CAJ | 학술논문

背景:如何评估股骨近端转移瘤的骨折风险在临床上争议较多. 目的:建立股骨近端不同大小溶骨性转移瘤的三维有限元模型,分析在慢步行走过程中病变局部的应力变化,评估骨折风险. 方法:对志愿者双下肢进行薄层 CT 扫描获得股骨数据,图像处理软件 Mimics11.1进行图像处理后数据导入建模软件 UG4.0建立股骨近端3个部位溶骨性病变模型,给予加载缓慢行走时单足落地状态下股骨的载荷,利用有限元软件分析股骨颈区,转子间区及转子下区应力的变化. 结果与结论:①股骨颈水平:皮质完整的髓内缺损破坏直径至相应冠状面直径的90%局部应力突然增长至135.98 MPa,破坏一半内侧皮质的髓内病变至70%局部应力突然增长至92.34 MPa,完全破坏皮质的半球形病变至60%时,局部应力大于屈服应力,增长至101.19 MPa.②转子间水平:内侧皮质完整的髓内球形病变破坏直径至80%局部应力突然增长至131.21 MPa,破坏一半内侧皮质的髓内病变破坏至80%局部应力突然增长至105.19 MPa,完全破坏皮质的半球形病变至70%时,局部应力大于屈服应力,增长至92.21 MPa.③转子下水平:破坏一半内侧皮质的髓内病变破坏至80%局部应力突然增长至92.42 MPa,完全破坏皮质的半球形病变至70%-80%之间,局部应力增长至89.97-105.19 MPa,大于屈服应力.结果表明股骨近端未穿透骨皮质的髓内病变对股骨近端应力变化影响不大.对于破坏单侧骨皮质的病变,在股骨颈水平破坏直径大于60%时存在骨折风险,转子间水平破坏直径大于70%时存在骨折风险,转子下水平破坏直径大于70%时存在骨折风险.
배경:여하평고고골근단전이류적골절풍험재림상상쟁의교다. 목적:건립고골근단불동대소용골성전이류적삼유유한원모형,분석재만보행주과정중병변국부적응력변화,평고골절풍험. 방법:대지원자쌍하지진행박층 CT 소묘획득고골수거,도상처리연건 Mimics11.1진행도상처리후수거도입건모연건 UG4.0건립고골근단3개부위용골성병변모형,급여가재완만행주시단족락지상태하고골적재하,이용유한원연건분석고골경구,전자간구급전자하구응력적변화. 결과여결론:①고골경수평:피질완정적수내결손파배직경지상응관상면직경적90%국부응력돌연증장지135.98 MPa,파배일반내측피질적수내병변지70%국부응력돌연증장지92.34 MPa,완전파배피질적반구형병변지60%시,국부응력대우굴복응력,증장지101.19 MPa.②전자간수평:내측피질완정적수내구형병변파배직경지80%국부응력돌연증장지131.21 MPa,파배일반내측피질적수내병변파배지80%국부응력돌연증장지105.19 MPa,완전파배피질적반구형병변지70%시,국부응력대우굴복응력,증장지92.21 MPa.③전자하수평:파배일반내측피질적수내병변파배지80%국부응력돌연증장지92.42 MPa,완전파배피질적반구형병변지70%-80%지간,국부응력증장지89.97-105.19 MPa,대우굴복응력.결과표명고골근단미천투골피질적수내병변대고골근단응력변화영향불대.대우파배단측골피질적병변,재고골경수평파배직경대우60%시존재골절풍험,전자간수평파배직경대우70%시존재골절풍험,전자하수평파배직경대우70%시존재골절풍험.
@@@@BACKGROUND:There are many controversies about how to assess fracture risks of the proximal femoral metastases tumor in clinical practice. @@@@OBJECTIVE:To establish the three-dimensional finite element model of different sizes of the osteolytic metastases tumor in proximal femur, and to analyze the stress changes in the local lesion during slow walk mode and to assess the fracture risks. @@@@METHODS:Both lower extremities of the volunteers underwent thin CT scan to obtain data related to the femur. The image data were input into Mimics11.1 image processing software for image processing, then, the data were input into UG4.0 software to establish the bone lesion model of three parts of proximal femur. Then, loaded the femur when single foot landing during slow walking mode. Final y, the finite element software was used to analyze the femoral neck district, intertrochanteric area and change of stress levels in subtrochanteric zone. @@@@RESULTS AND CONCLUSION:Defects of femoral neck level:when the intramedul ary defect did not involved inner cortex in diameter to 90%, the local stress abruptly increased to 135.98 MPa, while intramedul ary defects involved half of medial cortex to 70%, the local stress abruptly increased to 92.34 MPa. When the hemispheric lesions with destruction of the cortex up to 60%, the local stress became greater than the yield stress, and up to 101.19 Mpa. Intertrochanteric level:when the intramedul ary defect did not involved inner cortex in diameter to 80%, the local stress jumped to 131.21 MPa, while intramedul ary defects involved half of medial cortex to 80%, the local stress abruptly increased to 105.19 MPa. The hemispherical lesions with destruction of the cortex defect of 80%, the local stress was greater than the yield stress scale, and up to 92.21 MPa. While intramedul ary defects involved half of medial cortex to 80%, the local stress jumped to 92.42 MPa. When hemispheric lesions with destruction of the cortex increased to 70%-80%, the local stress wil increased to 89.97-105.19 Mpa, and greater than the yield stress. In proximal femur, the intramedul ary lesions which do not penetrate the cortical bone have little effect on stress scales in the same place. For the lesions which destroy the unilateral cortical bone, the risks would occur on such conditions as:in femoral neck level, the destruction in diameter greater more than 60%;in intertrochanteric level, the destruction in diameter greater more than 70%;in subtrochanteric level, the destruction in diameter greater more than 70%.