双螺钉与三螺钉固定方式治疗胫骨平台Schatzker I型骨折的效果比较
A Stress Comparative Study of Double Screws System and Triple Screws System Fixation in the Treatment of Schatzker Type I Tibial Plateau Fracture
DOI: 10.12677/ACM.2020.109297, PDF,   
作者: 王旭梁：中国医学科学院北京协和医学院阜外医院，北京；陈帆成, 张方雪：复旦大学上海医学院，上海；王成贵*：浙江大学附属第二医院骨科，浙江 杭州
关键词: 胫骨平台骨折；Schatzker I型骨折；有限元分析；螺钉固定；Tibial Plateau Fracture； Schatzker Type I Fracture； Finite Element Analysis； Screw Fixation
摘要: 目的：对双螺钉和三螺钉固定治疗胫骨平台Schatzker I型骨折的生物力学进行有限元分析，为临床手术设计以及选择提供思路。方法：利用1位健康男性志愿者下肢CT数据构建胫骨平台Schatzker I型骨折的三维有限元模型。采用不同螺钉固定方式对骨折模型进行固定后，胫骨平台上方设置600 N的力量载荷同时对胫骨模型下方坚强固定来模拟成人膝关节的受力。比较模型在不同固定方式下的等效应力以及剪切力情况。结果：双螺钉固定系统的最大von Mises应力值为23.014 MPa，三螺钉固定系统的最大von Mises应力值为6.252 MPa。双螺钉固定系统与三螺钉固定系统中骨折块的von Mises应力最大值分别是0.736 MPa，2.158 MPa；胫骨的von Mises应力最大值为1.933 MPa 1.991 MPa。结论：使用三螺钉对骨折处进行固定优于双螺钉固定治疗胫骨平台Schatzker I型骨折，可降低固定物固定失败的风险，有利于愈合。
Abstract: Objective: A finite element analysis was performed on the biomechanics of double screws and triple screws fixation for the treatment of Schatzker type I tibial plateau fracture to provide ideas for clinical surgical design and selection. Methods: A three-dimensional finite element model of Schatzker type I fracture of the tibial plateau was constructed using CT data of the lower limbs of a healthy male volunteer. After the fracture model is fixed with different screw fixation methods, a force load of 600 N is set above the tibial platform and the tibial model is firmly fixed at the same time to simulate the force of the adult knee joint. The von Mises equivalent stress and shearing force of the model under different fixing methods are compared. Results: The maximum von Mises stress value of the double screw fixing system was 23.014 MPa, and the maximum von Mises stress value of the three screws fixing system was 6.252 MPa. The maximum von Mises stresses of the fracture block in the double-screw fixation system and the three-screw fixation system were 0.736 MPa and 2.158 MPa, respectively; the maximum von Mises stress of the tibia was 1.933 MPa and 1.991 MPa, respectively. Conclusion: The use of three screws to fix the fracture is more superior to double screw fixation for the treatment of Schatzker type I tibial plateau fracture, which reduces the risk of fixation failure and facilitates healing.
文章引用：王旭梁, 陈帆成, 张方雪, 王成贵. 双螺钉与三螺钉固定方式治疗胫骨平台Schatzker I型骨折的效果比较[J]. 临床医学进展, 2020, 10(9): 1979-1986. https://doi.org/10.12677/ACM.2020.109297

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