A),fixation with inverted anterior PHILOS(group B),and fixation with anterior reconstruction plate(group C).Results In groups A,B,and C,respectively,the overall stress peak values were 409.07 MPa,217.04 MPa,and 370.64 MPa;the peak stresses under torsional load were 234.55 MPa,348.80 MPa and 458.17 MPa;the overall stress peaks under bending load were 250.22 MPa,466.76 MPa,and 582.32 MPa.The smaller the stress,the smaller the risk of fatigue fracture.In groups A,B,and C,re-spectively,the overall displacement peak values were 5.18 mm,3.04 mm and 3.75 mm;the peak dis-placements under torsional load were 1.20 mm,1.02 mm and 2.05 mm;the peak displacements under bending load were 3.85 mm,5.28 mm and 9.04 mm.The smaller the displacement,the better the fixation stability.Conclusions In the treatment of distal humeral shaft fractures,fixation with inverted anterior PHILOS leads to the best mechanical stability under axial compression and torsional stress,while fixation with the posterolateral distal humeral plate leads to the best mechanical stability under bending stress.
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