SchatzkerⅡ型胫骨平台骨折不同内固定方式的有限元分析

牛勇翔; 曹颖; 马旋; 吴石磊; 陈明; 黄玉成

doi:10.14188/j.1671-8852.2026.0868

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SchatzkerⅡ型胫骨平台骨折不同内固定方式的有限元分析

临床医学研究 | 更新时间：2026-11-05

- SchatzkerⅡ型胫骨平台骨折不同内固定方式的有限元分析
- Finite element analysis of different fixation methods for Schatzker Ⅱ tibial plateau fractures
- 武汉大学学报（医学版） 2026年47卷第10期页码：1345-1351
- 作者机构：
  
  1.江汉大学湖北武汉 430033
  2.武汉市第四医院/湖北省运动医学中心/湖北省骨科临床医学研究中心/运动损伤与精准治疗湖北省重点实验室湖北武汉 430033
- 作者简介：
  
  牛勇翔，男，2000—，医学硕士生，主要从事创伤骨科疾病的研究，E‐mail：1940580778@qq.com。
  陈明，E⁃mail：cm19720@163.com。
  黄玉成，E‐mail：ehyc836@163.com
- 基金信息：
  
  湖北省自然科学基金项目(JCZRLH202602028);武汉市卫健委医学科研项目(WX23A13)
- DOI：10.14188/j.1671-8852.2026.0868
  中图分类号： R687.4
- 收稿：2026-05-25，
  
  纸质出版：2026-10-25
- 稿件说明：
移动端阅览
牛勇翔,曹颖,马旋等.SchatzkerⅡ型胫骨平台骨折不同内固定方式的有限元分析[J].武汉大学学报（医学版）,2026,47(10):1345-1351.

NIU Yongxiang,CAO Ying,MA Xuan,et al.Finite element analysis of different fixation methods for Schatzker Ⅱ tibial plateau fractures[J].Medical Journal of Wuhan University,2026,47(10):1345-1351.
牛勇翔,曹颖,马旋等.SchatzkerⅡ型胫骨平台骨折不同内固定方式的有限元分析[J].武汉大学学报（医学版）,2026,47(10):1345-1351. DOI： 10.14188/j.1671-8852.2026.0868.

NIU Yongxiang,CAO Ying,MA Xuan,et al.Finite element analysis of different fixation methods for Schatzker Ⅱ tibial plateau fractures[J].Medical Journal of Wuhan University,2026,47(10):1345-1351. DOI： 10.14188/j.1671-8852.2026.0868.

摘要

目的

对比SchatzkerⅡ型胫骨平台骨折四种不同内固定方式的生物力学差异，明确人工骨填充和不同螺钉组合的力学优势，为临床个体化微创手术方案提供理论依据。

方法

选取一名健康成年男性志愿者，利用有限元软件构建SchatzkerⅡ型胫骨平台骨折模型。根据不同内固定方式分为4组，A组采用无人工骨填充+栅栏螺钉（前后双螺钉+外内双螺钉+防滑螺钉）；B组采用人工骨填充+栅栏螺钉（前后双螺钉+外内双螺钉+防滑螺钉）；C组采用人工骨填充+前后双螺钉+防滑螺钉；D组采用人工骨填充+外内双螺钉+防滑螺钉。在相同的支撑和约束条件下，运用有限元分析软件分析比较不同载荷下四种内固定模型的生物力学性能。

结果

在相同载荷下，D组内固定应力分布最均匀，整体应力表现最优；C组内固定应力水平最高，存在明显应力集中，力学性能最差。骨折位移方面，B组外侧骨折块及关节面骨块位移最小，固定稳定性最佳；C组的位移最大，固定稳定性最差。在A组和B组相同螺钉配置下，B组人工骨填充可有效分散内固定应力，降低骨折块位移幅度，提升整体固定稳定性。

结论

人工骨填充联合外内双螺钉+防滑螺钉固定，应力分布更合理，适用于简单骨折；人工骨填充联合栅栏螺钉固定整体稳定性最佳，适用于骨折塌陷严重患者；人工骨填充联合前后双螺钉+防滑螺钉固定力学效果最差，不推荐临床常规使用。

Abstract

Objective

To compare the biomechanical differences among four internal fixation methods for Schatzker Ⅱ tibial plateau fractures

and to identify the mechanical advantages of bone graft substitute combined with different screw configurations

thereby providing a theoretical basis for individualized minimally invasive surgical strategies in clinical practice.

Methods

A finite element model of a Schatzker Ⅱ tibial plateau fracture was constructed using data from a healthy adult male volunteer. Four fixation groups were established: Group A (no bone graft substitute+palisade screws

i.e.

anteroposterior double screws+lateromedial double screws+anti⁃slip screw); Group B (bone graft substitute+palisade screws

i.e.

anteroposterior double screws+lateromedial double screws+anti⁃slip screw); Group C (bone graft substitute+anteroposterior double screws+anti⁃slip screw); and Group D (bone graft substitute+lateromedial double screws+anti⁃slip screw). Under identical support and boundary conditions

finite element analysis was performed to evaluate and compare the biomechanical performance of the four fixation models under different loading conditions.

Results

Under the same loading conditions

Group D exhibited the most uniform stress distribution within the internal fixation

representing the optimal overall stress performance. Group C showed the highest stress level with marked stress concentration

indicating the poorest mechanical behavior. In terms of fracture fragment displacement

Group B achieved the smallest displacement of the lateral condylar fragment and articular surface fragment

demonstrating the best fixation stability

while Group C showed the largest displacement and the worst stability. Comparison of Group A and Group B

which had identical screw configurations but differed in the use of bone graft substitute

revealed that the addition of bone graft substitute in Group B effectively dispersed internal fixation stress

reduced fracture fragment displacement

and enhanced overall fixation stability.

Conclusion

Bone graft substitute combined with lateromedial double screws plus an anti‐slip screw provides a more reasonable stress distribution and is suitable for simple fractures. Bone graft substitute combined with palisade screws offers the best overall stability and is indicated for fractures with severe collapse. The combination of bone graft substitute with anteroposterior double screws plus an anti⁃slip screw yields the worst mechanical outcomes and is not recommended for routine clinical use.

关键词

Keywords

references

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