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Article(id=1196100422332101456, tenantId=1146029695717560320, journalId=1189918454225211397, issueId=1196100421094781769, articleNumber=null, orderNo=null, doi=10.20104/j.cnki.1674-6546.20240279, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=research-article, receivedDate=null, receivedDateStr=null, revisedDate=1725724800000, revisedDateStr=2024-09-08, acceptedDate=null, acceptedDateStr=null, onlineDate=1763102163155, onlineDateStr=2025-11-14, pubDate=1741968000000, pubDateStr=2025-03-15, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1763102163155, onlineIssueDateStr=2025-11-14, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1763102163155, creator=13701087609, updateTime=1763102163155, updator=13701087609, issue=Issue{id=1196100421094781769, tenantId=1146029695717560320, journalId=1189918454225211397, year='2025', volume='', issue='3', pageStart='1', pageEnd='48', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1763102162860, creator=13701087609, updateTime=1763102929825, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1196103638025289814, tenantId=1146029695717560320, journalId=1189918454225211397, issueId=1196100421094781769, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1196103638025289815, tenantId=1146029695717560320, journalId=1189918454225211397, issueId=1196100421094781769, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=42, endPage=48, ext={EN=ArticleExt(id=1196100422533428049, articleId=1196100422332101456, tenantId=1146029695717560320, journalId=1189918454225211397, language=EN, title=Evaluation of Traffic Injury by Finite Element Method for the Crescent Fracture Dislocation of Pelvis under Different Fixation Systems, columnId=1196108900442354451, journalTitle=Automotive Engineer, columnName=Special Issue on Automotive Passive Safety and Injury Biomechanics, runingTitle=null, highlight=null, articleAbstract=

To reduce the impact of Day Ⅱ crescent pelvic fractures in pedestrian traffic injuries, finite element analysis is used to investigate the biomechanical influences of Day Ⅱ Crescent Fracture Dislocation of Pelvis (CFDP) with different fixation systems. Based on a human pelvic finite element model, the pelvic model with fracture and four different fixation systems for Day Ⅱ CFDP are constructed according to human anatomical theory. These fixation systems include: one sacroiliac screw combined with one iliac screw (S1+I1), two sacroiliac screws combined with two iliac screws (S2+I2), three reconstructive titanium plates (P3), and one S2AI screw combined with two iliac screws (S2AI1+ I2). The advantages and disadvantages for the different fixation systems are comprehensively evaluated by the overall stiffness and stress of the pelvic model, the difference on the stress of iliac bone and internal fixation, and the difference on the stress and displacement of the fracture line. It is found that the stiffness of pelvic model with P3 solution and S2AI1+ I2 solution is higher than that of the other two internal fixation systems. In addition, the stress distribution on the undamaged side predicted by the pelvic model with P3 is also closer to that predicted by the normal model without fracture. However, the highest stress values on the reconstructed plate and the posterior inferior iliac spine are also predicted by the pelvic model P3 fixation systems, because of the direct contact between the reconstructed plate and cortical bone. This direct contact is also not conducive to the healing of the fracture. The stress and displacement distribution on fracture line predicted by the pelvic model with S2AI1+ I2 are closer to that predicted by the normal model without fracture. For the treatment of Day Ⅱ CFDP, it is recommended to choose S2AI sacroiliac screw combined with 2 iliac screws for internal fixation, which can achieve a firm fixation effect without adding other internal fixation systems.

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为降低行人交通损伤中Day Ⅱ型骨盆新月形骨折的损伤影响，采用有限元分析方法比较了不同内固定方式对Day Ⅱ型骨盆新月形骨折脱位（CFDP）的生物力学影响。在人体骨盆有限元模型的基础上，依据人体解剖学理论，构建Day Ⅱ型骨盆骨折模型及4种不同的内固定仿真模型，即1枚骶髂螺钉与1枚髂骨螺钉（S1+I1）、2枚骶髂螺钉与2枚髂骨螺钉（S2+I2）、3枚重建钛板（P3）、1枚S2AI螺钉与2枚髂骨螺钉（S2AI1+I2），依据骨盆模型的整体刚度、整体应力分布，髂骨、内固定应力差异性及骨折线的应力和位移差异性综合评价不同内固定方案的优劣。研究表明：P3方案和S2AI1+I2方案相较于另外2种内固定方案的刚度更大，更接近正常模型，未受损侧的应力分布也与正常模型的应力分布更加接近；P3方案因重建钢板与皮质骨直接接触，导致重建板与髂后下棘等部位的应力较大，不利于骨折愈合；S2AI1+I2方案在骨折线上应力及位移分布方面更接近正常模型。Day Ⅱ型骨盆新月形骨折脱位应采用1枚S2AI螺钉与2枚髂骨螺钉内固定，能够在不增加其他内固定方案的情况下达到理想的内固定效果。

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李东强（1978—），男，高级工程师，主要研究方向为人体舒适性与人体有限元建模等，。
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模型 最大位移/mm 刚度/N·mm-1
正常模型 2.865 209.4
骨折模型 3.088 194.3
S1+I1 2.894 207.3
S2+I2 2.882 208.2
P3 2.877 208.6
S2AI1+I2 2.878 208.5
), ArticleFig(id=1196111889135616757, tenantId=1146029695717560320, journalId=1189918454225211397, articleId=1196100422332101456, language=CN, label=表1, caption=

不同模型在站立位的最大位移及刚度

, figureFileSmall=null, figureFileBig=null, tableContent=
模型 最大位移/mm 刚度/N·mm-1
正常模型 2.865 209.4
骨折模型 3.088 194.3
S1+I1 2.894 207.3
S2+I2 2.882 208.2
P3 2.877 208.6
S2AI1+I2 2.878 208.5
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行人交通损伤髋部新月形骨折的内固定方案有限元评估
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姜叶洁 1 , 李东强 1 , 何玉俊 1 , 甘秋雨 2 , 蒋彬辉 2
汽车工程师 | 汽车被动安全与损伤生物力学专刊 2025,(3): 42-48
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汽车工程师 | 汽车被动安全与损伤生物力学专刊 2025, (3): 42-48
行人交通损伤髋部新月形骨折的内固定方案有限元评估
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姜叶洁1, 李东强1 , 何玉俊1, 甘秋雨2, 蒋彬辉2
作者信息
  • 1 广州汽车集团股份有限公司汽车工程研究院，广州 511434
  • 2 湖南大学，整车先进设计制造技术全国重点实验室，长沙 410082

通讯作者:

李东强（1978—），男，高级工程师，主要研究方向为人体舒适性与人体有限元建模等，。
Evaluation of Traffic Injury by Finite Element Method for the Crescent Fracture Dislocation of Pelvis under Different Fixation Systems
Yejie Jiang1, Dongqiang Li1 , Yujun He1, Qiuyu Gan2, Binhui Jiang2
Affiliations
  • 1 Research & Design Center, Guangzhou Automobile Group Co., Ltd., Guangzhou 511434
  • 2 State Key Lab of Advanced Design and Manufacturing Technology for Vehicle, Hunan University, Changsha 410082
出版时间: 2025-03-15 doi: 10.20104/j.cnki.1674-6546.20240279
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摘要
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为降低行人交通损伤中Day Ⅱ型骨盆新月形骨折的损伤影响，采用有限元分析方法比较了不同内固定方式对Day Ⅱ型骨盆新月形骨折脱位（CFDP）的生物力学影响。在人体骨盆有限元模型的基础上，依据人体解剖学理论，构建Day Ⅱ型骨盆骨折模型及4种不同的内固定仿真模型，即1枚骶髂螺钉与1枚髂骨螺钉（S1+I1）、2枚骶髂螺钉与2枚髂骨螺钉（S2+I2）、3枚重建钛板（P3）、1枚S2AI螺钉与2枚髂骨螺钉（S2AI1+I2），依据骨盆模型的整体刚度、整体应力分布，髂骨、内固定应力差异性及骨折线的应力和位移差异性综合评价不同内固定方案的优劣。研究表明：P3方案和S2AI1+I2方案相较于另外2种内固定方案的刚度更大，更接近正常模型，未受损侧的应力分布也与正常模型的应力分布更加接近；P3方案因重建钢板与皮质骨直接接触，导致重建板与髂后下棘等部位的应力较大，不利于骨折愈合；S2AI1+I2方案在骨折线上应力及位移分布方面更接近正常模型。Day Ⅱ型骨盆新月形骨折脱位应采用1枚S2AI螺钉与2枚髂骨螺钉内固定，能够在不增加其他内固定方案的情况下达到理想的内固定效果。

交通行人损伤  /  损伤生物力学  /  新月形骨折脱位  /  有限元  /  治疗方案评估

To reduce the impact of Day Ⅱ crescent pelvic fractures in pedestrian traffic injuries, finite element analysis is used to investigate the biomechanical influences of Day Ⅱ Crescent Fracture Dislocation of Pelvis (CFDP) with different fixation systems. Based on a human pelvic finite element model, the pelvic model with fracture and four different fixation systems for Day Ⅱ CFDP are constructed according to human anatomical theory. These fixation systems include: one sacroiliac screw combined with one iliac screw (S1+I1), two sacroiliac screws combined with two iliac screws (S2+I2), three reconstructive titanium plates (P3), and one S2AI screw combined with two iliac screws (S2AI1+ I2). The advantages and disadvantages for the different fixation systems are comprehensively evaluated by the overall stiffness and stress of the pelvic model, the difference on the stress of iliac bone and internal fixation, and the difference on the stress and displacement of the fracture line. It is found that the stiffness of pelvic model with P3 solution and S2AI1+ I2 solution is higher than that of the other two internal fixation systems. In addition, the stress distribution on the undamaged side predicted by the pelvic model with P3 is also closer to that predicted by the normal model without fracture. However, the highest stress values on the reconstructed plate and the posterior inferior iliac spine are also predicted by the pelvic model P3 fixation systems, because of the direct contact between the reconstructed plate and cortical bone. This direct contact is also not conducive to the healing of the fracture. The stress and displacement distribution on fracture line predicted by the pelvic model with S2AI1+ I2 are closer to that predicted by the normal model without fracture. For the treatment of Day Ⅱ CFDP, it is recommended to choose S2AI sacroiliac screw combined with 2 iliac screws for internal fixation, which can achieve a firm fixation effect without adding other internal fixation systems.

Pedestrian traffic injury  /  Injury biomechanics  /  Crescent Fracture Dislocation of Pelvis (CFDP)  /  Finite element method  /  Evaluation of treatment methods
姜叶洁, 李东强, 何玉俊, 甘秋雨, 蒋彬辉. 行人交通损伤髋部新月形骨折的内固定方案有限元评估. 汽车工程师, 2025 , (3) : 42 -48 . DOI: 10.20104/j.cnki.1674-6546.20240279
Yejie Jiang, Dongqiang Li, Yujun He, Qiuyu Gan, Binhui Jiang. Evaluation of Traffic Injury by Finite Element Method for the Crescent Fracture Dislocation of Pelvis under Different Fixation Systems[J]. Automotive Engineer, 2025 , (3) : 42 -48 . DOI: 10.20104/j.cnki.1674-6546.20240279
正文
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1 前言
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行人交通事故中，下肢（包含髋部）损伤是发生中度损伤的主要区域，易造成长期伤残，对伤者的健康和生活产生严重影响。行人下肢与汽车接触后，髋部及躯干将倒向车辆发生侧向高速碰撞，具有较高的骨折风险。其中，髋部骨折易使内部脏器进一步受到损伤，若涉及尾椎骨折，还将导致神经损伤，严重时会引发半身不遂等后果。髋部的多种骨折形式中，骨盆新月形骨折，即靠近骶髂关节的髂骨翼骨折并波及骶髂关节脱位，是侧方挤压型骨折中的一种常见类型，存在较高的神经损伤风险[1]。骨盆新月形骨折多由高能量暴力所致，致伤原因主要是交通伤，还包括高处坠落及压砸伤等，常伴有其他部位损伤[2-3]。Day分型是骨盆新月形骨折最常见的分型方法，其中Ⅱ型骨折涉及骶髂关节的1/3到2/3，骨折线进入前S1和S2骶孔之间的关节，形成中等大小的新月形骨折块[4-5]，又称为侧方挤压伤，是行人与车辆碰撞事故中常见的骨折形式。
目前，针对Day Ⅱ型骨盆新月形骨折力学性能的研究方法主要包括尸体实验、临床观察和有限元分析等，对于Day Ⅱ型骨折的固定方案，已有较多相关研究。冯永增等通过有限元方法研究发现，后方3枚交叉空心螺钉模型的刚度最大[6]。Borrelli等首次报告了骨盆新月形骨折脱位（Crescent Fracture Dislocation of Pelvis，CFDP），并采用后外侧入路切开复位钢板内固定治疗22例患者，临床发现骨折愈合满意且后期并发症较少[7]。Starr等首次报道采用闭合复位经皮螺钉内固定治疗27例骨盆新月形骨折患者，研究发现，闭合复位经皮螺钉内固定方法在骨盆新月形骨折治疗中具有诸多优势，例如能够对骨折直接进行复位、手术暴露小、术中出血量少、对软组织创伤小、感染率低、不破坏骨折端血供及并发症少等[8]。Calafi等[9]对128例骨盆新月形骨折脱位患者进行研究，结果表明，临床上Day分型的大部分患者均可采用闭合复位和经皮螺钉治疗，二者均安全有效，且研究发现，垂直载荷下骶髂螺钉固定力学传导特性优于钢板固定。独行业等研究了2枚LC-Ⅱ螺钉和2块钢板在Day型骨盆新月状骨折固定中的效果，发现两者均能维持稳定，但钢板存在疲劳破坏和螺钉松脱风险，因此，如果能闭合复位成功，则宜采用2枚LC-Ⅱ螺钉固定[10]。裴璇等[11]研究发现，只选择S1骶髂螺钉联合1枚LC-Ⅱ螺钉内固定可以在不增加螺钉数量的情况下实现牢固固定。然而，对于何种方式更合理，目前还缺少生物力学方面研究的支持。
针对上述问题，本文基于志愿者骨盆医学影像，在行人交通事故伤害的背景下，构建骨盆有限元模型及Day Ⅱ型骨盆新月形骨折有限元模型，并且在临床医生的指导下构建多种不同的内固定模型，通过比较其刚度、髂骨位移及内固定应力分布，探讨其生物力学特性，为临床治疗提供必要的生物力学依据。
2 骨盆有限元模型的建立
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本文通过有限元方法研究Day Ⅱ型骨盆新月形骨折不同内固定方案的生物力学特性，首先建立骨盆有限元模型。招募一名成年男性志愿者进行计算机断层扫描（Computed Tomography，CT），获取骨盆图像数据。基于该扫描结果，结合医学影像处理工具Mimics，进行图像分割、几何重建和光滑处理，得到骨盆的几何模型。通过有限元前处理工具HyperMesh对几何模型进行网格划分，得到包含韧带、终板等软组织在内的骨盆有限元模型。
然后对模型进行边界条件的设置，在Abaqus中对骨盆的各组织进行材料属性的赋值及载荷约束的添加。本文模拟站立位骨盆受力，于S1椎体上施加垂直向下的均布载荷，大小为600 N，并对股骨头末端添加约束，限制其6个方向的自由度。
最后，基于已建立的正常骨盆模型，依据Young-Burgess分型构建典型的Day Ⅱ型骨折模型，如图1所示，并在临床医师的指导下构建4种临床上常见的不同内固定方案模型，如图2所示。对于骨折模型，因在事故中行人通常为侧面被车辆撞击，冲击力集中在骨盆的一侧，所以构建由侧方挤压造成的Day Ⅱ型骨折。此外，由于Day Ⅱ型骨折涉及骶髂关节的部分脱位，因此将脱落的骶髂关节的约束由正常骨盆的绑定（Tie）约束减弱为面面约束，并删除骶髂关节处相应的韧带。所构建的4种内固定模型分别为：1枚骶髂螺钉与1枚髂骨螺钉（S1+I1）、2枚骶髂螺钉与2枚髂骨螺钉（S2+I2）、3枚重建钛板（P3）、1枚S2AI螺钉与2枚髂骨螺钉（S2AI1+I2）。
骨折模型的边界条件与正常模型相同，通过综合比较前人的研究工作[12]，采用骨盆模型的整体刚度、整体应力分布、髂骨内固定应力差异性及骨折线的应力和位移差异性来评价不同内固定方案的有效性。
3 结果与讨论
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在进行内固定后，骨盆最大位移应尽量减小，整体刚度应得到一定提升。表1所示为不同模型在站立位的最大位移及刚度比较结果。其中，正常模型的位移最小，刚度最大，可达209.4 N/mm，这与其他学者的研究结果具有一致性[4,12-13]。骨折模型的位移最大、刚度最小，而4种内固定方案的位移及刚度差异性较小，均位于骨折模型与正常模型之间，说明4种内固定方案均有较好的内固定效果。由于S1+I1方案相对其他方案的内固定效果较差，因此，其刚度相比其他内固定方案更弱，最大位移更大。P3方案内固定效果较好，其刚度最大、位移最小，这与其结构有关，多块钛板相较于螺钉可提供更牢靠的固定和支持。
通过分析不同模型的应力分布，可比较内固定装置的应力传递情况。站立位下不同骨盆模型的应力分布如图3所示。
正常模型下，由于对股骨头施加了约束，导致股骨头约束位置应力较大，髂骨上应力较大的区域主要集中于骨盆的稳定结构及承重部位，如骶髂关节、髋臼窝、坐骨切迹、耻骨支等。当骨盆右侧髂骨出现Day Ⅱ型骨折时，股骨及左侧髂骨的应力分布趋势基本不改变，主要是右侧受损髂骨的应力分布发生较大改变，尤其是髂嵴与髂窝处。骨折模型中，髂窝的应力较其他模型略大，且从骶骨应力分布情况可以看出，骶骨右侧的应力远大于左侧的应力。这说明当重力由腰椎传导至骶骨后，完整髂骨传导的力远大于受损侧的髂骨传导的力。当施加内固定方案后，力传递的不均衡性大幅改善，骶骨的应力分布与正常模型的应力分布具有较高的一致性。不同模型下完整髂骨的应力分布基本一致，说明Day Ⅱ型骨折仅影响骨折侧，对完整髂骨的影响很小。由于骨折发生后骨盆力的传导路径发生改变，未受损侧会传导更多的力，而受损侧的承载力减小。此外，P3方案髂骨应力分布与正常模型的应力分布最为接近，因此P3方案可以认为是实现恢复站立状态下Day Ⅱ型骨折骨盆正常传递人体重力状态的最佳途径。
髂骨的应力分布内面观如图4所示。正常模型中髂骨的坐骨大切迹处及髂后下棘的应力较大，髂骨终板接触面的应力很小。发生骨折后，应力分布大幅改变，骨折模型中，由于骨折线弹性模量较小，导致其应力远小于其他部位的应力。脱落后的髂骨翼后部分布的应力远小于正常模型的应力，其他部位的应力较正常模型大，尤其是髂后下棘与坐骨大切迹。施加内固定方案后，髂骨翼后部的应力分布得到较大改善，应力相比于骨折模型大很多，但是均小于正常模型。S1+I1方案下坐骨大切迹的应力较其他模型大，说明有更多的力由骶髂关节从坐骨大切迹传递至髋臼窝。施加P3方案后，由于重建钛板直接与骶髂关节的皮质骨接触，因此髂骨皮质骨的应力较其他部位显著提高，当应力过大时并不有利于骨折的愈合，且应力过大会增加重建钛板上固定螺钉与皮质骨脱钉的概率。由于其他3种内固定方案均采用螺钉固定，因此对皮质骨表面的应力影响不大。S2AI1+I2方案下，弓状线及坐骨上的应力分布与正常模型的应力分布很接近，因此从髂骨应力来看，S2AI1+I2方案是最优的选择。
内固定系统的应力分布内面观如图5所示，各内固定模型中骶髂螺钉最大应力集中在骨折线与螺钉的接触位置，且研究发现，骶髂螺钉的最大应力略小于髂骨螺钉的应力。S1+I1方案中髂骨螺钉、骶髂螺钉的最大应力分别为53.7 MPa、51.4 MPa，最大值基本上位于骶髂关节处，这也表明在站立位时，骶骨与髂骨发生相对位移。S2+I2与S2AI1+I2方案存在相同的情况，但是从应力峰值来看，S1+I1方案、S2+I2方案、S2AI1+I2方案依次减小。在P3方案中，由于重建板与皮质骨的相互作用，其最大应力位于重建板上，但是其应力峰值位于螺钉与重建板的接触位置，且明显小于其他3种工况。
为了进一步评估固定方案的有效性，考察固定方案在维持骨折稳定方面的效果，对骨折线上的应力及位移差异性进行分析。沿着骨折线生成两条路径，分别沿着骨折线上、下缘，如图6a所示。骨折线上、下缘位移如图6b、图6c所示，可以发现，骨折发生后，骨折模型的位移均远大于正常模型的位移，采用内固定方案后，骨折线的位移分布与正常模型的差异均较小，可以认为内固定均可以达到很好的固定效果。为了进一步评估内固定对骨折的力学响应，图6d给出了上、下缘骨折线的位移差。研究发现，不同内固定方案具有很好的复位效果，位移误差由小到大依次为S2+I2、S1+I1、P3、S2AI1+I2。图6e显示了髂骨骨折线上缘的应力分布情况，研究发现，骨折模型中，其应力大于其他模型，施加内固定后，皮质骨的应力均有一定改善，应力误差由小到大依次为S1+I1、P3、S2+I2、S2AI1+I2。综上所述，对于骨折线上的应力及位移分布，S2AI1+I2方案具有最优的内固定效果。
4 结束语
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针对行人交通损伤中多见的Day Ⅱ型骨盆新月形骨折，本文在构建正常骨盆有限元模型的基础上，在临床医生的指导下构建了Day Ⅱ型骨盆新月形骨折及不同的内固定系统的骨盆有限元模型。Day Ⅱ型骨折发生后，整个骨盆结构的稳定性发生了重大改变，导致骨盆的整体刚度及站立姿态下应力、位移分布受到很大影响。Day Ⅱ型骨折中脱落后的髂骨翼后部由于脱离了整个骨盆结构，骨盆承受的人体载荷无法再传递到该部位，导致该部位分布的应力远小于正常模型的应力，其他部位需承受更多载荷，导致它们的应力较正常模型大，尤其是髂后下棘与坐骨大切迹，对正常骨盆的力的传递路径有很大影响。施加内固定方案后，均能够获得很好的整体刚度。骨盆、髂骨、4种内固定方案以及骨折线处应力与位移均处于骨折模型与正常模型之间，对于Day Ⅱ型骨折均有良好的固定效果。相比较而言，1枚S2AI螺钉与2枚髂骨螺钉（S2AI1+I2）方案骨盆刚度较大，内固定系统承受较大的力并且骨折线处位移差较小，对Day Ⅱ型骨折产生良好的固定效果。
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doi: 10.20104/j.cnki.1674-6546.20240279
  • 首发时间：2025-11-14
  • 出版时间：2025-03-15
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  • 修回日期：2024-09-08
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    1 广州汽车集团股份有限公司汽车工程研究院，广州 511434
    2 湖南大学，整车先进设计制造技术全国重点实验室，长沙 410082

通讯作者:

李东强（1978—），男，高级工程师，主要研究方向为人体舒适性与人体有限元建模等，。
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2种不同金属材料的力学参数
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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
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红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
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