CAJ | 학술논문

目的：利用三维有限元力学分析方法，研究髋关节发育不良患者髋臼外上缘结构性植骨重建髋臼、增加臼杯假体包容对髋臼假体-骨界面间的应力分布情况的影响。方法选取髋关节发育不良患者的骨盆为实验对象，用螺旋CT做全长连续扫描，然后利用计算机仿真技术对CT图像进行三维重建，建立髋关节发育不良骨盆模型。在计算机环境中对重建模型进行髋臼外上缘结构性植骨重建髋臼并臼杯植入的模拟手术，利用有限元分析软件对重建模型进行有限元网格化及力学分析。结果髋臼植骨重建后，臼杯置入无需突破髋臼底，髋臼外上缘得到植骨块的包容覆盖，臼杯接触面积增大，单位面积所受应力相对较少，应力集中的情况得到明显改善。同时，植骨块及原髋臼外上缘区域承担了臼杯较多的应力。结论结构性植骨重建髋臼使骨床与臼杯接触面积较大，单位面积所受应力较小且均匀，有利于臼杯的稳定，植骨块承担了臼杯较多的应力，若臼杯外上缘外露面积过大，而过多的靠植骨块来弥补骨床的覆盖，使植骨块所受应力过大则臼杯松动的风险较大。
목적：이용삼유유한원역학분석방법，연구관관절발육불량환자관구외상연결구성식골중건관구、증가구배가체포용대관구가체-골계면간적응력분포정황적영향。방법선취관관절발육불량환자적골분위실험대상，용라선CT주전장련속소묘，연후이용계산궤방진기술대CT도상진행삼유중건，건립관관절발육불량골분모형。재계산궤배경중대중건모형진행관구외상연결구성식골중건관구병구배식입적모의수술，이용유한원분석연건대중건모형진행유한원망격화급역학분석。결과관구식골중건후，구배치입무수돌파관구저，관구외상연득도식골괴적포용복개，구배접촉면적증대，단위면적소수응력상대교소，응력집중적정황득도명현개선。동시，식골괴급원관구외상연구역승담료구배교다적응력。결론결구성식골중건관구사골상여구배접촉면적교대，단위면적소수응력교소차균균，유리우구배적은정，식골괴승담료구배교다적응력，약구배외상연외로면적과대，이과다적고식골괴래미보골상적복개，사식골괴소수응력과대칙구배송동적풍험교대。
Objective To study the stress distribution in the acetabular cup-bone interface affected by the structural bone graft for the acetabulum reconstruction during the total hip replacement (THR) in treating the dysplasia of hip by using the three dimensional (3D) finite element analysis. Methods The acetabulumm of the hip with dysplasia was scanned by CT.The computer simulation technology was used to reconstruct the three-dimensional (3D) model of the pelvic from CT scan picture in order to observe the dysplasia of the hip.The structural bone graft for reconstruction of the acetabulum reconstruction in THR was simulated.Then the pelvis and acetabular cup models were meshed.The mechanical analysis tool was used to analyze the 3D model, and the stress data in the acetabular cup-bone interface was achieved.After the statistical analysis of the experimental results, the structural bone graft affecting the stress distribution in the acetabular cup-bone interface was observed.Results The structural bone graft augmented the deficient acetabulum and improved the bone-bed inclusion of the cup during THR in treating the dysplasia of the hip, which leaded to greater contact area and smaller stress per unit area. The structural autograft which covered the anterior-lateral part of the cup bore greater stress.Conclusion The acetabular reconstruction with the structural bone graft improves the bone-bed inclusion of the cup during THR in treating the dysplasia of the hip.The stress deconcentration due to the larger contact area could benefit the stability of the cup.The coverage of the cup by the graft should not be too much, otherwise, the great stress on the structural bone graft would increase the risk of loosening.