锁定多向带锁髓内钉与锁定接骨板固定胫骨平台骨折的有限元分析

Comparison of tibial locking multi-way interlocking intramedullary nail and locking plate for tibial plateau fractures： a finite element analysis

目的 通过有限元分析比较胫骨锁定多向带锁髓内钉（TLMIIN）与5孔锁定接骨板（LP）重建胫骨平台的生物力学. 方法 获取1名45岁男性健康志愿者的胫骨CT薄层图像资料,利用Mimics10.01软件等建立胫骨三维模型,模拟胫骨平台骨折Schatzker分型Ⅰ型、Ⅳ型、V型、Ⅵ型4种骨折类型,并分别与TLMIIN、锁定接骨板模型装配生成8个模型,通过ANSYS软件分别测量各组模型的最大位移及受力情况. 结果 TLMIIN的综合位移小于锁定接骨板,除SchatzkerⅣ型外,TLMIIN固定模型的Ⅰ、Ⅴ、Ⅵ型最大应力值均小于锁定接骨板,锁定接骨板固定模型的Ⅵ型内侧骨折块最大应力值最大（19.1MPa）;锁定接骨板的骨折块局部的应力分布较TLMIIN骨折块应力分布相对集中.结论 TLMIIN固定胫骨平台骨折的生物力学效果优于5孔锁定接骨板.

Objective To compare the biomechanical performance of tibial locking multi-way interlocking intramedullary nail （TLMIIN） and five-hole locking plate （LP） in reconstruction of the tibial plateau through finite element analysis.Methods A healthy 45 year-old male volunteer was enrolled for CT scan of his tibia.The image data of healthy human tibia were obtained for construction of three-dimensional models of the tibia using software Mimics10.01.Tibial plateau fractures of Schatzker types Ⅰ,Ⅳ,Ⅴ and Ⅵ were simulated in the tibial models.Fixations with TLMIIN and LP were next simulated respectively in models of each type.The maximum displacement and force conditions were measured using software ANSYS in each model.The results were analyzed.Results TLMIIN led to smaller comprehensive displacement than LP.Except in Schatzker type Ⅳ,TLMIIN resulted in smaller maximum stress in Schatzker types Ⅰ,Ⅴ and Ⅵ than LP.LP resulted in the largest maximum stress （19.1 MPa） on medical fracture fragments in fixation of Schatzker type Ⅵ.LP led to more concentrated local distribution of stress on the fracture fragments than TLMIIN.Conclusion In fixation of tibial plateau fractures,the biomechanical performance of TLMIIN is better than five-hole LP.