本文關(guān)鍵詞： 脛骨中下段骨折 有限元分析 鎖定接骨板 外固定 隨訪　出處：《南華大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:1、構(gòu)建成人脛骨中下段骨折的三維有限元模型,我們通過三維有限元法對脛骨中下段骨折鎖定接骨板內(nèi)固定、鎖定接骨板外固定、單邊外固定架三種不同固定方式的固定效果進(jìn)行比較分析,判斷鎖定接骨板外置固定脛骨中下段骨折的效果,為臨床采用鎖定接骨板外置治療脛骨中下段骨折提供生物力學(xué)理論依據(jù)。2、隨訪我院行鎖定接骨板外置治療脛骨中下段骨折的患者,評估其近中期療效。方法:1、選取健康28歲女性患者,對其右膝關(guān)節(jié)髕骨最上緣以上1.0cm開始,至脛骨踝關(guān)節(jié)下5.0cm進(jìn)行128排螺旋CT掃描,獲取薄層CT掃描數(shù)據(jù),利用Mimics10.0數(shù)字化三維醫(yī)學(xué)影像交互式處理軟件和Abaqus6.10有限元處理軟件建立脛骨中下段骨折的三維有限元模型,并將鎖定接骨板、單邊外固定架與骨折模型裝配,通過設(shè)定邊界和加載負(fù)荷,對裝配后的脛骨骨折三維有限元模型進(jìn)行軸向壓縮、扭轉(zhuǎn)加載和四點(diǎn)彎曲加載生物力學(xué)分析得出相應(yīng)的應(yīng)力分布、應(yīng)力值、位移值、固定系統(tǒng)的剛度值。2、回顧性分析我院2011年6月~2014年8月采用解剖鎖定板外置治療脛骨中下段骨折7例,其中,男3例,女4例;手術(shù)時(shí)平均年齡37.6歲,平均隨訪22.8個(gè)月(7~36個(gè)月)。于術(shù)后及骨折愈合時(shí)、末次隨訪時(shí)復(fù)查正位及側(cè)位X線片及進(jìn)行臨床評估。結(jié)果:1、通過有限元分析,不同加載方式下,鎖定板外固定系統(tǒng)脛骨骨折端總位移及X、Y、Z軸分位移大于鎖定板內(nèi)固定系統(tǒng),小于單邊外固定架系統(tǒng);各固定系統(tǒng)的剛度值比較:鎖定板內(nèi)固定系統(tǒng)平均軸向剛度值(2066.9259+0.0494)、鎖定板外固定系統(tǒng)平均軸向剛度值(256.7541+0.0011)及單邊外固定架系統(tǒng)平均軸向剛度值(188.6585+0.0005)多重兩兩比較結(jié)果,P值0.05,有統(tǒng)計(jì)學(xué)意義。鎖定板內(nèi)固定系統(tǒng)平均扭轉(zhuǎn)剛度值(225.3137+0.0003)、鎖定板外固定系統(tǒng)平均扭轉(zhuǎn)剛度值(103.3419+0.0001)及單邊外固定架系統(tǒng)平均扭轉(zhuǎn)剛度值(97.7292+0.00006)多重兩兩比較結(jié)果,P值0.05,有統(tǒng)計(jì)學(xué)意義。鎖定板內(nèi)固定系統(tǒng)平均彎曲剛度值(225.3137+0.0003)、鎖定板外固定系統(tǒng)平均彎曲剛度值(109.0122+0.0002)及單邊外固定架系統(tǒng)平均彎曲剛度值(34.6815+0.00002)多重兩兩比較結(jié)果,P值0.05,有統(tǒng)計(jì)學(xué)意義。2、臨床隨訪結(jié)果:本組所有患者骨折愈合后均對位對線良好,未出現(xiàn)肢體畸形,肢體功能恢復(fù)均優(yōu)良。結(jié)論:1、鎖定接骨板外置固定脛骨中下段骨折的穩(wěn)定性小于鎖定接骨板內(nèi)固定,大于半針單邊外固定架;鎖定接骨板外置固定脛骨中下段骨折的系統(tǒng)剛度值比單邊外固定架要大,小于鎖定接骨板內(nèi)固定。2、鎖定接骨板外置治療脛骨中下段骨折可獲得較滿意的近中期臨床療效。
[Abstract]:Objective to construct a three-dimensional finite element model of middle and lower tibial fractures in adults. We used three-dimensional finite element method to fix the fractures of middle and lower tibia with locking plate and external fixation. The results of three different fixation methods of unilateral external fixator were compared and analyzed to judge the effect of locking plate external fixation for the middle and lower tibial fractures. In order to provide biomechanical theoretical basis for the treatment of middle and lower tibial fractures by locking plate external placement, we followed up the patients who were treated with locking plate external placement for the fracture of the middle and lower tibia. Methods: to evaluate the efficacy in the near and medium term. Methods 1: 1 was selected from a healthy 28-year-old female patient, and 1.0 cm above the upper edge of the patella of the right knee joint was selected. From 5.0cm below the ankle joint of tibia, 128 slice spiral CT scanning was performed, and thin slice CT scanning data were obtained. The 3D finite element model of middle and lower tibia fracture was established by Mimics10.0 digital 3D medical image interactive processing software and Abaqus6.10 finite element processing software. The locking plate, unilateral external fixator and fracture model were assembled, and the three-dimensional finite element model of tibial fracture was subjected to axial compression by setting the boundary and loading load. The corresponding stress distribution, stress value, displacement value and stiffness value of the fixed system are obtained by the biomechanical analysis of torsional loading and four-point bending loading. From June 2011 to August 2014, 7 cases of middle and lower tibial fractures were treated by anatomic locking plate placement, including 3 males and 4 females. The mean age at the time of operation was 37.6 years, and the average follow-up was 22.8 months, ranging from 7 to 36 months. At the time of postoperative and fracture healing, X-ray films of positive and lateral position and clinical evaluation were reexamined at the last follow-up. Results: 1. According to the finite element analysis, the total displacement of tibial fracture end and the axial branch displacement of XMY Z in the locking plate external fixation system were larger than those in the locking plate internal fixation system and were smaller than those in the unilateral external fixation system under different loading modes. Comparison of the stiffness of each fixed system: the average axial stiffness of the locking plate fixation system is 2066.9259 0.0494). The average axial stiffness of the locking plate external fixation system is 256.7541 0.0011) and the average axial stiffness value of the unilateral external fixator system is 188.6585 0.0005). Multiple pairwise comparison results. The mean torsional stiffness of the locking plate fixation system was 225.3137 0.0003). The average torsional stiffness of the locked plate external fixation system is 103.3419 0.0001) and the mean torsional stiffness of the unilateral external fixator system is 97.7292 0.00006). Multiple pairwise comparison results. P value was 0.05, there was statistical significance. The average bending stiffness of locking plate fixation system was 225.3137 0.0003). The average bending stiffness of the locking plate external fixation system is 109.0122 0.0002) and the average bending stiffness value of the unilateral external fixator system is 34.6815 0.00002). Multiple pairwise comparison results. P value was 0.05, with statistical significance. 2. The clinical follow-up results showed that all the patients had good alignment after fracture healing, no limb deformity and good recovery of limb function. Conclusion: 1. The stability of external fixation of middle and lower tibial fractures with locking plate was less than that with locking plate, and the stability was greater than that of unilateral external fixator with half needle. The system stiffness value of locking plate external fixation for middle and lower tibial fractures was larger than that of unilateral external fixation frame, and less than that of locking plate internal fixation .2. Locking plate external placement for middle and lower tibial fractures can obtain satisfactory clinical results in the near and medium term.
【學(xué)位授予單位】：南華大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R687.3

【共引文獻(xiàn)】

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