两点固定和三点固定治疗跟骨SandersⅢ型骨折的生物力学比较
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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 and Three-Point Fixation for Treating SandersⅢ Calcaneal Fracture
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    摘要:

    目的 分析桡骨远端钢板两点固定治疗跟骨SandersⅢ型骨折的生物力学可行性。方法基于CT和MRI图像建立足踝部骨骼-肌肉的三维有限元模型。在验证其有效性的基础上,建立SandersⅢ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,比较两种固定方式的生物力学差异。结果 负重站立时,两点固定和三点固定模型的最大应力分别为324.70、407.90 MPa;两点固定和三点固定模型的最大位移分别为2.498、2.541 mm,前者在前后和垂直方向位移较大,但内外侧位移较小。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治疗的稳定性需要,与传统钢板相比具有手术创伤小、整体应力分布更均匀、可以早期开展康复训练等优点,是一种值得推荐的治疗新方法

    Abstract:

    Objective To analyze the biomechanical feasibility of two-point fixation by distal radius plate for the treatment of SandersⅢ calcaneal fractures. Methods The three-dimensional (3D) finite element musculoskeletal foot model was established based on CT and MRI images, which comprised bones, muscles, plantar fascia, ligaments and soft tissues. After validation, the SandersⅢ calcaneal fracture models fixed by distal radial plate (two-point fixation) and calcaneal plate (three-point fixation) were established, so as to compare the biomechanical characteristics of two calcaneal models. Results The maximum stress of the two-point fixation and three-point fixation model was 324.70 and 407.90 MPa, respectively. The maximum displacements of the two models were 2.498 and 2.541 mm, respectively. 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. Conclusions The two-point fixation by distal radial plate can satisfy the biomechanical stability of calcaneal fracture treatment. Compared with traditional steel plate, the two-point fixation shows the advantage of smaller surgical trauma, more uniform overall stress distribution, early weight-bearing rehabilitation after surgery, which is a novel treatment recommended for treating calcaneal fractures.

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章浩伟,吕琳,刘颖,孙万驹,牛文鑫,倪明.两点固定和三点固定治疗跟骨SandersⅢ型骨折的生物力学比较[J].医用生物力学,2021,36(1):55-61

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  • 收稿日期:2020-02-14
  • 最后修改日期:2020-03-13
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  • 在线发布日期: 2021-02-26
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