带锁髓内钉与锁定加压接骨板固定胫骨近端骨折的有限元分析

Finite Element Analysis of Proximal Tibial Fractures Fixation with Interlocking Intramedullary Nail and Locking Compression Plate

目的评估带锁髓内钉(interlocking intramedullary nail,IIN)与锁定加压接骨板(locking compression plate,LCP)固定胫骨近端骨折的生物力学稳定性,为临床治疗方案的选择提供指导。方法按胫骨近端不同位置模拟骨折将其分成A、B、C三组,使用两种不同内固定物分别对骨折模型进行固定并用有限元法分析胫骨骨折模型及内固定物在500N轴向压缩载荷下的位移和等效应力及分布情况。结果 3组模型中使用IIN固定的胫骨骨折模型及胫骨的最大轴向位移均比使用LCP的小;IIN及其固定的胫骨最大等效应力值均比LCP及固定的胫骨的小。且IIN应力分布较均匀,LCP应力集中在骨板与锁定连接处。结论 IIN抗压缩能力强且固定坚强可靠,应力分布较均匀,抗疲劳性好,其固定胫骨近端骨折稳定性优于LCP。

Objective To evaluate the biomechanical stability of proximal tibial fractures fixation using Interlocking Intramedullary Nail（IIN） and Locking Compression Plate（LCP）,and to provide guidance for the choices of clinical treatment schemes.Methods Simulate fracture types were divided into three groups respectively A,B and C according to the different locations of the proximal tibia.Fracture models were fixed respectively using two different internal fixators.Displacement,equivalent stress and stress distribution were analyzed under axial compression load of 500 N of tibial fracture models and internal fixators.Results The maximum axial displacement of tibial fracture models fixed by IIN and tibia was smaller than that of tibial fracture models fixed by LCP.The stress distribution on IIN was relative uniform,and stress concentrates in the connection between bone plate and locking screws of LCP.Conclusion IIN＇s anti-compression capability is strong,fixation is stable and reliable,stress distribution is relative uniform,and fatigue resistance is high.The stability of proximal tibial fractures fixation with IIN is superior to LCP.