屈任伸 梁錦成 黃彬鋮

[摘要]目的 探討有限元分析在橈骨遠(yuǎn)端骨折中的應(yīng)用效果。方法 采集正常橈骨CT薄層掃描圖像，憑借有限元分析軟件Ansys l0.0，三維重建軟件Mimics 10.01構(gòu)建橈骨遠(yuǎn)端有限元模型，并在此基礎(chǔ)上構(gòu)建橈骨遠(yuǎn)端骨折模型，采用傳統(tǒng)小夾板固定實(shí)現(xiàn)緊固的目標(biāo)。設(shè)定骨折端不穩(wěn)移位的壓縮，拉伸載荷分別是66.7 N，內(nèi)外旋載荷是22 N，同時(shí)對(duì)常規(guī)杉樹(shù)皮夾板的應(yīng)力發(fā)布情況進(jìn)行分析。結(jié)果 壓縮情況下，夾板系統(tǒng)應(yīng)力的最大值為29.89 Mpa;拉伸情況下，夾板系統(tǒng)應(yīng)力的最大值為25.48 Mpa;外旋情況下，夾板系統(tǒng)應(yīng)力的最大值及位移分別為32.69 Mpa;內(nèi)旋情況下，夾板系統(tǒng)應(yīng)力的最大值及位移分別為30.33 Mpa。結(jié)論 建模方式與實(shí)際橈骨力學(xué)性能的三維有限元模型非常接近，且可以將患者真實(shí)的臨床情況體現(xiàn)出來(lái)，并在此基礎(chǔ)上，對(duì)橈骨結(jié)構(gòu)及材料力學(xué)性能進(jìn)行深入研究，可確定橈骨在骨折時(shí)應(yīng)力應(yīng)變與夾板固定后的改變，進(jìn)而為夾板設(shè)計(jì)的完善及優(yōu)化提供參考。

[關(guān)鍵詞]橈骨遠(yuǎn)端骨折：傳統(tǒng)小夾板;外固定術(shù);有限元分析

[中圖分類(lèi)號(hào)] R683? ? ? ? ? [文獻(xiàn)標(biāo)識(shí)碼] A? ? ? ? ? [文章編號(hào)] 1674-4721（2019）8（a）-0086-03

[Abstract] Objective To explore the application effect of finite element analysis in distal radius fracture. Methods The normal humeral CT thin-layer scan image was acquired， and the finite element model of the distal radius was constructed by the finite element analysis software Ansys l0.0 and the three-dimensional reconstruction software Mimics 10.01， based on this， a distal radius fracture model was constructed， which was fixed by traditional small splint. The compression of the unstable displacement of the fracture end was set. The tensile load was 66.7 N and the internal and external rotation load was 22 N. At the same time， the stress release of the conventional cedar bark splint was analyzed. Results In the case of compression， the maximum stress of the splint system was 29.89 Mpa. Under tension， the maximum stress of the splint system was 25.48 Mpa. Under the circumstance of external rotation， the maximum stress and displacement of the splint system were 32.69 Mpa， respectively. In the case of internal rotation， the maximum stress and displacement of the splint system were 30.33 Mpa， respectively. Conclusion The modeling method is very close to the three-dimensional finite element model of the actual mechanical properties of the radius， and can reflect the real clinical situation of the patients. On this basis， the mechanical properties of the radius structure and materials are deeply studied. The stress-strain changes of the radius during fracture and the changes after splint fixation can be determined， and then splints can be set up. It provides reference for the improvement and optimization of the design.

[Key words] Distal radius fracture; Traditional small splint; External fixation; Finite element analysis

健康人的橈骨遠(yuǎn)端關(guān)節(jié)面向掌側(cè)的傾斜范圍為10°～15°，向尺側(cè)傾斜的范圍為20°～25°（尺傾角）。橈骨遠(yuǎn)端具備尺，掌，橈，背4個(gè)面，背側(cè)凸起，掌側(cè)光滑凹陷，共具備4個(gè)骨性腿溝，下尺橈關(guān)節(jié)是前臂旋轉(zhuǎn)的樞紐，其由尺側(cè)面構(gòu)成。若橈骨遠(yuǎn)端發(fā)生骨折的情況，不僅橈骨下端的關(guān)節(jié)面會(huì)改變角度，而且腿部肌肉會(huì)出現(xiàn)扭曲的情況。倘若復(fù)位的情況相對(duì)較差，會(huì)影響患者的腕與手指功能[1]。因此，橈骨遠(yuǎn)端若發(fā)生骨折的情況，務(wù)必運(yùn)用科學(xué)的固定方式及器械，固定物的位置、手術(shù)后的制動(dòng)設(shè)備會(huì)在很大程度上影響骨折患者的臨床治療。在橈骨遠(yuǎn)端骨折試驗(yàn)的實(shí)際應(yīng)用階段，采用有限元的方式針對(duì)腕關(guān)節(jié)的形變、骨小梁以及應(yīng)力進(jìn)行分析及研究?；颊叩墓钦鄄课槐还潭ê?，應(yīng)結(jié)合患者骨骼與鄰近軟組織對(duì)關(guān)節(jié)部的力學(xué)特性，采用合適的固定方法對(duì)患者進(jìn)行治療，同時(shí)分析各項(xiàng)體位與功能鍛煉對(duì)骨折斷端產(chǎn)生的作用及影響，應(yīng)用現(xiàn)代化的計(jì)算機(jī)技術(shù)進(jìn)行數(shù)據(jù)的輸出，能為患者的骨折治療奠定數(shù)據(jù)基礎(chǔ)。有限元分析方式的骨折仿真方式具備較強(qiáng)的吸引力，且治療效果較佳。有限元分析方式應(yīng)用模擬手術(shù)，能有效處理內(nèi)外固定后對(duì)關(guān)節(jié)所致的不良反應(yīng)，使動(dòng)物實(shí)驗(yàn)統(tǒng)計(jì)周期長(zhǎng)、繁瑣的不足之處得到彌補(bǔ)，現(xiàn)報(bào)道如下。