Xu Zhi, Li Yuwan, Tian Shoujin, Xu Xing, Zhou Hao, Yang Min
Department of Orthopedic, Zhangjiagang Fifth People's Hospital, No.120 Lefeng Road, Zhangjiagang, 215600, Jiangsu, China.
Department of Orthopaedics, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, Zhejiang, China.
Sci Rep. 2025 May 7;15(1):15913. doi: 10.1038/s41598-025-01085-0.
The aim of this study was to compare the clinical outcomes, biomechanical performance, and cost-effectiveness of finite element planning (FEP) with those of traditional (Trad) methods in the treatment of complex tibial plateau fractures in middle-aged and elderly patients to ultimately optimize treatment protocols, improve surgical efficiency, and reduce the economic burden on patients. Sixteen patients with complex tibial plateau fractures were randomly divided into FEP and Trad groups, with eight patients in each group. The FEP group underwent preoperative finite element analysis for personalized surgical planning and dual-plate fixation; the Trad group participated in traditional preoperative discussions and underwent a multi-plate fixation. Perioperative and postoperative indicators were collected from both groups, and the stress distribution and displacement under different internal fixation modes were evaluated using finite element analysis. Additionally, a cost-effectiveness analysis was conducted to compare the total costs of internal fixation and hospitalization. The surgical times were significantly shorter in the FEP group than in the Trad group (170.00 ± 59.52 vs. 240.00 ± 59.04 min, p = 0.033), and patients in the Trad group had shorter times to ambulation (12.88 ± 0.99 vs. 14.25 ± 1.49 days, p = 0.047). There were no significant differences between the groups in terms of postoperative orthopaedic scores, mobility indices, fracture healing times, or radiological indicators. Biomechanical analysis revealed that the multiplate fixation mode provided a more uniform stress distribution, but this difference was not statistically significant. In the FEP group, the total costs of internal fixation (4772.25 ± 217.31 vs. 8991.88 ± 2811.25 yuan, p = 0.004) and hospitalization (34796.75 ± 9749.19 vs. 65405.14 ± 28684.80 yuan, p = 0.013) were significantly lower. While ensuring clinical effectiveness, FEP demonstrated greater cost-effectiveness by shortening the surgery time and reducing internal fixation costs. Although the multiplate fixation mode was biomechanically superior to the dual-plate mode, it did not result in significant clinical advantages and was more costly. FEP improves the economic efficiency of treatment for complex tibial plateau fractures in middle-aged and elderly patients and is recommended. This study has certain limitations, such as a small sample size and a short follow-up period. Thus, larger-scale studies with longer-term follow-up data are needed to further validate these findings and explore whether all patient populations can benefit from these practices or if the benefits are limited to specific groups, such as elderly patients or those with certain types of fractures.
本研究旨在比较有限元规划（FEP）与传统（Trad）方法在治疗中老年复杂胫骨平台骨折时的临床疗效、生物力学性能和成本效益，以最终优化治疗方案、提高手术效率并减轻患者经济负担。16例复杂胫骨平台骨折患者被随机分为FEP组和Trad组，每组8例。FEP组术前行有限元分析以进行个性化手术规划并采用双钢板固定；Trad组参与传统术前讨论并采用多钢板固定。收集两组围手术期和术后指标，并使用有限元分析评估不同内固定方式下的应力分布和位移。此外，进行成本效益分析以比较内固定和住院的总成本。FEP组的手术时间显著短于Trad组（170.00±59.52 vs. 240.00±59.04分钟，p = 0.033），Trad组患者的下地行走时间较短（12.88±0.99 vs. 14.25±1.49天，p = 0.047）。两组在术后骨科评分、活动指数、骨折愈合时间或影像学指标方面无显著差异。生物力学分析显示，多钢板固定方式提供了更均匀的应力分布，但这种差异无统计学意义。FEP组的内固定总成本（4772.25±217.31 vs. 8991.88±2811.25元，p = 0.004）和住院总成本（34796.75±9749.19 vs. 65405.14±28684.80元，p = 0.013）显著更低。在确保临床疗效的同时，FEP通过缩短手术时间和降低内固定成本显示出更高的成本效益。虽然多钢板固定方式在生物力学上优于双钢板固定方式，但并未带来显著的临床优势且成本更高。FEP提高了中老年复杂胫骨平台骨折治疗的经济效率，值得推荐。本研究有一定局限性，如样本量小和随访期短。因此，需要开展更大规模的研究并获取长期随访数据，以进一步验证这些发现，并探索是否所有患者群体都能从这些做法中获益，或者这些益处是否仅限于特定群体，如老年患者或某些类型骨折的患者。
