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外侧皮质固定作为实现肋骨骨折稳定性的最佳策略：一项基于患者的有限元分析

Lateral Cortical Fixation as the Optimal Strategy for Achieving Stability in Rib Fractures: A Patient-Specific Finite Element Analysis.

作者信息

Zhang Xiang, Lan Xuejun, Shen Wang, Zhou Qinghua

机构信息

Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.

Lung Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China.

出版信息

Bioengineering (Basel). 2025 May 31;12(6):594. doi: 10.3390/bioengineering12060594.

DOI:10.3390/bioengineering12060594
PMID:40564411
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12189894/
Abstract

The surgical stabilization of rib fractures helps maintain chest wall stability and reduces respiratory complications. This study aimed to identify the key biomechanical parameters for evaluating the stability of rib fracture fixation using finite element analysis (FEA) and compare four rib fixation configurations-intramedullary rib splint (IRS), locking plate (LP), claw-shape plate, and intrathoracic plate (IP)-using biomechanical analysis. Forty patient-specific FEA models of fourth-rib fractures were constructed using the computed tomography scans of 10 patients. Maximum implant displacement (MID), maximum rib fracture displacement, maximum implant von Mises stress (MIVMS), maximum rib von Mises stress, maximum rib strain, and maximum interfragmentary gap (MIG) were assessed by simulating the anterior and posterior loads on the ribs during postoperative frontal collision. The fixation stabilities were evaluated using entropy scores. MIVMS, MIG, and MID exhibited the highest weighting coefficients. Lateral cortical fixation strategies, particularly LP configuration, demonstrated superior biomechanical performance compared with IRS and IP systems. The composite score of the LP was significantly higher than that of the other modalities. MIVMS, MIG, and MID were identified as critical parameters for evaluating the rib fracture fixation stability, and the lateral cortical fixation strategy (LP) enhanced the structural stability of rib fracture fixation.

摘要

肋骨骨折的手术固定有助于维持胸壁稳定性并减少呼吸并发症。本研究旨在使用有限元分析（FEA）确定评估肋骨骨折固定稳定性的关键生物力学参数，并通过生物力学分析比较四种肋骨固定构型——髓内肋骨夹板（IRS）、锁定钢板（LP）、爪形钢板和胸腔内钢板（IP）。利用10名患者的计算机断层扫描构建了40个第四肋骨骨折的患者特异性FEA模型。通过模拟术后正面碰撞时肋骨上的前后负荷，评估最大植入物位移（MID）、最大肋骨骨折位移、最大植入物冯·米塞斯应力（MIVMS）、最大肋骨冯·米塞斯应力、最大肋骨应变和最大骨折间隙（MIG）。使用熵得分评估固定稳定性。MIVMS、MIG和MID表现出最高的加权系数。与IRS和IP系统相比，外侧皮质固定策略，尤其是LP构型，表现出更好的生物力学性能。LP 的综合得分显著高于其他方式。MIVMS、MIG和MID被确定为评估肋骨骨折固定稳定性的关键参数，外侧皮质固定策略（LP）增强了肋骨骨折固定的结构稳定性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/62c0/12189894/7f0af95876fe/bioengineering-12-00594-g007.jpg
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