| Objective:1.To build 3-D finite element model of adult the middle-lower of tibial fractures.Using finite element method,compare the comparative analysis effect of Locking plate internal fixator, Locking plate external fixator and unilateral external fixator treatment the middle-lower of tibial fractures. To assess the effect of Locking plate external fixator,provide a biomechanics theoretical basis for the clinical use of locking plates for external treatment adult middle-lower of tibial fractures.2.To folow-up of the Locking plate external fixator treatment the adult middle-lower of tibial fractures and to evaluate the clinic outcome. Methods:1. A healthy 28-year-old female patient choosed to make 128-row spiral CT scan from the upper edge of the beginning of the right knee patella 1.0cm to the lower ankle 5.0cm and achieve data for building the middle-lower of tibial fractures3-D finite element models by using Mimics10.0 digital interactive three-dimensional medical imaging processing software and Abaqus6.10 finite element processing software.The fracture model was assembled the locking plate, unilateral external fixation.After that,get the gress distribution,stress,diaplacement values and stiffness values by setting boundary and loading conditions,and axial compression, torsion loads and four-point bending load.2. A retrospective analysis 7cases of the anatomical Locking plate external fixator treatment the adult middle-lower of tibial fractures between June 2011 and August 2014 in our hospital.7cases were followed up with an average of 22.8 month(rang,7 to 36 months)including 3 males and 4 females with an average of 37.6 years At the surgery time.The clinical outcome was evaluated at the afteroperation time, the fracture healing time and at the final follow-up.the fracture healing Situation was reviewed by anteroposterior and lateral X-ray.Results:1.By finite element analysis, under different loading,the total displacement and X, Y, Z axis points displacement values of the tibial fracture placement of locking plate external fixation system are greater than locking plate internal fixation system, and smaller than unilateral external fixation system. The comparison of average stiffness values of the fixed system :the result of comparison of average axial stiffness values between locking plate internal fixation system( 2066.9259+0.0494), locking plate external fixation system( 256.7541+0.0011) and unilateral external fixation system(188.6585+0.0005)had statiatics significant(P<0.05).the result of comparison of average torsion stiffness values between locking plate internal fixation system( 225.3137+0.0003), locking plate external fixation system( 103.3419+0.0001) and unilateral external fixation system(97.7292+0.00006)had statiatics significant(P<0.05).the result of comparison of average bending stiffness values between locking plate internal fixation system( 225.3137+0.0003), locking plate external fixation system(109.0122+0.0002)and unilateral external fixation system(34.6815+0.00002)had statiatics significant(P<0.05).2.Clinical follow-up results:All patients of the fractures healed in an acceptable position.No clinically relevant malrotation or limb-length discrepancies were observed. limb functional recovery are excellent.All patients had excellent or good functional results and were walking freely at the final follow-up.Conclusion : 1. the stability of Locking plate external fixator treatment the middle-lower of tibial fractures are greater than locking plate internal fixation system, and smaller than unilateral external fixation system. the average stiffness values of Locking plate external fixator treatment the middle-lower of tibial fractures are greater than unilateral external fixation system and smaller than.locking plate internal fixation system.2.Locking plate external fixator treatment the middle-lower of tibial fractures can obtain satisfactory short medium-term effectiveness. |
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