老年肱骨近端内侧皮质不稳定性骨折不同内固定方式生物力学研究和有限元分析

随着我国人口老龄化，想保留肩关节功能，老年肱骨近端骨折行内固定手术患者越来越多，相应治疗失败病例时有发生，我们发现主要集中在严重骨质疏松、伴肱骨近端内侧皮质存在不稳定老年患者。因此如何提高肱骨近端骨折部位的固定强度，是一项非常有意义的工作。本课题拟制作肱骨近端缺损骨折模型，分别应用钢板系统（A.单纯锁定钢板固定、B.锁定钢板+异体腓骨干、C.锁定钢板+解剖腓骨髓内支撑、D.内外侧双钢板）和髓内固定系统（E.髓内钉、F.Multilock、G.解剖髓内支撑肱骨近端内固定系统）固定，在多种应力作用下进行生物力学测试并和对侧对比；建立骨缺损的肱骨近端骨折有限元模型、不同内固定物固定的有限元模型.通过基于成CT和MRI 扫描数据的有限元分析分别考察不同内固定物固定伴骨缺损的肱骨近端骨折的稳定性以及应力应变分布，与生物力学试验相补充，更加全面地反映不同内固定物固定效果，帮助临床医生选择最佳治疗方案。

With China's aging population, more and more old patients suffering from osteoporotic proximal humeral fracture wanted to preserve the shoulder functions and received internal fixation treatment. However, the corresponding treatment failure cases often occurred because of severely osteoporosis and medial cortex discontinuity or bone defect. Therefore, how to promote the stability of proximal humerus with intenal fixation will be a challenging work. This study intends to make proximal humeral fracture model with bone defect and apply plate system (A. isolated lateral locking plate; B. lateral locking plate + allograft fibula; C. lateral locking plate+ anatomic fibular intramedullary support; D. medial and lateral double locking plate) and intramedullary fixation system (E. custom intramedullary nail; F. Multilock nail; G. intramedullary anatomical support internal fixation system for proximal humerus) for fixing proximal humerus .We apply a variety of stress and biomechanical testing with contralateral contrast. Finite element analysis model with bone defect of proximal humerus and with different internal fixation system was established according to CT and MRI scanning data. The proximal humeral fracture stability and the distribution of stress and strain with seven kinds of internal fixation was measured, as the supplement of biomechanical testing. This will more comprehensively reflect the different internal fixation effect and help surgeon to choose the best scheme.