Jian Zhen, Jiang Xinhua, Li Dejian, Zhou Jianhua, Yu Baoqing, Yi Chengqing
Department of Orthopedics, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China.
Department of Orthopedics, Seventh People's Hospital of Shanghai, Shanghai, China.
Front Surg. 2024 Jul 15;11:1346462. doi: 10.3389/fsurg.2024.1346462. eCollection 2024.
This study aims to analyze the biomechanical characteristics of posterolateral plateau fractures fixed by a novel anatomical plate using finite element analysis.
A three-dimensional digital model of the full length of right tibiofibula was obtained by CT scanning. A posterolateral tibial plateau fracture model was then created. The acquired fracture model was assembled with 4 groups of internal fixations: Group A, novel anatomical plate; Group B, straight buttress plate; Group C, oblique T-shaped locking plate; Group D, two lag screws. Axial loads of 500, 1,000 and 1,500 N perpendicular to the horizontal plane were used to simulate the stress on the lateral plateau of a 65 kg person standing, walking and fast running.
Vertical displacements of the posterolateral fragments in each of the four groups gradually increased under loads from 500 N to 1,500 N. The maximum displacement of the fracture fragment in four groups were all located on the lateral side of the proximal part, and the displacement gradually decreased from the proximal part to the distal end. The maximum displacement values under the axial load of 1,500 N was in the following order: novel anatomical plate (1.2365 mm) < oblique T-shaped locking plate (1.314 mm) < two lag screws (1.3747 mm) < straight buttress plate (1.3932 mm). As the axial load increased, the stress value of the different internal fixation models gradually increased. The stress behavior of the same internal fixation model under different loads was similar. The maximum stress value under the axial load of 1,500 N was in the following order: novel anatomical plate (114.63 MPa) < oblique T-shaped locking plate (277.17 MPa) < two lag screws (236.75 MPa) < straight buttress plate (136.2 MPa).
The patients with posterolateral plateau fractures fixed with a novel anatomical plate in standing, walking and fast running can achieve satisfactory biomechanical results, which lays the foundation for future applications. At the same time, clinical fracture types are often diverse and accompanied by damage to the soft tissue. Therefore, the ideal surgical approach and appropriate internal fixation must be selected based on the patient's injury condition.
本研究旨在通过有限元分析，分析一种新型解剖钢板固定后外侧平台骨折的生物力学特性。
通过CT扫描获得右侧胫腓骨全长的三维数字模型。然后建立胫骨后外侧平台骨折模型。将获得的骨折模型与4组内固定装置进行组装：A组，新型解剖钢板；B组，直形支撑钢板；C组，斜T形锁定钢板；D组，两枚拉力螺钉。使用垂直于水平面的500、1000和1500 N轴向载荷，模拟一名65 kg体重的人站立、行走和快速奔跑时外侧平台的应力。
在500 N至1500 N载荷下，四组中外侧骨折块的垂直位移逐渐增加。四组中骨折块的最大位移均位于近端外侧，且位移从近端向远端逐渐减小。在1500 N轴向载荷下的最大位移值顺序为：新型解剖钢板（1.2365 mm）＜斜T形锁定钢板（1.314 mm）＜两枚拉力螺钉（1.3747 mm）＜直形支撑钢板（1.3932 mm）。随着轴向载荷增加，不同内固定模型的应力值逐渐增大。同一内固定模型在不同载荷下的应力表现相似。在1500 N轴向载荷下的最大应力值顺序为：新型解剖钢板（114.63 MPa）＜斜T形锁定钢板（277.17 MPa）＜两枚拉力螺钉（236.75 MPa）＜直形支撑钢板（136.2 MPa）。
采用新型解剖钢板固定后外侧平台骨折的患者在站立、行走和快速奔跑时可获得满意的生物力学结果，为其未来应用奠定了基础。同时，临床骨折类型往往多样且伴有软组织损伤。因此，必须根据患者的损伤情况选择理想的手术入路和合适的内固定方式。
