Lee Chian-Her, Shih Kao-Shang, Hsu Ching-Chi, Cho Tomas
Department of Orthopaedics, School of Medicine, College of Medicine, Taipei Medical University and Hospital, Taipei 110, Taiwan, ROC.
Department of Orthopaedics, School of Medicine, College of Medicine, Taipei Medical University and Hospital, Taipei 110, Taiwan, ROC; Department of Orthopedic Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 111, Taiwan, ROC; College of Medicine, Fu Jen Catholic University, Taipei 242, Taiwan, ROC.
Med Eng Phys. 2014 Jan;36(1):57-64. doi: 10.1016/j.medengphy.2013.09.005. Epub 2013 Oct 3.
Locking compression plates (LCPs) have been used to fix femoral shaft fractures. Previous studies have attempted to identify the best LCP screw positions and numbers to achieve the fixation stability. However, the determined screw positions and numbers were mainly based on the surgeons' experiences. The aim of this study was to discover the best number and positions of LCP screws to achieve acceptable fixation stability. Three-dimensional numerical models of a fractured femur with the LCP were first developed. Then, the best screw position and number of LCPs were determined by using a simulation-based particle swarm optimization algorithm. Finally, the results of the numerical study were validated by conducting biomechanical tests. The results showed that the LCP with six locking screws resulted in the necessary fixation stability, and the best combination of positions of locking screws inserted into the LCP was 1-5-6-7-8-12 (three locking screws on either side of the bone fragment with two locking screws as close as practicable to the fracture site). In addition, the numerical models and algorithms developed in this study were validated by the biomechanical tests. Both the numerical and experimental results can provide clinical suggestions to surgeons and help them to understand the biomechanics of LCP systems.
锁定加压钢板（LCPs）已被用于固定股骨干骨折。以往的研究试图确定最佳的LCP螺钉位置和数量以实现固定稳定性。然而，所确定的螺钉位置和数量主要基于外科医生的经验。本研究的目的是发现LCP螺钉的最佳数量和位置，以实现可接受的固定稳定性。首先建立了带有LCP的股骨骨折三维数值模型。然后，通过基于模拟的粒子群优化算法确定LCP的最佳螺钉位置和数量。最后，通过进行生物力学测试验证了数值研究的结果。结果表明，带有六枚锁定螺钉的LCP可实现必要的固定稳定性，插入LCP的锁定螺钉的最佳位置组合为1-5-6-7-8-12（在骨碎片两侧各有三枚锁定螺钉，另外两枚锁定螺钉尽可能靠近骨折部位）。此外，本研究中开发的数值模型和算法通过生物力学测试得到了验证。数值和实验结果均可为外科医生提供临床建议，并帮助他们理解LCP系统的生物力学原理。
