CAJ | 학술논문

目的：运用三维有限元的方法比较髋关节表面置换术中股骨头缺损区填充骨水泥和空置后的生物力学变化，探讨术中股骨头缺损区可靠的处理方法。方法采用CT扫描获得正常股骨图像数据，重建正常股骨三维有限元模型，建立缺损区直径为股骨头直径50％和80％的两个股骨模型，采用计算机辅助技术按标准手术技术装配假体模型，对缺损区采用骨水泥填充和空置两种处理方式，建立四个不同的股骨头坏死行髋关节表面置换术有限元模型。对模型施加模拟站立位应力，分析和比较股骨头和颈部各区峰值应力和等效应变。结果股骨头内应力变化：50％股骨头直径缺损组，填充模型股骨头各区应力集中不明显，空置模型股骨头近端1区内应力集中明显；80％股骨头直径缺损组，填充模型股骨头各区的应力集中在1区超过100％，2区内则低于100％，空置模型1区内应力集中都超过1000％，2区内S2区达766.89％为最高。股骨颈内应力变化：50％直径缺损组填充和空置模型股骨颈各区应力集中在±50％以内；80％股骨头直径缺损组填充模型颈部各区应力集中在±50％以内，空置模型的各区峰值应力集中明显。股骨头等效应变：50％直径缺损组填充模型头内各区变化不明显，空置模型头内近端增加明显。80％直径缺损组填充模型头内近端1区等效应变增加率有两个区块明显增高；而空置模型的等效应变增加率急剧增高。股骨颈的等效应变：50％直径缺损组填充和空置模型颈部各区变化不明显，80％直径缺损组填充模型颈部近端1区等效应变率有增高，空置模型颈部近端1区等效应变率增加明显。结论股骨头坏死行髋关节表面置换术时，一定的范围内的骨缺损予以骨水泥填充是安全可靠的方法，缺损在小范围内可予松质骨填充，但随着缺损增加，股骨头和颈部骨折风险急剧增高。目的：運用三維有限元的方法比較髖關節錶麵置換術中股骨頭缺損區填充骨水泥和空置後的生物力學變化，探討術中股骨頭缺損區可靠的處理方法。方法採用CT掃描穫得正常股骨圖像數據，重建正常股骨三維有限元模型，建立缺損區直徑為股骨頭直徑50％和80％的兩箇股骨模型，採用計算機輔助技術按標準手術技術裝配假體模型，對缺損區採用骨水泥填充和空置兩種處理方式，建立四箇不同的股骨頭壞死行髖關節錶麵置換術有限元模型。對模型施加模擬站立位應力，分析和比較股骨頭和頸部各區峰值應力和等效應變。結果股骨頭內應力變化：50％股骨頭直徑缺損組，填充模型股骨頭各區應力集中不明顯，空置模型股骨頭近耑1區內應力集中明顯；80％股骨頭直徑缺損組，填充模型股骨頭各區的應力集中在1區超過100％，2區內則低于100％，空置模型1區內應力集中都超過1000％，2區內S2區達766.89％為最高。股骨頸內應力變化：50％直徑缺損組填充和空置模型股骨頸各區應力集中在±50％以內；80％股骨頭直徑缺損組填充模型頸部各區應力集中在±50％以內，空置模型的各區峰值應力集中明顯。股骨頭等效應變：50％直徑缺損組填充模型頭內各區變化不明顯，空置模型頭內近耑增加明顯。80％直徑缺損組填充模型頭內近耑1區等效應變增加率有兩箇區塊明顯增高；而空置模型的等效應變增加率急劇增高。股骨頸的等效應變：50％直徑缺損組填充和空置模型頸部各區變化不明顯，80％直徑缺損組填充模型頸部近耑1區等效應變率有增高，空置模型頸部近耑1區等效應變率增加明顯。結論股骨頭壞死行髖關節錶麵置換術時，一定的範圍內的骨缺損予以骨水泥填充是安全可靠的方法，缺損在小範圍內可予鬆質骨填充，但隨著缺損增加，股骨頭和頸部骨摺風險急劇增高。
목적：운용삼유유한원적방법비교관관절표면치환술중고골두결손구전충골수니화공치후적생물역학변화，탐토술중고골두결손구가고적처리방법。방법채용CT소묘획득정상고골도상수거，중건정상고골삼유유한원모형，건립결손구직경위고골두직경50％화80％적량개고골모형，채용계산궤보조기술안표준수술기술장배가체모형，대결손구채용골수니전충화공치량충처리방식，건립사개불동적고골두배사행관관절표면치환술유한원모형。대모형시가모의참립위응력，분석화비교고골두화경부각구봉치응력화등효응변。결과고골두내응력변화：50％고골두직경결손조，전충모형고골두각구응력집중불명현，공치모형고골두근단1구내응력집중명현；80％고골두직경결손조，전충모형고골두각구적응력집중재1구초과100％，2구내칙저우100％，공치모형1구내응력집중도초과1000％，2구내S2구체766.89％위최고。고골경내응력변화：50％직경결손조전충화공치모형고골경각구응력집중재±50％이내；80％고골두직경결손조전충모형경부각구응력집중재±50％이내，공치모형적각구봉치응력집중명현。고골두등효응변：50％직경결손조전충모형두내각구변화불명현，공치모형두내근단증가명현。80％직경결손조전충모형두내근단1구등효응변증가솔유량개구괴명현증고；이공치모형적등효응변증가솔급극증고。고골경적등효응변：50％직경결손조전충화공치모형경부각구변화불명현，80％직경결손조전충모형경부근단1구등효응변솔유증고，공치모형경부근단1구등효응변솔증가명현。결론고골두배사행관관절표면치환술시，일정적범위내적골결손여이골수니전충시안전가고적방법，결손재소범위내가여송질골전충，단수착결손증가，고골두화경부골절풍험급극증고。
Objective To investigate the reliable treatment methods for the femoral head defect during the hip resurfacing arthroplasty,by comparing the biomechanical effects between bone cement filling and cement vacancy using three-dimensional (3-D) finite element analysis.Methods The 3-D finite element model of the normal femur was constructed based on the CT scanning.Four defect models were established by the computer assissted design technology.The defect diameter was 50%of the femoral head diameter in two models, and it was 80%of the femoral head diameter in the other two models.The femoral head defects were dealt with cement filling or vacancy.The models were loaded with the simulated standing stress, and the biomechanical indices of the femoral head and neck were compared and analyzed, including the stress peak and the equivalent strain.Results The stress concentration in the femoral head: in the model of 50%diameter defect, the stress concentration was not significant in the cement filling group, but it was significant in areaⅠof the femoral head in the vacancy group;in the model of 80%diameter defect filled with cement, the stress concentration exceeded 100% in area Ⅰ of the femoral head, while in the vacancy group, it exceeded 1000%in areaⅠ;the maximum stress concentration in areaⅡwas as high as 766.89%.The stress concentration in the femoral neck:in the model of 50% diameter defect, the stress concentration in the femoral neck was between -50% and 50% in both groups;in the model of 80%diameter defect, it was between -50% and 50% in the cement filling group, while it was extremely increased in the vacancy group.The equivalent strain in the femoral head:in the model of 50% diameter defect, the equivalent strain did not chang significantly in the cement filling group, while it increased significantly in the proximal part of the head in the vacancy group;in the model of 80%diameter defect, it increased significantly in the vacancy group.The equivalent strain in the femoral neck: in the model of 50%diameter defect, the equivalent strain rate of the femoral neck was less than 50% in both groups;in the model of 80% diameter defect, it increased radically in the vacancy group.Conclusion A certain range of bone defect should be filled with bone cement during the hip resurfacing arthroplasty for the femoral head necrosis;the small defect may be filled with cancellous bone, but with the bone defect enlarging, the fracture risk of the femoral head and neck will dramatically increase.