背景:内旋外旋(PER)IV型踝关节骨折的手术治疗有多种选择,包括腓骨钢板和螺钉的使用,这项研究的目的是通过有限元分析探讨不同内固定方法治疗PERIV型踝关节骨折的生物力学稳定性和安全性。
方法:建立了一个健康的26岁成年男性的踝关节和全足的三维有限元模型,并根据其下肢的计算机断层扫描图像进行了验证,并使用计算机辅助设计制作了PERIV型踝关节骨折和钢板螺钉模型。模拟四种不同的内固定方式,包括(所有踝关节固定-利用腓骨钢板和螺钉进行踝关节的全面稳定),b(下胫腓关节固定+全踝固定),c(下胫腓关节固定+前踝关节未固定)d(下胫腓骨关节固定+前、后踝关节未固定)。通过有限元分析比较了四种不同固定方法的结果,和冯·米塞斯的压力。分析了四种不同固定方法的位移作为输出指标。
结果:在四种内固定方式中,使用腓骨钢板和螺钉的结果与骨折断裂的位移之间没有显着差异。胫骨关节中的vonMises应力,踝关节正中,后踝关节,前踝关节在D的工作状态下最小化,D,B,分别为d。腓骨板和螺钉中的vonMises应力在a的工作条件下最小化。腓骨远端的vonMises应力在a的工作条件下最小化。然而,应力主要集中在下胫腓前韧带的附着点,在下胫腓关节固定的工作状态下,在所有腓骨钢板和螺钉中,应力明显集中在下胫腓骨关节螺钉上。
结论:这项研究的结果表明,使用有限元分析来比较四种配置的腓骨钢板和螺钉治疗PERIV型踝关节骨折的生物力学稳定性和安全性的可行性。所有四种模式都提供了相当的生物力学稳定性和安全性,没有显着差异。然而,有限元分析方法的当前局限性排除了特定的临床推论.在未来的研究中,有必要进一步完善该方法,以实现可靠的临床应用。
BACKGROUND: There are many options for the surgical treatment of pronation external rotation (PER) type IV ankle fractures, including the use of fibular plates and screws, the aim of this study was to investigate the biomechanical stability and safety of different internal fixation methods for PER type IV ankle fractures via finite element analysis.
METHODS: A three-dimensional finite element model of the ankle joint and the whole foot of a healthy 26-years-old adult male was established and validated based on computed tomography images of his lower limb, and a computer-aided design was used to produce a PER type IV ankle fracture and plate and screw model. Four different internal fixation modes were simulated, including a (all ankle fixation-utilizing a fibular plate and screws for comprehensive stabilization of the ankle), b (inferior tibiofibular joint fixation + all ankle fixation), c (inferior tibiofibular joint fixation + unfixed anterior ankle), and d (inferior tibiofibular joint fixation + unfixed anterior and posterior ankles). The results of the four different fixation methods were compared via finite element analysis, and the von Mises stresses. The displacements of the four different fixation methods were analyzed as the output indices.
RESULTS: There were no significant differences between the results of using fibular plates and screws and the displacement of fracture breaks among the four internal fixation modalities. The von Mises stress in the tibiotalar joint, median ankle, posterior ankle, and anterior ankle was minimized in the working condition of d, d, b, and d respectively. The von Mises stress in the fibular plate and screws was minimized in the working condition of a. The von Mises stress in the distal fibula was minimized in the working condition of a. However, the stress was mainly concentrated at the attachment point of the inferior tibiofibular anterior ligament, and in the working condition with inferior tibiofibular joint fixation, the stress was significantly concentrated in the inferior tibiofibular joint screw in all the fibular plates and screws.
CONCLUSIONS: The results of this study demonstrate the feasibility of using finite element analysis to compare the biomechanical stability and safety of four configurations of fibular plates and screws for treating PER type IV ankle fractures. All four modalities provided comparable biomechanical stability and safety, showing no significant differences. However, the current limitations of the finite element analysis methodology preclude specific clinical inferences. Further refinement of the methodology in future studies is necessary to enable reliable clinical applications.