3种方式固定锁骨中段斜行骨折的有限元分析

Finite element analysis of mid-shaft oblique clavicle fractures fixed with three different methods

目的通过有限元法分析锁定钢板双层皮质、单层皮质固定和普通钢板双皮质固定3种方式固定锁骨中段斜行骨折的生物力学特性,为临床应用提供理论参考。方法建立锁骨中段斜行骨折,分别予以锁定钢板双皮质和单皮质固定以及普通钢板固定的三维有限元模型,相同的加载和约束条件下模拟轴向压缩、顺时针扭转、逆时针扭转和三点弯曲4种工况,评价不同内固定方式的最大等效应力、骨折块的最大综合位移。结果1 3种固定方式都可出现一定的内固定应力集中,但4种工况下单层皮质固定的最大应力均明显高于其他两种方式。2位移情况:压缩工况三者无差别;扭转工况下,单层皮质固定的位移大于双皮质固定;弯曲试验中双层皮质固定大于单皮质固定。结论对于锁定钢板固定锁骨中段斜行骨折,单层皮质固定比双层皮质固定和普通钢板双皮质固定更容易出现应力集中,提示临床治疗应采用双层皮质固定。

Objective To provide theoretical reference for clinical applications by analyzing the biomechanical properties of mid-shaft oblique clavicle fractures fixed by the three ways（ double cortical locking plate,single cortical locking plate,and common bi-cortical fixation with reconstruction plate） through finite element（ FE） analysis. Methods3 D FE model of the mid-shaft oblique clavicle fracture with different fixations of locked plate fixation double and single cortical cortex and the common reconstruction plate fixed was developed. Each construct was tested in axial compression,bending,internal,and external torsion. The different fixations were compared for the maximum equivalent stress,maximum comprehensive isplacement were also compared. Results 1 There was a certain fixation stress concentration for the three fixation methods,but single cortex fixed maximum stress were significantly higher than the other two ways under the four kinds of conditions; 2 displacement situation： compression condition of the three nondiscriminatory; reverse conditions,the displacement of single cortical fixed was greater than bi-cortical fixation;double cortex fixed was more than single cortical locked under bending test. Conclusions For the mid-shaft clavicle oblique fracture fixed by locking plate,single cortical locking lock than double cortex and the general reconstruction plate bi-cortical fixing more prone to stress concentration,suggesting that the clinical application should be fixed in the double cortex.