【摘要】：背景:隨著現(xiàn)代社會(huì)交通事故、高處墜落傷等的增加,使髖臼骨折的發(fā)生與日俱增。髖臼解剖位置深在,結(jié)構(gòu)復(fù)雜,保守治療效果差,手術(shù)治療難度大,若治療方式選擇不當(dāng),術(shù)后發(fā)生并發(fā)癥的概率較高。因此,髖臼骨折的治療異常重要。目前臨床上主張積極手術(shù)治療,切開復(fù)位內(nèi)固定的方式已成為治療髖臼骨折的首選方案。髖臼結(jié)構(gòu)復(fù)雜,有學(xué)者將其領(lǐng)近結(jié)構(gòu)分為前柱和后柱,后柱為髖臼骨折常累及的部位。臨床上單純的髖臼后柱骨折不常見,多為伴有前柱骨折的雙柱骨折,手術(shù)中使用前后聯(lián)合入路治療髖臼雙柱骨折無外乎會(huì)增加患者的創(chuàng)傷,不利于術(shù)后恢復(fù)。近年來,改良Stoppa入路作為傳統(tǒng)髂腹股溝入路的良好補(bǔ)充得到廣泛應(yīng)用,有學(xué)者采用改良Stoppa入路治療前柱骨折的同時(shí),在后柱骨盆內(nèi)面坐骨大切跡移形處及與坐骨相連的髂骨部分放置預(yù)彎的接骨板來固定后柱,效果良好。因其一端固定于髂骨,一端固定于坐骨,且鋼板位于后柱前方,為與后髂坐鋼板(常規(guī)后柱鋼板)區(qū)分,本文使用內(nèi)髂坐鋼板將其命名,但目前國際社會(huì)上對(duì)于內(nèi)髂坐鋼板尚無生物力學(xué)分析評(píng)價(jià)其穩(wěn)定性。目的:利用計(jì)算機(jī)分析軟件,建立骨盆三維有限元模型并驗(yàn)證其有效性。在有限元模型基礎(chǔ)上,建立包括內(nèi)髂坐鋼板在內(nèi)共5種內(nèi)固定方式模型,模擬站立及坐位下,其對(duì)髖臼后柱骨折固定的生物力學(xué)特點(diǎn),為臨床提供依據(jù)。方法:1、選取1例健康女性志愿者行CT掃描,將數(shù)據(jù)以DICOM格式導(dǎo)入Mimics15.0軟件生成骨盆三維模型,經(jīng)有限元前處理軟件處理后導(dǎo)入有限元分析軟件ANSYS中,添加韌帶附屬結(jié)構(gòu),建立骨盆三維有限元模型并驗(yàn)證其有效性。2、應(yīng)用軟件生成后柱骨折模型,建立5種內(nèi)固定模型,對(duì)模型行應(yīng)力加載,分析評(píng)價(jià)其應(yīng)力位移分布、關(guān)節(jié)面骨折線的位移、髖臼整體剛度等。3、使用t檢驗(yàn)行統(tǒng)計(jì)學(xué)處理,P0.05表示結(jié)果有統(tǒng)計(jì)學(xué)差異。結(jié)果:站立位時(shí)后髂坐鋼板、內(nèi)髂坐鋼板、順行拉力螺釘、經(jīng)坐骨結(jié)節(jié)逆行拉力螺釘和經(jīng)坐骨小切跡逆行拉力螺釘?shù)墓钦劬�位點(diǎn)平均位移為(6.13± 1.04)m、(7.08±0.24)μm、(7.85±0.88)μm、(6.85±0.42)μm、(7.07±0.49)μm;坐位其平均位移分別為(7.77±1.0)μm、(9.65±0.83)μm、(9.69±1.12)μm、(10.2±0.37)μm、(10.1 ±0.51)μm。鋼板固定和螺釘固定的結(jié)果之間有統(tǒng)計(jì)學(xué)差異(P0.05),而坐位時(shí),內(nèi)髂坐鋼板與螺釘內(nèi)固定結(jié)果無統(tǒng)計(jì)學(xué)差異,但其平均位移明顯小于螺釘內(nèi)固定。結(jié)論:內(nèi)髂坐鋼板及后髂坐鋼板固定后柱骨折穩(wěn)定性較空心螺釘具有優(yōu)勢(shì),可應(yīng)用于臨床,具體情況需結(jié)合臨床及個(gè)體情況而定。
[Abstract]:Background: with the increase of traffic accidents and falling injuries in modern society, the incidence of acetabular fractures is increasing day by day. The acetabular anatomical position is deep, the structure is complex, the conservative treatment effect is poor, the surgical treatment is difficult, if the treatment method is not proper, the probability of postoperative complications is higher. Therefore, the treatment of acetabular fractures is extremely important. At present, active surgical treatment and open reduction and internal fixation have become the first choice in the treatment of acetabular fractures. The acetabular structure is complex. The proximal structure of acetabular is divided into anterior column and posterior column, and the posterior column is often involved in acetabular fracture. Clinical simple acetabular posterior column fractures are uncommon, most of them are double-column fractures with anterior column fractures. The use of combined anterior and posterior approach in the treatment of acetabular double-column fractures will increase the trauma of patients, which is not conducive to postoperative recovery. In recent years, the modified Stoppa approach has been widely used as a good supplement to the traditional ilioinguinal approach. Some scholars have used the modified Stoppa approach to treat anterior column fractures. The posterior column was fixed with precurved plates at the position of the great notch of the ischium on the inner side of the posterior column and the iliac bone associated with the ischium. Because its one end is fixed in the iliac bone and the other in the ischium, and the steel plate is located in the front of the posterior column, in order to distinguish it from the posterior iliac plate (conventional posterior column plate), this paper uses the internal iliac plate to name it. However, there is no biomechanical analysis to evaluate the stability of the internal iliac plate in the international community. Objective: to establish a three-dimensional finite element model of pelvis by computer software and verify its validity. Based on the finite element model, five internal fixation models, including internal iliac plate, were established to simulate the biomechanical characteristics of acetabular posterior column fracture fixation under standing and sitting position. Methods: 1. A healthy female volunteer was selected to perform CT scanning. The data were imported into Mimics15.0 software to generate three dimensional model of pelvis in DICOM format. The data were processed by finite element preprocessing software and imported into the finite element analysis software ANSYS to add ligamentum appendage structure. The three-dimensional finite element model of pelvis was established and its validity was verified. 2. The posterior column fracture model was created by software. Five kinds of internal fixation models were established, and the stress displacement distribution of the model was analyzed and evaluated, and the displacement of the fracture line of the articular surface was analyzed and evaluated. Acetabular stiffness, etc. 3, using t test for statistical processing, P0.05 indicated that the results were statistically different. Results: the average displacement of the fracture line of the posterior iliac plate, the internal iliac plate, the anterograde pull screw, the retrograde lag screw through the ischium tubercle and the retrograde lag screw through the small notch of the ischium was (6.13 鹵1.04) m, when standing, the average displacement of the fracture line was (6.13 鹵1.04) m. (7.08 鹵0.24) 渭 m, (7.85 鹵0.88) 渭 m, (6.85 鹵0.42) 渭 m, (7.07 鹵0.49) 渭 m; The average displacement in sitting position was (7.77 鹵1.0) 渭 m, (9.65 鹵0.83) 渭 m, (9.69 鹵1.12) 渭 m, (10.2 鹵0.37) 渭 m, (10.1 鹵0.51) 渭 m respectively. There was statistical difference between the results of plate fixation and screw fixation (P0.05), but there was no significant difference between the results of internal fixation of internal iliac plate and screw in sitting position, but the average displacement was significantly smaller than that of screw fixation. Conclusion: internal iliac plate and posterior iliac plate are superior to hollow screw in the stability of posterior column fracture.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R687.3

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