Objective To compare the biomechanical differences among three internal fixation methods by establishing a three-dimensional model of scaphoid waist fracture, so as to provide a method of selection of clinical internal fixation. Methods The wrist CT data of a healthy volunteer were selected. The application software was used to establish three internal fixation models of scaphoid waist fracture: a Kirschner wire fixation group, a Herbert screw fixation group, and a nail-feet-fixation device group. Load was applied to the neutral grip position and radial deviation-extension, and the deformation of the scaphoid, and the stress of the internal fixation device were analyzed. Results Among three internal fixation devices, the largest deformation of the scaphoid was under the action of the Kirschner wire, and the smallest was under the action of the nail holder. Under the two working conditions, the deformation of the scaphoid and the maximum stress of the fixture was different, but the trend was the same. Under the nail holder, both the scaphoid deformation and the maximum stress were the smallest. But the nail holder had an eccentric effect. When the load reached a critical value, the scaphoid healing surface was easily cracked or asymmetrically eccentric. Conclusion Kirschner wire fixation and nail-feet fixation is the worst and best in effect, respectively. The weight of the hand should be properly restricted after nail-feet fixation.
Key words
Scaphoid /
Waist fracture /
Internal fixation /
Finite element analysis
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References
[1] Meyer C, Chang J, Stern P, et al. Complications of distal radial and scaphoid fracture treatment[J]. J Bone Joint Surg Am, 2013, 95(16): 1517-1526.
[2] Hove LM. Epidemiology of scaphoid fractures in Bergen, Norway[J]. Scand J Plast Reconstr Surg Hand Surg, 1999, 33(4): 423-426.
[3] 洪加源, 肖建华, 曾荣铭. 掌侧逆行固定治疗腕舟骨腰部骨折三维有限元分析[J]. 生物骨科材料与临床研究, 2012, 9(1): 17-20.
[4] 郑文源, 陆芸, 孟立民, 等. 螺钉、克氏针内固定治疗距骨颈骨折的三维有限元分析[J]. 山东医药, 2013, 53(3): 7-9.
[5] 孟立民, 苏啸天, 张银光, 等. 微型外固定支架和克氏针治疗Bennett骨折的三维有限元分析[J]. 中国组织工程研究, 2012, 16(9): 1626-1630.
[6] Ezquerro F, Jiménez S, Pérez A, et al. The influence of wire positioning upon the initial stability of scaphoid fractures fixed using Kirschner wires a finite element study[J]. Med Eng Phys, 2007, 29(6): 652-660.
[7] 郭阳, 孙丽颖, 荣起国, 等. 舟骨骨折螺钉固定方式的有限元分析[J]. 骨科临床与研究杂志, 2017, 2(2): 101-104.
[8] Moritomo H, Apergis EP, Herzberg G, et al. 2007 IFSSH committee report of wrist biomechanics committee: biomechanics of the so-called dart-throwing motion of the wrist[J]. J Hand Surg Am, 2007, 32(9): 1447-1453.
[9] 徐达传, 黄美贤. 手舟骨的形态血供特点及其临床意义[J]. 中华关节外科杂志(电子版), 2010, (2): 251-255.
[10] 刘卫华, 唐曦, 王智, 等. Micro CT三维重建手舟骨相关显微影像解剖学数据测量[J]. 中国组织工程研究, 2014, 18(22): 3537-3541.
[11] 王敏, 周小兵, 赵胜, 等. 手舟骨血供3D可视化模型的制备[J]. 中国临床解剖学杂志, 2016, 34(6): 639-642.
[12] 张旭林, 何晓清, 徐永清. 腕舟骨骨折固定物研究进展[J]. 国际骨科学杂志, 2017, 38(6): 345-348.
[13]Li C, Xu X, Su Y, et al. Treatment of scaphoid fractures using a memory alloy nail-feet-fixation device[J]. ANZ J Surg, 2016, 86(7-8): 584-588.
[14]徐永清, 钟世镇, 徐达传, 等. 腕关节韧带解剖及组织学特性研究[J]. 中华创伤骨科杂志, 2005, 7(12): 1147-1151.
[15] Varga P, Zysset PK, Schefzig P, et al. A finite element analysis of two novel screw designs for scaphoid waist fractures[J]. Med Eng Phys, 2016, 38(2): 131-139.
