本文選題：有限元 + 股骨骨折　； 參考：《中國人民解放軍醫(yī)學院》2017年碩士論文

【摘要】：背景股骨干骨折是臨床常見骨折之一,經(jīng)過正確治療大部分能夠治愈,但仍有部分患者因為種種原因?qū)е鹿遣贿B的發(fā)生。骨不連是股骨干骨折的主要并發(fā)癥,會導致疼痛、功能缺失、畸形及其他一系列并發(fā)癥。目前臨床上針對股骨干骨折術(shù)后骨不連的治療方法較多,主要包括:髓內(nèi)釘動力化、擴髓更換髓內(nèi)釘、保留原髓內(nèi)釘附加鋼板、雙鋼板以及Ilizarov外固定架等。但仍存在血供破壞嚴重、下肢易短縮、成功率低、適應癥狹窄等問題。目的本課題利用有限元模擬生物力學分析的研究方法,從生物力學角度對比單外側(cè)鋼板、兩種不同角度雙鋼板(180°、90°)以及髓內(nèi)釘附加鋼板治療股骨干骨折骨不連的力學穩(wěn)定性,從而為臨床上治療股骨干骨折及術(shù)后骨不連提供生物力學證據(jù),指導臨床治療和術(shù)后康復。方法1、重建人工股骨的三維模型,建立股骨干骨折骨不連模型。2、建立單外側(cè)鋼板、兩種不同角度雙鋼板(180°、90°)以及髓內(nèi)釘附加鋼板模型。3、將骨折模型和內(nèi)固定模型進行匹配、三角面片網(wǎng)格劃分、材料賦值等有限元前處理過程。4、模型裝配、接觸面定義、設(shè)置邊界條件和載荷,進行有限元模擬生物力學分析。5、對有限元分析數(shù)據(jù)進行解讀。6、臨床初步觀察結(jié)果1、四種固定模型下最大應力值從大到小排序:單外側(cè)鋼板模型髓內(nèi)釘附加鋼板模型90°雙鋼板模型180°雙鋼板模型。單外側(cè)鋼板模型最大應力值為2506Mpa,髓內(nèi)釘附加鋼板模型最大應力值為1945Mpa,90°雙鋼板模型最大應力值為1001Mpa, 180°雙鋼板模型最大應力值為324Mpa。 2、四種固定模型下內(nèi)翻成角穩(wěn)定性比較從大到小依次為:180°雙鋼板模型髓內(nèi)釘附加鋼板模型 90°雙鋼板模型單外側(cè)鋼板模型。180°雙鋼板模型下骨折塊角度為0.4°,內(nèi)固定角度為0.8°;髓內(nèi)釘附加鋼板模型下骨折塊角度為0.9°,內(nèi)固定角度為0.8°; 90°雙鋼板模型下骨折塊角度為2.7°,內(nèi)固定角度為3.2°;單外側(cè)鋼板模型下骨折塊角度為11.3°,內(nèi)固定角度為14.6°。3、四種固定模型下旋轉(zhuǎn)成角穩(wěn)定性比較從大到小依次為:180°雙鋼板模型90°雙鋼板模型髓內(nèi)釘附加鋼板模型=單外側(cè)鋼板模型。180°雙鋼板模型下旋轉(zhuǎn)成角0.2°,90°雙鋼板模型下旋轉(zhuǎn)成角0.9°,髓內(nèi)釘附加鋼板模型下旋轉(zhuǎn)成角1.2°,單外側(cè)鋼板模型下旋轉(zhuǎn)成角1.2°。結(jié)論1、180°雙鋼板模型與其他內(nèi)固定方法相比具有更強的穩(wěn)定性。在應力大小及旋轉(zhuǎn)成角穩(wěn)定性上90°雙鋼板優(yōu)于髓內(nèi)釘附加鋼板;在內(nèi)翻成角穩(wěn)定性方面,髓內(nèi)釘附加鋼板強于90°雙鋼板,因此我們推斷二者在股骨干骨不連的治療上效果相似。2、雙鋼板結(jié)合植骨治療股骨干骨不連具有高愈合率及低并發(fā)癥率的特點,尤其適用于缺乏內(nèi)側(cè)支撐蝶形骨塊的患者,有助于患者早期下地活動,最大限度恢復患肢正常功能,療效滿意,值得推廣。
[Abstract]:Background femoral shaft fracture is one of the common clinical fractures, most of them can be cured by correct treatment, but some patients still have nonunion due to various reasons. Nonunion is a major complication of femoral shaft fractures, leading to pain, loss of function, deformities, and a range of other complications. At present, there are many clinical treatment methods for nonunion after femoral shaft fracture, including: intramedullary nail dynamics, reaming and replacement of intramedullary nail, retaining the original intramedullary nail attached plate, double plate and Ilizarov external fixator, etc. However, there are still some problems, such as serious blood supply destruction, easy shortening of lower extremities, low success rate and narrow indications. Objective to compare the biomechanical stability of single lateral plate, two different angles of double plate (180 擄~ 90 擄) and intramedullary nail plus plate in the treatment of femoral shaft fracture nonunion by means of finite element simulation biomechanical analysis. It can provide biomechanical evidence for the treatment of femoral shaft fracture and postoperative nonunion, and guide clinical treatment and postoperative rehabilitation. Methods 1. The 3D model of artificial femur was reconstructed, and the fracture nonunion model was established. The single lateral plate, two different angles of double plate with 180 擄or 90 擄) and the intramedullary nail plus plate model were established. The fracture model and the internal fixation model were matched. Pre-processing process of finite element, such as triangulation, material assignment, etc., model assembly, interface definition, boundary condition and load setting, Do finite element simulation biomechanical analysis .5, analyze the data of finite element analysis .6. clinical preliminary observation results 1, the maximum stress value of four fixed models from large to small order: single lateral steel plate model intramedullary nail attached steel plate mold Type 90 擄double steel plate model 180 擄double plate model. The maximum stress value of single-lateral steel plate model was 2506Mpa. the maximum stress value of intramedullary nail attached plate model was 1945Mpa90 擄double plate model was 1001Mpa. the maximum stress value of 180 擄double-plate model was 324Mpa. Comparison of the stability of inversion angle under four fixation models: 1: 180 擄double plate model intramedullary nail additional plate model 90 擄double plate model single lateral steel plate model .180 擄double plate model fracture block angle 0.4 擄, internal fixation The angle is 0.8 擄, the angle of fracture block is 0.9 擄and the angle of internal fixation is 0.8 擄under the model of intramedullary nail plus plate, the angle of fracture block is 2.7 擄and the angle of internal fixation is 3.2 擄under 90 擄double plate model, the angle of fracture block is 11.3 擄and the angle of internal fixation is 11.3 擄under the model of single lateral plate. Comparison of rotation angular stability under four fixed models: 180 擄double plate model 90 擄double plate model intramedullary nail additional plate model = single lateral plate model .180 擄double plate model rotation 0.2 擄angle 90 擄double plate model The angle of rotation was 0.9 擄under the model of intramedullary nail, 1.2 擄in the model of intramedullary nail and 1.2 擄in the model of single lateral plate. Conclusion 1180 擄double plate model is more stable than other internal fixation methods. The stability of 90 擄double plate is better than that of intramedullary nail plate in stress magnitude and rotation angle stability, and that of intramedullary nail attached plate is stronger than that of 90 擄double plate. Therefore, we infer that the results of treatment of femoral shaft nonunion are similar. The double plate combined with bone graft has the characteristics of high healing rate and low complication rate, especially for patients lacking medial support butterfly bone mass. It is helpful for the patients to get down early and restore the normal function of the affected limb to the maximum extent, and the curative effect is satisfactory, which is worth popularizing.
【學位授予單位】：中國人民解放軍醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R687.3

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