CAJ | 학술논문

目的：利用有限元方法评估坏死股骨头对日常动作的耐受程度。方法招募单侧股骨头坏死患者7例和健康志愿者11名。行螺旋CT断层扫描，取得DICOM格式文件并导入医学图像处理软件ScanIP，建立股骨头有限元模型，同时借助Orthoload数据库模拟日常动作场景（正常站立，上、下楼梯，单、双腿站立，蹲，坐），将整体模型导入有限元软件Abaqus中进行分析。判断两组志愿者双侧股骨力学性能有无对称性，同时比较各日常动作下两组志愿者双侧股骨应力集中区域的平均弹性模量及变形程度有无差异。结果两组年龄、身高、体重的差异均无统计学意义。正常对照组双侧股骨头平均弹性模量为[（7125±745) MPa，（7112±751）MPa]和微应变为（952微应变，954微应变）,差异均无统计学意义；股骨头坏死组患、健侧股骨头平均弹性模量为[（5798±1036）MPa，（6667±888）MPa]和微应变为（1261微应变，987微应变），差异均有统计学意义。正常对照组双侧股骨在任何动作下股骨头平均弹性模量和变形程度的差异均无统计学意义，而股骨头坏死组除双腿站立外的各动作下，患侧平均弹性模量明显低于健侧，差异有统计学意义；变形程度在下楼梯动作时明显高于其他动作，差异有统计学意义。结论不同日常活动状态对坏死股骨头的力学性能影响不同，运动强度越大对股骨头内部结构损害越严重，早期股骨头坏死患者适合低强度的康复运动锻炼。
목적：이용유한원방법평고배사고골두대일상동작적내수정도。방법초모단측고골두배사환자7례화건강지원자11명。행라선CT단층소묘，취득DICOM격식문건병도입의학도상처리연건ScanIP，건립고골두유한원모형，동시차조Orthoload수거고모의일상동작장경（정상참립，상、하루제，단、쌍퇴참립，준，좌），장정체모형도입유한원연건Abaqus중진행분석。판단량조지원자쌍측고골역학성능유무대칭성，동시비교각일상동작하량조지원자쌍측고골응력집중구역적평균탄성모량급변형정도유무차이。결과량조년령、신고、체중적차이균무통계학의의。정상대조조쌍측고골두평균탄성모량위[（7125±745) MPa，（7112±751）MPa]화미응변위（952미응변，954미응변）,차이균무통계학의의；고골두배사조환、건측고골두평균탄성모량위[（5798±1036）MPa，（6667±888）MPa]화미응변위（1261미응변，987미응변），차이균유통계학의의。정상대조조쌍측고골재임하동작하고골두평균탄성모량화변형정도적차이균무통계학의의，이고골두배사조제쌍퇴참립외적각동작하，환측평균탄성모량명현저우건측，차이유통계학의의；변형정도재하루제동작시명현고우기타동작，차이유통계학의의。결론불동일상활동상태대배사고골두적역학성능영향불동，운동강도월대대고골두내부결구손해월엄중，조기고골두배사환자괄합저강도적강복운동단련。
Objective To propose an optimal therapeutic scheme, finite element analysis was used to evaluate the biome?chanical status of femoral head under daily activities. Methods Non?necrotic femoral head volunteers (11 people) and necrotic femoral head patients (7 cases) were included in this study. All these participants were divided into two groups:control group and abnormal group. The DICOM imaging files of each participant were imported into ScanIP software to form a mask showing the prox?imal femurs. Then the finite element models of proximal femurs were progressively reconstructed. The generated models were im?ported into Abaqus, and the forces were added on these models to simulate daily activities, including standing, sitting, upstairs, and squatting etc. The loads and boundary conditions of digital daily activities simulation were collected from Orthoload database. All of the femoral finite element models were progressed in Abaqus under above activity conditions. After the models were pro?cessed, stress concentrating region was defined in each models respectively, which expressed the main bearing structure in each model based on the result of finite element analysis. At last, the elastic modulus (E?modulus) and strain of the stress concentrating region in each femoral model were extracted and calculated. Results There was no significant difference in age, weight, and height between these two groups. In control group, no significant differences of E?modulus (7 125±745 MPa on left, and 7 112±751 MPa on right) and strain (micro?strain:952 on left, and 954 on right)were found between their bilateral proximal femurs;however in abnormal group, the patients' E?modulus (5 798±1036 MPa on normal side, and 6 667±888 MPa on necrotic side) and strain (mi?cro?strain:1 261 on normal side, and 987 on necrotic side) of necrotic side were significantly lower than normal side. As to all the daily activities which were considered in this study, in abnormal group, the E?modulus among each postures of abnormal side were significantly lower than the E?modules of healthy side;the micro?strain in downstairs was also significantly lower than other pos?tures. Conclusion Daily activities with different intensity could generate different mechanical effects on femoral head, espe?cially on necrotic femoral head. The higher intensity of posture, the greater damage would be found in necrotic femoral head.