腓骨内植入物材质的选择及螺钉布局方式

为了探究不同螺钉数量的布局方式、接骨板材质对腓骨骨折愈合过程中的影响。利用组合梁理论验证了腓骨内固定模型的有效性后，在ANSYS Workbench中模拟3种腓骨骨折内固定方案术后康复前期、后期的受力过程，分析螺钉的布局方式、接骨板材质对腓骨、接骨板的应力的影响，并计算了骨折区域的应力遮挡率。研究结果表明：B₁、B₂和B₃内固定方案的接骨板应力集中现象均主要在接骨板的中间区域，而腓骨的应力集中现象主要在骨折块末端内侧的螺钉孔处。螺钉的不同布局方式对应力遮挡率的影响小于接骨板材质对应力遮挡率的影响，接骨板材质的杨氏模量越大，对应力遮挡率的影响愈大。从生物力学角度考虑，金属接骨板联接的腓骨内侧表面最容易受到损伤，康复期可佩戴护具来减少损伤。组合方案B₂C₁既能够提供在骨愈合时内固定系统所需的稳定性，也可以保证较低的应力遮挡和足够的刚度，是腓骨远端骨折值得推荐的内固定方式之一。

Study of intra-articular fibular implants plate material and screw configuration

In order to investigate the effects of different screws configuration methods and joint plate materials on the fibular fracture healing process. The combined beam theory was used to verify the internal fixation model of the fibula, different internal fixation schemes of fibula fractures in every postoperative rehabilitation stages were simulated in ANSYS Workbench, stresses distribution on the fibula and the splinters were analyzed by screw configuration method and the splinters material, then stress shielding rate of the fracture region was calculated. The results showed that: (1) The stress concentration for all the internal fixation schemes of B1, B2 and B3 on the splinters was mainly in the middle area of the plates, while the stress concentration for the fibula was mainly at the screw holes on the medial side of fracture block end. (2) The effect of different screw configurations on the stress shielding rate was less than that of the material of the plate, and the greater the Young''s modulus of the plate material, the greater the effect on the stress shielding rate. The medial surface of the fibula connected with a metal plate is most vulnerable to damage on Biomechanics, and a brace can be worn to reduce the damage during the rehabilitation period. The combined scheme B2-C1 can offer the required stability of the internal fixation system during bone healing, but also ensure less stress shielding and sufficient stiffness, which is one of the recommended internal fixation methods for distal fibula fractures.