北京生物医学工程

四孔螺钉肋骨接骨板治疗多发性肋骨骨折的力学分析

Mechanical analysis of four-hole screw rib plate in the treatment of multiple rib fractures

作者：黎健明王冬冬王晓奇王长涛王盛章

单位：复旦大学航空航天系(上海 200433) 复旦大学附属浦东医院胸外科(上海 201399）

关键词：四孔螺钉肋骨接骨板; 多发性肋骨骨折; 内固定; 有限元分析

分类号：R318.01

出版年·卷·期（页码）：2021·40·2（111-116）

摘要：

目的自主设计开发新型四孔螺钉肋骨接骨板，分析其在治疗多发性肋骨骨折中的力学特性并验证临床疗效。方法使用有限元方法，分析四孔螺钉肋骨接骨板固定后断骨的最大位移与骨折断面间隙，并与目前临床常用的六爪肋骨接骨板的固定效果进行对比，最后回顾临床数据验证其治疗多发性肋骨骨折的临床疗效。结果有限元分析结果表明,使用四孔螺钉肋骨接骨板固定后，断骨的最大位移降低，断面间隙缩小，固定效果优于六爪肋骨接骨板。但螺钉孔处存在应力集中，可能会损伤皮质骨。回顾分析复旦大学附属浦东医院30例使用四孔螺钉肋骨接骨板治疗多发性肋骨骨折的临床资料，术后患者胸痛症状明显减轻，呼吸恢复顺畅，术后CT显示骨折复位良好，验证了四孔螺钉肋骨接骨板的临床疗效。结论四孔螺钉肋骨接骨板对断骨固定良好，且对于大曲率肋骨的骨折情形适用性强，适用于治疗多发性肋骨骨折。

Objective A new four-hole screw rib plate was designed and developed independently, the goal of this paper was to analyze its mechanical properties in the treatment of multiple rib fractures and verify the clinical efficacy. Methods Finite element method was used to analyze the maximum displacement of broken ribs and fracture section gap after the fixation with four-hole screw rib plate, and then compared the fixation efficacy with the current clinical commonly used six-claw rib plate. Finally, the clinical data was reviewed to confirmed the clinical effect of the plate in the treatment of multiple rib fractures. Results The results of finite element analysis showed that the maximum displacement of the broken ribs was reduced and the fracture section gap was reduced after fixation with four-hole screw rib plate, and the fixation efficacy was better than that of the six-claw rib plate. However, the stress concentration at the screw hole may damage the cortical bone. Clinical data of 30 cases of multiple rib fractures treated with four-hole screw rib plate in Shanghai Pudong Hospital of Fudan University were retrospectively analyzed. The chest pain of the patients was obviously relieved after the operation, and the respiratory recovery was smooth. Postoperative CT reconstruction of the chest showed good restoration of the rib fractures, which verified the clinical efficacy of four-hole screw rib plate. Conclusions The four-hole screw rib plate has good fixation property for the broken ribs, and can be adaptive to rib fracture with large curvature, which make it suitable for the treatment of multiple rib fractures.

参考文献：

[1] 刘俊清, 胡晓冬, 王科, 等. 可吸收髓内钉与形状记忆合金环抱器治疗多发肋骨骨折的疗效比较[J] . 华北煤炭医学院学报, 2010,12(5):673.

[2] 刘洋, 胡长利, 石岩江, 等. 可吸收螺钉内固定治疗多发性肋骨骨折的临床疗效[J]. 现代生物医学进展, 2016,16(27):5287-5289.

[3] 廖海浪, 杨文彬, 王成日, 等. 形状记忆合金环抱器治疗肋骨骨折的临床评价[J]. 中国骨与关节损伤杂志, 2007, 22(8):685-686.

[4] 黎健明, 王冬冬, 王晓奇, 等. 三翼肋骨接骨板治疗多发性肋骨骨折及连枷胸的临床应用与力学分析[J]. 中国医疗器械杂志, 2020,44(5):395-398,435.

Li JM, Wang DD, Wang XQ, et al. Clinical application and mechanical analysis of the treatment of multiple rib fractures and flail chest using three-wings rib plate [J]. Chinese Journal of Medical Instrumentation, 2020,44(5):395-398, 435.

[5] 王长涛, 王盛章, 王伟中, 等. 四爪接骨板内固定治疗多发性肋骨骨折和连枷胸的有限元建模和临床分析[J]. 中国胸心血管外科临床杂志, 2013,20(5):551-554.

Wang CT, Wang SZ, Wang WZ, et al. Finite element modeling and clinical analysis of internal fixation of multiple rib fractures and flail chest using four-claw Ti-planes[J]. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2013,20(5):551-554.

[6] 李高阳. 纯钛肋骨接骨板和钛镍记忆合金环抱器在肋骨骨折内固定中的生物力学比较[D]. 石家庄: 河北医科大学, 2016.

Li GY. Biomechanical comparison of pure titanium rib plate and titanium nickel memory alloy connector on rib fracture internal fixation [D]. Shijiazhuang: Hebei Medical University, 2016.

[7] 王彦, 葛明. 纯钛肋骨爪型接骨板在多发性肋骨骨折中的运用[J]. 实用临床医药杂志, 2008,12(3): 63-64.

[8] 韩敏, 张旭峰, 王征. 胸腔镜下小切口纯钛肋骨接骨板固定术治疗多发性肋骨骨折的疗效分析[J]. 腹腔镜外科杂志, 2017,22(5):381-385.

Han M, Zhang XF, Wang Z. Curative effect analysis in thoracoscopic-assisted small incision titanium rib plate fixation for the treatment of multiple rib fracture [J]. Journal of Laparoscopic Surgery, 2017,22(5):381-385.

[9] 刘刚, 王树军, 张道忠, 等. 八爪型肋骨接骨板在外伤性肋骨骨折的临床应用[J]. 中国实用医药, 2013,8(36):23-24.

Liu G, Wang SJ, Zhang DZ, et al. Clinical application of octopussy rib plates in the treatment of traumatic rib fracture [J]. China Practical Medicine, 2013,8(36):23-24.

[10] 梁小军, 卢新源, 任涛, 等. 重建钢板在多发性肋骨骨折手术治疗中的应用[J]. 吉林医学, 2012, 33(17): 3600-3601.

Liang XJ, Lu XY, Ren T, et al. Application of reconstruction plate in the surgical treatment of patients with multiple rib fractures[J]. Jilin Medical Journal, 2012,33(17): 3600-3601.

[11] 费军, 余洪俊, 黄显凯, 等. 连枷胸手术内固定器械的选择和意义[J]. 创伤外科杂志, 2003,5(4):310-311, 306.

Fei J, Yu HJ, Huang XK et al. Form and significance of internal fixation in flail chest operation[J]. Journal of Traumatic Surgery, 2003,5(4):310-311, 306.

[12] Bottlang M, Walleser S, Noll M, et al. Biomechanical rationale and evaluation of an implant system for rib fracture fixation[J]. European Journal of Trauma and Emergency Surgery, 2010, 36(5): 417-426.

[13] Helzel I, Long W, Fitzpateick D, et al. Evaluation of intramedullary rib splints for less-invasive stabilisation of rib fractures[J]. Injury, 2009,40(10):1104-1110.

[14] 李沛雨, 许述财, 杜雯菁, 等. 中国人肋骨密质骨厚度的测定与特征分析[J]. 清华大学学报(自然科学版), 2017,57(8):815-820,831.

Li PY, Xu SC, Du WJ, et al. Measurement and characterization of the cortical bone thickness in Chinese human ribs[J]. Journal of Tsinghua University (Science and Technology), 2017,57(8):815-820,831.

[15] Magesh V, Sundar S. Finite element analysis of human rib bone and implant design[J]. J Pharm Sci, 2016:3039-3044.

[16] 卫延斌,史仪凯,高亚. 漏斗胸NUSS矫形的仿真分析[J]. 系统仿真学报, 2011,23(6):1284-1287.

Wei YB, Shi YK, Gao Y. Simulation of Nuss orthopedic for pectus excavatum [J]. Journal of System Simulation, 2011,23(6):1284-1287.

[17] 王方, 杨济匡, 李桂兵. 多种冲击载荷条件下的人体肋骨骨折有限元分析[J]. 力学学报, 2014,46(2):300-307.

Wang F, Yang JK, Li GB. Finite element analysis of human rib fracture under various impact loading conditions[J]. Chinese Journal of Theoretical and Applied Mechanics, 2014,46(2):300-307.

[18] 蔡志华, 兰凤崇, 陈吉清, 等. 基于汽车碰撞损伤的人体胸部有限元模型构建与验证[J]. 医用生物力学, 2013,28(1):36-43.

Cai ZH, Lan FC, Chen JQ, et al. Development and validation for finite element model of human thorax based on automotive impact injuries [J]. Journal of Medical Biomechanics, 2013, 28(1): 36-43.

[19] 王方, 杨济匡, 李桂兵. 准静态和动态载荷下的人体胸部响应有限元分析[J]. 汽车工程, 2014,36(2):189-194,203.

Wang F, Yang JK, Li GB. Finite element analysis on human thorax responses under quasi-static and dynamic loading [J]. Automotive Engineering, 2014,36(2):189-194,203.

[20] Marasco S, Quayle M, Summerhayes R, et al. An assessment of outcomes with intramedullary fixation of fractured ribs[J]. Journal of Cardiothoracic Surgery, 2016,11: 126.

[21] Bottlang M, Helzel I, Long W, et al. Less-invasive stabilization of rib fractures by intramedullary fixation: a biomechanical evaluation[J]. The Journal of Trauma, 2010, 68(5): 1218-1224.

[22] Marasco SF, ?utalo ID, Bui AV. Mode of Failure of Rib Fixation With Absorbable Plates: A Clinical and Numerical Modeling Study[J].The Journal of Trauma, 2010,68(5):1225-1233.

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