Wei Guoqiang, Niu Xiaofen, Li Yuan, Chang Tingjie, Zhang Jianfang, Wang Haiyan, Li Xiaohe, He Yujie, Wang Ruijiang, Tian Fei, Xu Yangyang
Department of Rehabilitation Medicine, Changzhi Medical College Affiliated Changzhi People's Hospital, Changzhi, China.
Department of Orthopedics, Changzhi Medical College Affiliated Peace Hospital, Changzhi, China.
Front Bioeng Biotechnol. 2023 Jun 14;11:1199944. doi: 10.3389/fbioe.2023.1199944. eCollection 2023.
Complex bone plateau fractures have been treated with bilateral plate fixation, but previous research has overemphasized evaluating the effects of internal fixation design, plate position, and screw orientation on fracture fixation stability, neglecting the internal fixation system's biomechanical properties in postoperative rehabilitation exercises. This study aimed to investigate the mechanical properties of tibial plateau fractures after internal fixation, explore the biomechanical mechanism of the interaction between internal fixation and bone, and make suggestions for early postoperative rehabilitation and postoperative weight-bearing rehabilitation. By establishing the postoperative tibia model, the standing, walking and running conditions were simulated under three axial loads of 500 N, 1000 N, and 1500 N. Accordingly, finite element analysis (FEA) was performed to analyze the model stiffness, displacement of fractured bone fragments, titanium alloy plate, screw stress distribution, and fatigue properties of the tibia and the internal fixation system under various conditions. The stiffness of the model increased significantly after internal fixation. The anteromedial plate was the most stressed, followed by the posteromedial plate. The screws at the distal end of the lateral plate, the screws at the anteromedial plate platform and the screws at the distal end of the posteromedial plate are under greater stress, but at a safe stress level. The relative displacement of the two medial condylar fracture fragments varied from 0.002-0.072 mm. Fatigue damage does not occur in the internal fixation system. Fatigue injuries develop in the tibia when subjected to cyclic loading, especially when running. The results of this study indicate that the internal fixation system tolerates some of the body's typical actions and may sustain all or part of the weight early in the postoperative period. In other words, early rehabilitative exercise is recommended, but avoid strenuous exercise such as running.
复杂的胫骨平台骨折已采用双侧钢板固定进行治疗，但以往的研究过于强调评估内固定设计、钢板位置和螺钉方向对骨折固定稳定性的影响，而忽视了内固定系统在术后康复锻炼中的生物力学特性。本研究旨在探讨胫骨平台骨折内固定后的力学性能，探索内固定与骨骼相互作用的生物力学机制，并为术后早期康复和术后负重康复提出建议。通过建立术后胫骨模型，在500 N、1000 N和1500 N三种轴向载荷下模拟站立、行走和跑步条件。据此，进行有限元分析（FEA），以分析模型刚度、骨折骨块位移、钛合金钢板、螺钉应力分布以及胫骨和内固定系统在各种条件下的疲劳性能。内固定后模型刚度显著增加。内侧前钢板受力最大，其次是内侧后钢板。外侧钢板远端的螺钉、内侧前钢板平台处的螺钉和内侧后钢板远端的螺钉受力较大，但处于安全应力水平。两个内侧髁骨折块的相对位移在0.002 - 0.072 mm之间。内固定系统未发生疲劳损伤。胫骨在承受循环载荷时会出现疲劳损伤，尤其是在跑步时。本研究结果表明，内固定系统能够耐受身体的一些典型动作，并且在术后早期可能承受全部或部分体重。换句话说，建议进行早期康复锻炼，但应避免跑步等剧烈运动。
