Medial açıklığı olan proksimal humerus kırıklarında kilitli plak tespiti üzerinde medial kortikal ve medial vida desteklerinin biyomekanik etkisi:Sonlu elemanlar yöntemi

Yıl 2015, Cilt: 49 Sayı: 2, 203 - 209, 22.05.2015

Pan Yang Ying Zhang Jian Liu Jin Xiao Li Min Ma Chang Rong Zhu

https://doi.org/10.3944/AOTT.2015.14.0204

Öz

Amaç: Bu sonlu elemanlar yöntemi, medial açıklığı olan proksimal humerus kırıklarının implant-kemik ara yüzeyindeki yüklerde medial kortikal ve medial vida desteklerinin etkisini araştırmayı amaçladı.

Çalışma planı: Sağlıklı bir gönüllüden alınan sağlam humerus 3 boyutlu (3D) bilgisayar-destekli tasarım (BDT) modelinde kaynak olarak kullanıldı. Kilitli plak sisteminin 3D BDT modeli, üretici firmanın kılavuzundaki bilgiler üzerine kuruldu. Humerusun proksimal kısmı, standart üç-parça kırıkları yaratmak için osteotomize edildi ve sonra –MKD grubu (medial kortikal desteği eksik ve bu eksiklik kırıklarda 5 mm’lik medial kemik açıklığı kaynaklı) ve +MKD grubu (medial kortikal destek mevcut ve bu destek kırıklarda kortikalden kortikale medial temas kaynaklı) olarak ikiye ayrıldı. Her iki kırık grubu ya +MVD (ki burada medial vida desteği kilitli plak sistemine ilave iki kalkar vidası eklentisi ile sağlandı) ya da –MVD (ki burada medial vida desteği eksikliği kilitli plak sistemine ilave iki kalkar vidası eklenmemesi ile sağlandı) ile sırasıyla onarıldı. Bütün modelleme 90°’lik kol abdüksiyonunu yansıtmak için yürütüldü.

Bulgular: Vida-kemik ara yüzeyinde medial vida desteği ve medial kortikal destek maksimum kayma gerilimini sırasıyla %17 ve %23 oranında azalttı. Kilitli plak üzerinde, medial vida desteği ve medial kortikal destek maksimum von Mises gerilimini sırasıyla %11 ve %22 oranında azalttı. Ancak, bu ikisinin kombinasyonunun vida-kemik ara yüzeyi için maksimum kayma gerilimini %56 oranında ve kilitli plak için maksimum von Mises gerilimini %54 oranında azalttığı göründü.

Çıkarımlar: Medial açıklığı olan proksimal humerus kırıklarının kilitli plak tespiti sırasında varusta iyi medial kortikal temas ile bileşik kalkar vida yerleştirilmesi tespit için optimal stabilite sağlayabilir.

 

Anahtar Kelimeler

Biyomekanik; sonlu elemanlar yöntemi; kilitli plak; omuz kırıkları.

Biomechanical effect of medial cortical support and medial screw support on locking plate fixation in proximal humeral fractures with a medial gap: a finite element analysis

Öz

Objective: This finite element analysis aimed to examine the effect of medial cortical support and medial screw support on loads at the implant-bone interface of locking plate fixation of proximal humeral fractures with a medial gap.

Methods: An intact humerus from a healthy volunteer was used as the basis for a 3-dimensional (3D) computer-aided design (CAD) model. The 3D CAD model of the locking plate system was based on information in the manufacturer’s catalogue. The proximal part of the humerus was osteotomized to create standard three-part fractures, which were then divided into a –MSC group (which lacked medial cortical support, and in which fractures with a 5-mm medial bone gap simulated this lack) and +MCS group (which had medial cortical support, and in which fractures with medial corticalto-cortical contact simulated this). Both fracture groups were respectively fixed with either +MSS (in which medial screw support was simulated by the addition of two calcar screws to the locking plate system), or with –MSS (in which the lack of medial screw support was simulated by absence of the two additional calcar screws to the locking plate system). All the modeling was conducted to represent 90° arm abduction.

Results: On the screw-bone interface, medial screw support and medial cortical support decreased maximum shear stress by 17% and 23% respectively. On the locking plate, medial screw support and medial cortical support decreased maximum von Mises stress by 11% and 22% respectively. However,a combination of these two appeared to decrease maximum shear stress by 56% for the screw-bone interface, and maximum von Mises stress by 54% for the locking plate.

Conclusion: Placement of calcar screws combined with good medial cortical contact in varus in locking plate fixation of proximal humeral fractures with a medial gap may provide optimal stability for the fixation.

 

Anahtar Kelimeler

Biomechanics, finite element analysis, locking plate, shoulder fractures

Kaynakça

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