“两点固定”和“三点固定”治疗跟骨关节内骨折的生物力学比较
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1.上海理工大学医疗器械与食品学院;2.上海理工大学 医疗器械与食品学院;3.上海市浦东新区人民医院;4.同济大学医学院 康复治疗系

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上海市浦东新区卫生系统优秀学科带头人项目(PWRd2019-05)


Biomechanical comparison of “two-point fixation” and “three-point fixation” in the treatment of intra-articular calcaneal fracture
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Affiliation:

1.University of Shanghai for Science and Technology;2.Shanghai Pudong New Area Peoples’ Hospital;3.Medical College of Tongji University

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Shanghai pudong new area health system outstanding academic leader project

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    摘要:

    目的 提出并分析桡骨远端钢板“两点固定”治疗跟骨关节内骨折的生物力学可行性,为临床治疗提供新的思路和建议。方法 基于CT和MRI图像数据建立了足踝部骨骼-肌肉的三维有限元模型,模型包括骨骼,肌肉,韧带,筋膜等组织。在验证其有效性的基础上,建立Sanders III型跟骨骨折模型,并通过桡骨远端钢板和跟骨钢板模拟“两点固定”和“三点固定”,运用ABAQUS软件比较两种模型的生物力学特征。结果 负重站立时,“两点固定”模型的最大应力为324.70MPa,小于“三点固定”模型的407.90 MPa。位移方面,“两点固定”和 “三点固定”模型分别为2.498mm和2.541mm。此外,前者的前后和垂直方向位移更大,但内外侧位移更小。两种模型的后关节面位移无显著性差异,Bohler’s角和Gissane’s角也在正常范围内。结论 桡骨远端钢板“两点固定”可以满足跟骨骨折固定的生物力学稳定性需要,模型整体应力分布均匀,术后可以早期负重,是一种值得推荐的治疗新方法。

    Abstract:

    Objective This study proposed and analyzed the biomechanical feasibility of the "two-point fixation" by distal radius plate for the treatment of intra-articular calcaneal fractures, and provided suggestions for the clinical treatment. Method A three-dimensional finite element (FE) musculoskeletal foot model was established based on CT and MRI images, which comprised bones, muscles, plantar fascia, ligaments and soft tissues. After validation of the FE model, we established the Sanders III calcaneal fracture model and fixed by distal radial plate (two-point fixation) and calcaneal plate (three-point fixation). The biomechanical characteristics of two calcaneal models were compared using ABAQUS software. Result The maximum stress of the "two-point fixation MPa, which is smaller compared to the "three-point fixed" model (407.90MPa).The maximum displacement of the two models are 2.498mm and 2.541mm, respectively. The longitudial displacement and vertical displacement of the former is greater than the latter, but the transverse displacement is less than the latter. There was no significant difference in the posterior articular surface displacement between the two models. In both models, the Bohler"s Angle and Gissane"s Angle were within the normal range. Conclusion The "two-point fixation" by distal radial plate can satisfy the biomechanical stability of calcaneal fracture treatment and the overall stress distribution of the fracture model is uniform. Patients can carry out early weight-bearing rehabilitation after surgery. The "two-point fixation" is a novel recommended treatment for the treatment of calcaneal fractures.

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  • 收稿日期:2020-02-14
  • 最后修改日期:2020-03-13
  • 录用日期:2020-03-17
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