Ni Ming, Zhang Fangfang, Mei Jiong, James Lin Chia-Ying, M S Gruber Stacey, Niu Wenxin, Wai-Chi Wong Duo, Zhang Ming
Department of Orthopaedics, Pudong New Area Peoples' Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai 201299, P.R. China.
Department of Biomedical Engineering, College of Engineering and Applied Sciences, University of Cincinnati, Cincinnati, OH 45221, USA.
Exp Ther Med. 2020 Sep;20(3):2106-2112. doi: 10.3892/etm.2020.8898. Epub 2020 Jun 17.
Sufficient stabilization of comminuted mid-shaft clavicle fractures via plate fixation is difficult to achieve. Various augmentations, including interfragmentary screws and cerclage wiring, have been adopted to reinforce fixation stability. The present study aimed to assess the biomechanical stability of augmented plate fixations using the finite element method. First, a clavicle fracture model was created from CT data. Fixation was then induced using a locking compressive plate (LCP) with the following four augmentations: i) Double inner cerclage wirings (DICW), ii) double outer cerclage wirings (DOCW), iii) a single interfragmentary screw (SIS) and iv) double interfragmentary screws (DIS). Compressive and bending forces of 100 N were subsequently applied at the acromial region of the clavicle. The stress distribution, displacement and fracture micro-motions of the model were assessed and compared. The DOCW resulted in the highest stress exerted on the LCP, followed by SIS, DICW and DIS. For the clavicle fracture, DICW, DOCW and SIS resulted in high stress levels. However, DIS fixation alone resulted in levels of stress that were below the yield strength of cortical bone. Displacement analysis revealed that DOCW fixation resulted in the greatest degree of displacement and fracture micro-motions, followed by SIS, DICW and DIS. The results indicated that SIS, DIS and DOCW may be used as augmentations of LCP fixation for comminuted mid-shaft clavicle fractures. However, DIS was the recommended augmentation due to it exerting the lowest stress and the highest stability compared with the other fixations. The DICW may be used to aid fracture reduction and plate placement in surgery but should be avoided for permanent fixation.
通过钢板固定来充分稳定粉碎性锁骨中段骨折是很难实现的。人们采用了包括骨折块间螺钉和环扎钢丝在内的各种增强方法来加强固定稳定性。本研究旨在使用有限元方法评估增强钢板固定的生物力学稳定性。首先，根据CT数据创建锁骨骨折模型。然后使用锁定加压钢板（LCP）进行固定，并采用以下四种增强方式：i）双内侧环扎钢丝（DICW），ii）双外侧环扎钢丝（DOCW），iii）单枚骨折块间螺钉（SIS）和iv）双枚骨折块间螺钉（DIS）。随后在锁骨肩峰区域施加100 N的压缩力和弯曲力。评估并比较模型的应力分布、位移和骨折微动情况。DOCW导致LCP上施加的应力最高，其次是SIS、DICW和DIS。对于锁骨骨折，DICW、DOCW和SIS导致高应力水平。然而，单独的DIS固定导致的应力水平低于皮质骨的屈服强度。位移分析表明，DOCW固定导致的位移和骨折微动程度最大，其次是SIS、DICW和DIS。结果表明，SIS、DIS和DOCW可作为LCP固定粉碎性锁骨中段骨折的增强方式。然而，由于与其他固定方式相比，DIS产生的应力最低且稳定性最高，因此推荐使用DIS。DICW可用于手术中辅助骨折复位和钢板放置，但应避免用于永久固定。
