對於開放式復位跟骨關節內骨折固定術而言，確保手術後的穩定性是十分必要的。目前在實施關節內固定手術時提供患者選擇的骨板有新型解剖型Aplus骨板以及傳統Y型骨板兩款。本研究目的是探討兩款骨板在Sanders type II-B型骨折型態下承受負載之力學與生物力學行為，探究兩骨板能否提供足夠穩定性、比較兩者對骨折跟骨造成的應力遮蔽效應程度並對固定骨板之骨釘數量與位置對結構穩定性之影響進行探討。本研究使用COMSOL Multiphysics有限元素分析軟體建立兩種骨板在Sanders type II-B型跟骨骨折下之有限元素模型。結果顯示，Aplus骨板固定之跟骨模型，擁有相對優秀的穩定性以及較小的應力屏蔽效應。

For open reduction internal fixation of intra-articular calcaneal fractures, initial stability is essential. Currently there are two type of calcaneal plate can be chosen for calcaneal fixation, new type anatomical calcaneal plate Aplus and conventional Y plate. The objective of this study is to investigate the mechanical and biomechanical behavior of the two bone plates subjected to load in the Sanders type II-B calcaneal fracture, and to explore whether the two bone plates can provide sufficient stability. Also, compare the stress shielding effect cause by the plate and discuss the influence of the number and position of bone screws to the stability. This study used COMSOL Multiphysics finite analysis software to establish two finite element models for two kind of calcaneal plate under the Sanders type II-B calcaneal fracture. Analysis results indicate that Aplus calcaneal plate model has relatively great stiffness and causing small stress shielding effect.

[1] T. Illert, S. Rammelt, T. Drewes, R. Grass, and H. Zwipp, "Stability of locking and non-locking plates in an osteoporotic calcaneal fracture model," Foot & ankle international, vol. 32, no. 3, pp. 307-313, 2011.
[2] R. Buckley and R. Meek, "Comparison of open versus closed reduction of intra-articular calcaneal fractures: a matched cohort in workmen," in Major Fractures of the Pilon, the Talus, and the Calcaneus: Springer, 1993, pp. 195-205.
[3] S. K. Benirschke and B. J. Sangeorzan, "Extensive intraarticular fractures of the foot. Surgical management of calcaneal fractures," Clinical orthopaedics and related research, no. 292, pp. 128-134, 1993.
[4] D. Eastwood, V. Langkamer, and R. Atkins, "Intra-articular fractures of the calcaneum. Part II: open reduction and internal fixation by the extended lateral transcalcaneal approach," The Journal of bone and joint surgery. British volume, vol. 75, no. 2, pp. 189-195, 1993.
[5] P. Essex‐Lopresti, "The mechanism, reduction technique, and results in fractures of the os calcis," British Journal of Surgery, vol. 39, no. 157, pp. 395-419, 1952.
[6] 麥麗敏、陳智傑、廖美華, 解剖生理學, 台灣: 華杏出版股份有限公司, 2015, p. 755. [Online]. Available.
[7] https://reurl.cc/DLoqR.
[8] https://reurl.cc/GRQMx.
[9] https://reurl.cc/qjXdy.
[10] https://reurl.cc/LL6oX.
[11] H. M. Frost, "Wolffs Law and bone's structural adaptations to mechanical usage: an overview for clinicians.," The Angle Orthodontist, vol. 64, pp. 175- 188, 1994.
[12] E. Waris, Y. T. Konttinen, N. Ashammakhi, R. Suuronen, and S. Santavirta, "Bioabsorbable fixation devices in trauma and bone surgery: current clinical standing," Expert Review of Medical Devices, vol. 1, no. 2, pp. 229-240, 2004.
[13] M. Ni, D. W.-C. Wong, J. Mei, W. Niu, and M. Zhang, "Biomechanical comparison of locking plate and crossing metallic and absorbable screws fixations for intra-articular calcaneal fractures," Science China Life Sciences, vol. 59, no. 9, pp. 958-964, 2016.
[14] C. Piao, D. Wu, M. Luo, and H. Ma, "Stress shielding effects of two prosthetic groups after total hip joint simulation replacement," Journal of orthopaedic surgery and research, vol. 9, no. 1, p. 71, 2014.
[15] M. Richter, P. Droste, T. Goesling, S. Zech, and C. Krettek, "Polyaxially-locked plate screws increase stability of fracture fixation in an experimental model of calcaneal fracture," The Journal of bone and joint surgery. British volume, vol. 88, no. 9, pp. 1257-1263, 2006.
[16] M. H. Blake, J. R. Owen, T. S. Sanford, J. S. Wayne, and R. S. Adelaar, "Biomechanical evaluation of a locking and nonlocking reconstruction plate in an osteoporotic calcaneal fracture model," Foot & ankle international, vol. 32, no. 4, pp. 432-436, 2011.
[17] Q.-J. Pang, X. Yu, and Z.-H. Guo, "The sustentaculum tali screw fixation for the treatment of Sanders type II calcaneal fracture: a finite element analysis," Pakistan journal of medical sciences, vol. 30, no. 5, p. 1099, 2014.
[18] M. Ni, X.-H. Weng, J. Mei, and W.-X. Niu, "Primary stability of absorbable screw fixation for intra-articular calcaneal fractures: a finite element analysis," Journal of Medical and Biological Engineering, vol. 35, no. 2, pp. 236-241, 2015.
[19] B. Yu et al., "Biomechanical comparison of conventional and anatomical calcaneal plates for the treatment of intraarticular calcaneal fractures–a finite element study," Computer methods in biomechanics and biomedical engineering, vol. 19, no. 13, pp. 1363-1370, 2016.
[20] C.-H. Chen, Y.-H. Huang, C. Hung, C.-S. Chen, and C.-C. Chiang, "Finite Element Analysis of Tongue Type Calcaneal Fracture with Open Reduction and Internal Fixation with Locking Plate," Journal of Medical and Biological Engineering, vol. 38, no. 1, pp. 1-9, 2018.
[21] C.-H. Chen, C. Hung, Y.-C. Hsu, C.-S. Chen, and C.-C. Chiang, "Biomechanical evaluation of reconstruction plates with locking, nonlocking, and hybrid screws configurations in calcaneal fracture: a finite element model study," Medical & biological engineering & computing, vol. 55, no. 10, pp. 1799-1807, 2017.
[22] H. Ouyang et al., "Biomechanical comparison of conventional and optimised locking plates for the fixation of intraarticular calcaneal fractures: a finite element analysis," Comput Methods Biomech Biomed Engin, vol. 20, no. 12, pp. 1339-1349, Sep 2017.
[23] A. Hrennikoff, "Solution of Problems in Elasticity by the Frame Work Method," Journal od Appled Mechanics, vol. 8, no. 4, pp. 169-175, 1941.
[24] D. McHenry, "A Lattice Analogy for the Solution of Plane Stress Problems," Journal of Institution of Civil Engineers, vol. 21, pp. 59-82, 1943.
[25] COMSOL Structural Mechanics Module User's Guide. [Online]. Available.
[26] https://reurl.cc/EMDnK.
[27] B. Young, Wheater's fenctional histology : a text and colour atlas., sixth ed. 2006.
[28] P. Kerr, M. Pape, M. Jackson, and R. Atkins, "Early experiences with the AO calcaneal fracture plate," Injury, vol. 27, no. 1, pp. 39-41, 1996.
[29] "Locking calcaneal plates," ed.
[30] L. Peng, J. Bai, X. Zeng, and Y. Zhou, "Comparison of isotropic and orthotropic material property assignments on femoral finite element models under two loading conditions," Medical engineering & physics, vol. 28, no. 3, pp. 227-233, 2006.
[31] S. Benli, S. Aksoy, H. Havıtcıoğlu, and M. Kucuk, "Evaluation of bone plate with low-stiffness material in terms of stress distribution," Journal of Biomechanics, vol. 41, no. 15, pp. 3229-3235, 2008.
[32] C.-L. Wang, C.-K. Cheng, C.-W. Chen, C.-M. Lu, Y.-S. Hang, and T.-K. Liu, "Contact areas and pressure distributions in the subtalar joint," Journal of biomechanics, vol. 28, no. 3, pp. 269-279, 1995.
[33] 蕭德慶, "鎖定加壓骨板之有限元素分析與最佳化設計," 2017.
[34] 余欣儒, "以有限元素分析探討不同的無柄人工髖關節設計及骨釘方位的生物力學影響," 碩士論文, 國立台北科技大學, 民國104.