前路钛板加方形区螺钉联合后柱螺钉治疗髋臼双柱骨折的有限元分析

Three-dimensional finite element analysis of anterior reconstruction plate and trans-plate quadrilateral screws combined with posterior column screws in double column complex acetabular fractures

[目的]评估前路特殊塑形钛板加方形区螺钉联合后柱拉力螺钉内固定治疗髋臼双柱骨折的生物力学稳定性。[方法]利用有限元建模软件建立双柱钛板(A)、单纯前路特殊塑形钛板加方形区螺钉(B)及前路特殊塑形钛板加方形区螺钉联合后柱拉力螺钉(C)内固定治疗髋臼双柱骨折模型,在5种标准步态下,对其进行三维有限元分析。[结果]在各种步态下,三种内固定及正常模型进行比较,骨折线上各节点的平均位移大小为C<B<正常模型<A。经统计学分析发现,在髋关节前屈18°及后伸4°时,内固定A与C间差异有统计学意义,在髋关节后伸12°及14°时,内固定A和B、C之间的差异均有统计学意义(P<0.05)。所有模型其他两两之间的差异无统计学意义(P>0.05)。[结论]前路特殊塑形钛板加方形区螺钉联合后柱拉力螺钉内固定治疗髋臼双柱骨折具有良好生物力学稳定性。

[ Objective ] To evaluate the biomechanical stability of anterior reconstruction plate and trans - plate quadrilateral screws combined with posterior column lag screws in internal fixation surgery for the treatment of double column acetabular fractures. [ Method] Finite elemont modeling software was used to build three internal fixation models for treating a double column acetabular fracture, including a dual - column titanium plate （A） , simple anterior reconstruction plate and trans - plate quadrilateral screws （B） , and anterior reconstruction plate and trans - plate quadrilateral screws combined with posterior column lag screws （C）. Three -dimensional finite element analysis was carried out in five standard gait positions. [ Result] In different gaits, comparison of the three internal fixations with a normal model showed that the average node displacement size of the fracture line occurred in the order of C 〈 B 〈 normal model 〈 A. On statistical analysis, when the hip joint was extended to 4° and flexed to 18° ,there were significant differences between the A and C internal fixations. When the hip joint was extended to 12° and 14°, there were statistically significant differences between the A, B, and C internal fixations （P 〈 0.05 ）. No statistically significant differences were found for the rest of the comparisons （ P 〉 0.05 ）. [ Conclusion] Internal fixation surgery for the treatment of double column acetabular fractures with anterior reconstruction plate and trans - plate quadrilateral screws combined with posterior column lag screws have good biomechanical stability.