固定器刚度对不同类型骨折愈合的影响
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北京工业大学

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Effect of fixator stiffness on healing of different types of fracture
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    摘要:

    目的:系统探讨固定器刚度变化(50~7500 N/mm)对AO/OTA分型下7种不同类型骨折(A1、A2、A3、B2、B3、C2、C3)愈合效果的影响。方法:以长骨骨折髓内钉固定为研究对象,基于应变调控组织分化理论,结合模糊逻辑控制算法和有限元分析技术,数值模拟骨折愈合过程。结果 中等的固定器刚度(如1500~2500 N/mm)可以在保证骨折生物力学性能恢复的情况下缩短愈合时间。但是,每种骨折类型对应的适宜刚度不尽相同,且其愈合效果对固定器刚度变化的敏感度不一。对于A型骨折,当固定器刚度为1500 N/mm时,骨折断端生物力学性能恢复最佳,并且固定器刚度的变化对愈合效果影响较大;对于B型和C型骨折,当固定器刚度值在1500 N/mm以上时,刚度变化对生物力学性能恢复没有显著影响。结论 骨折愈合效果受固定器刚度和骨折类型的共同影响。在临床骨折治疗中,固定器的选用应充分考虑骨折类型。

    Abstract:

    Objective: To systematically explore the change of fixation stiffness (50-7500 N/mm) on the healing outcomes of seven different types of fracture (A1, A2, A3, B2, B3, C2, C3) under the OTA/AO fracture classification.Methods: Based upon an intramedullary nail fixation model of long bone fracture, we combined strain-regulated tissue differentiation theory with fuzzy logic algorithm and finite element analysis.Results: moderate fixation stiffnesses (e.g., 1500-2500 N/mm) shortened the healing time while ensuring recovery of the biomechanical performance of the fractured bone. However, the appropriate fixation stiffness for each fracture type is different. The sensitivity of the healing outcomes to the change of the fixation stiffness was also different between different fracture types. For type A fracture, a fixation stiffness of 1500 N/mm was associated with an optimal biomechanical recovery of the fractured site while the change in fixation stiffness had a large effect on healing; for type B and C fractures, the change in fixator stiffness above 1500 N/mm did not appreciably affect the healing results.Conclusions: Therefore, the fracture healing outcomes are affected by both the fixator stiffness and fracture type. When treating fractures in clinic, the selection of fixators should carefully take into account of fracture types.

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  • 收稿日期:2021-10-20
  • 最后修改日期:2021-12-06
  • 录用日期:2021-12-08
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