PDF(Pubmed)
Abstract：
Minimally invasive plate osteosynthesis is the most commonly used minimally invasive surgery technique for tibial fractures, possibly involving single or dual plate methods. Herein, we performed a finite element analysis to investigate plate strength according to the plate type, length, and presence of a fibula by constructing a three-dimensional tibia model. A thickness of 20 mm was cut 50 mm distal from the lateral plateau, and the ligaments were created. Plates were modeled with lengths of 150, 200, and 250 mm and mounted to the tibia. Screws were arranged to avoid overlapping in the dual plating. The von-Mises stress applied to the plates was measured by applying a load of 1 body weight. Dual plates showed the least stress with low displacement, followed by medial and lateral plates. As the plate length increased, the average stress gradually decreased, increasing plate safety. The difference in the influence of the fibula depending on the presence of proximal fibula osteotomy showed that the average stress increased by 35% following proximal fibula osteotomy in the D1(Plate type: Dual plate, Medial plate length: 150 mm, Lateral plate length: 200 mm, Non Proximal fibula osteotomy) and D1P(Plate type: Dual plate, Medial plate length: 150 mm, Lateral plate length: 200 mm, Proximal fibula osteotomy) models, confirming the necessity of the fibula model. There is no consensus guideline for treatment of this kind of fracture case. A single fracture plate can decrease the risk of skin damage, ligament damage, and wound infection, but because of its design, it cannot provide sufficient stability and satisfactory reduction of the condylar fragment, especially in cases of comminution or coronal fracture. So, these results will help clinicians make an informed choice on which plate to use in patients with tibial fractures.
摘要：
微创钢板接骨术是治疗胫骨骨折最常用的微创手术技术,可能涉及单板或双板方法。在这里，我们进行了有限元分析，以根据板类型研究板的强度，长度,通过构建三维胫骨模型来实现腓骨的存在。在远离外侧平台的50mm处切割20mm的厚度,并创建了韧带。板以150、200和250mm的长度建模并安装到胫骨。布置螺钉以避免在双镀层中重叠。通过施加1体重的负荷来测量施加到板的von-Mises应力。双板在低位移下显示出最小的应力，其次是内侧和外侧板。随着板长度的增加，平均应力逐渐降低，提高板的安全性。根据腓骨近端截骨术的存在，腓骨影响的差异表明，D1近端腓骨截骨后平均应力增加了35％（钢板类型：双板，中板长度：150毫米，侧板长度：200毫米，非腓骨近端截骨术)和D1P(钢板型:双钢板,中板长度：150毫米，侧板长度：200毫米，腓骨近端截骨)模型，证实腓骨模型的必要性。对于此类骨折病例的治疗尚无共识指南。单个骨折钢板可以降低皮肤损伤的风险，韧带损伤,伤口感染,但是因为它的设计，它不能提供足够的稳定性和令人满意的减少髁突碎片，尤其是在粉碎性骨折或冠状骨折的情况下。所以,这些结果将有助于临床医生在胫骨骨折患者中选择使用哪种钢板。
