收稿日期: 2023-11-13
网络出版日期: 2024-04-19
基金资助
上海健康医学院运动医学临床研究中心科研课题(20MC2020003)
A biomechanical comparison of three types of internal fixation for posterior malleolar fracture
Received date: 2023-11-13
Online published: 2024-04-19
目的 基于计算机三维有限元技术方法研究Haraguchi Ⅱ型后踝骨折不同内固定材料的生物力学特性，确定后踝骨折的最佳内固定材料，为临床提供基础理论支持。 方法 通过计算机三维有限元技术，建立后踝空心螺钉固定+内踝空心螺钉（A组）、后踝支撑钢板固定+内踝空心螺钉（B组）和后踝重建钢板固定+内踝空心螺钉（C组）三种不同内固定材料固定Haraguchi Ⅱ型后踝骨折的三维有限元模型，并对模型行生物力学分析，比较各组内固定材料的优劣性。 结果 两组钢板固定模型的最大主应力和胫骨应力要明显低于3枚空心螺钉固定模型组，而重建钢板组的应力又低于支撑钢板组；三组模型中内踝处空心螺钉的应力重建钢板组最小，空心螺钉组最大；胫骨的总位移变化范围空心螺钉组最大，支撑钢板组次之，重建钢板组最小。 结论 重建钢板固定Haraguchi Ⅱ型后踝骨折的生物力学稳定性最强，为一种比较理想的固定方法，对临床具有一定的指导性。
程邦君 , 黄燕峰 , 罗轶 . Haraguchi Ⅱ型后踝骨折3种内固定方式的有限元分析[J]. 实用医学杂志, 2024 , 40(8) : 1137 -1141 . DOI: 10.3969/j.issn.1006-5725.2024.08.020
Objective Based on computer three?dimensional finite element technology， this study investigates the biomechanical properties of different internal fixation materials for Haraguchi typeⅡ ankle fractures， determines the optimal internal fixation material for ankle fractures， and provides basic theoretical support for clinical practice. Methods Using computer three?dimensional finite element technology， a three?dimensional finite element model was established for the fixation of Haraguchi typeⅡ posterior ankle fractures using three different internal fixation materials： posterior ankle hollow screw fixation and inner ankle hollow screw （Group A）， posterior ankle support steel plate fixation and inner ankle hollow screw （Group B）， and posterior ankle reconstruction steel plate fixation and inner ankle hollow screw （Group C）. Biomechanical analysis was performed on the model to compare the advantages and disadvantages of the internal fixation materials in each group. Results The maximum principal stress and tibial stress of the two steel plate fixation models were significantly lower than those of the three hollow screw fixation model group， while the stress of the reconstructed steel plate group was lower than that of the supporting steel plate group； Among the three models， the stress reconstruction of the hollow screw at the inner ankle was the smallest in the steel plate group and the largest in the hollow screw group； The total displacement range of the tibia is the largest in the hollow screw group， followed by the supporting steel plate group， and the smallest in the reconstruction steel plate group. Conclusion Reconstructing steel plates to fix Haraguchi typeⅡ ankle fractures has the strongest biomechanical stability and is a relatively ideal fixation method， which has certain guidance for clinical practice.
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