髖臼主要功能是將上半身的負載通過骨盆轉移至下肢。髖臼骨折常於高能量或低能量的創傷後形成，最常見的種類為後壁骨折，約占所有髖臼骨折的24%。後壁骨折會使髖關節不穩定，導致股骨頭脫位等問題發生。目前常使用開放性復位內固定術(ORIF)搭配骨板與骨釘進行手術治療。臨床上手術常使用動態加壓骨板(DCP)與鎖定骨板(LP)，兩種骨板主要差在所使用的螺釘與釘孔的設計。DCP通過對加壓螺釘加壓產生高摩擦力，使鋼板與骨頭緊密貼合，增加穩定性，助於骨折癒合。缺點是手術需解剖復位，會損傷周圍組織，且骨板完全貼合骨頭對骨膜及表面血管可能造成傷害。LP則使用帶有螺紋頭的鎖定螺絲與骨板上的螺紋孔結合，形成類似內固定器的機制，並且因為不再依賴摩擦力穩定，骨板不需貼合骨頭，可避免傷害骨膜及血管，也可用於骨質疏鬆症患者。缺點是價格較為昂貴，螺釘施打角度受骨板限制，可能出現冷焊情形導致難以拆除。因此為了改善兩者缺點，開發了鎖定加壓骨板(LCP)，可結合兩螺釘優點，靈活應用於不同臨床情況。但隨著螺釘配置的選項增加，其生物力學的不確定性也隨之增加。本研究旨在透過有限元素分析研究加壓與鎖定螺釘治療髖臼後壁骨折的力學行為，包括整體穩定性、負荷傳遞方向以及von-Mises stress等，希望可以藉此確認兩種螺釘的療效並識別潛在風險，為臨床應用提供有價值的參考。本研究利用逆向工程方法建立脊椎-骨盆-股骨模型，並匯入Soildworks 建立軟組織、後壁骨折與各組器械，再匯入有限元分析軟體進行材料參數、接觸條件、網格元素分割以及邊界條件的設定。以骨折節段和器械位移量以及整體應力分布和數值當作評估整體固定穩定性與受破壞風險的標的。根據研究結果與討論，鎖定螺釘有最好的整體穩定性，可降低畸形癒合或螺釘鬆動的發生機率，並且應力分布均勻，能有效減少對骨頭的破壞風險，缺點是器械需承受較高應力，容易導致損壞。而加壓螺釘穩定性較差，長期使用可能會產生螺釘鬆動的現象，對骨頭的破壞風險也較高。將兩螺釘混合使用時力學表現則介於另外兩組之間，整體表現不如單獨使用鎖定螺釘，因此若想混合使用兩螺釘，需要進一步優化螺釘的配置。

The primary function of the acetabulum is to transfer the load from the upper body through the pelvis to the lower limbs. Acetabular fractures often occur impact trauma, with the most common type being posterior wall fractures, accounting for about 24% of all acetabular fractures. Posterior wall fractures can destabilize the hip joint, leading to femoral head dislocation. Currently, open reduction internal fixation (ORIF) with plates and screws is commonly used for surgical treatment. Clinically, dynamic compression plates (DCP) and locking plates (LP) are often used, with the main difference being the design of the screws and screw holes. DCP uses compression screws to create high friction, tightly fitting the plate to the bone to increase stability and aid in fracture healing. The drawback is that the surgery requires anatomical reduction, which can damage surrounding tissues, and the plate fully adhering to the bone may harm the periosteum and surface blood vessels. LP, on the other hand, uses screws with threaded heads that lock into threaded holes in the plate, creating a mechanism similar to an internal fixator. Since stability does not rely on friction, the plate does not need to adhere to the bone, avoiding damage to the periosteum and blood vessels, and can be used for patients with osteoporosis. The drawbacks are higher costs and screw insertion angles limited by the plate, possibly leading to cold welding and difficulty in removal. To address these issues, locking compression plates (LCP) were developed, combining the advantages of both screws for flexible application in various clinical situations. However, with the increased options for screw configuration, biomechanical uncertainty also rises. This study aims to investigate the mechanical behavior of compression and locking screws in treating posterior wall acetabular fractures through finite element analysis, including overall stability, load transfer direction, and von Mises stress, to verify the efficacy of the screws and identify potential risks, providing valuable references for clinical application.
This study used reverse engineering to establish a spine-pelvis-femur model from Visible Human Project image, imported into SolidWorks to create soft tissues, posterior wall fractures, and various implant groups and then imported into finite element analysis software to set material parameters, contact conditions, mesh elements, and boundary conditions. The displacement of the fracture segments and implants and overall stress distribution and values were used as criteria to evaluate overall fixation stability and risk of damage. According to the results and discussion, locking screws provided the best overall stability, reducing the incidence of malunion or screw loosening, and achieving uniform stress distribution, effectively reducing the risk of bone damage. However, the implants had to endure higher stress, making them prone to damage. Compression screws showed poorer stability, with potential long-term loosening and a higher risk of bone damage. When combining both screws, the mechanical performance was intermediate, with overall performance not as good as using locking screws alone. Therefore, if both screws are to be used together, further optimization of screw configuration is necessary.

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