本文選題：全髖關(guān)節(jié)置換 + 髖臼重建　； 參考：《醫(yī)用生物力學(xué)》2014年04期

【摘要】：目的研究全髖關(guān)節(jié)置換(total hip arthroplasty,THA)髖臼側(cè)重建中不同髖臼假體安放角度對髖臼周圍內(nèi)外應(yīng)力分布的影響,探索提高THA術(shù)后髖臼假體穩(wěn)定性的方法。方法基于材料屬性的非均勻賦值模型和由不同髖臼假體前傾角(15°,20°,25°)與外展角(40°,45°,50°)的9種組合方式構(gòu)建包括正常髖模型在內(nèi)的10種有限元模型,并以正常步行模式單支撐相中的髖關(guān)節(jié)最大接觸力為載荷條件進行求解。以正常髖模型分析結(jié)果為對照,按照從定性到定量原則對比分析各模型的內(nèi)外應(yīng)力。結(jié)果當髖臼假體的放置角度與正常髖臼的解剖角度(前傾19°、外展46°)最接近時,髖臼周圍的應(yīng)力遮擋現(xiàn)象最明顯。此外,當髖臼假體的外展角放置于45°,前傾角在15°~25°變化不會對模型整體應(yīng)力分布造成較大的影響;而且在15°前傾角條件下,模型不僅在應(yīng)力分布方面具有良好穩(wěn)定性,同時在皮質(zhì)骨和松質(zhì)骨上應(yīng)力遮擋現(xiàn)象相比于處于正常髖臼解剖角度時明顯改善。結(jié)論對于髖臼的正常解剖形態(tài)未發(fā)生明顯改變且需要接受THA手術(shù)的患者,應(yīng)把髖臼假體放置在正常外展角45°,而前傾角應(yīng)小于正常解剖前傾角5°左右并居于15°~20°之間。
[Abstract]:Objective to study the effect of different angles of acetabular prosthesis placement on the stress distribution around the acetabulum in total hip arthroplasty (THA), and to explore ways to improve the stability of acetabular prosthesis after THA. Methods Ten finite element models, including normal hip models, were constructed by non-uniform assignment model based on material properties and 9 combinations of different acetabular anteversion angles (15 擄/ 20 擄/ 25 擄) and abduction angle (40 擄/ 45 擄/ 50 擄). The maximum contact force of the hip joint in the single support phase of the normal walking mode is taken as the load condition. The internal and external stresses of the models were analyzed according to the qualitative and quantitative principles. Results when the placement angle of acetabular prosthesis was closest to that of normal acetabular anatomic angle (19 擄forward, 46 擄abduction), the stress occlusion around acetabular was the most obvious. In addition, when the abduction angle of the acetabular prosthesis is placed at 45 擄, the variation of the anteversion angle at 15 擄and 25 擄does not have a great influence on the overall stress distribution of the model, and the model has good stability in the stress distribution under the condition of 15 擄anteversion angle. At the same time, the stress occlusion in cortical bone and cancellous bone was significantly improved compared with the normal acetabular anatomic angle. Conclusion the acetabular prosthesis should be placed at the normal abduction angle of 45 擄, and the antegrade angle should be less than 5 擄of the normal antegrade angle and stay between 15 擄and 20 擄for the patients who have no obvious change in normal acetabular anatomy and need to undergo THA operation.
【作者單位】： 四川大學(xué)華西醫(yī)院骨科;
【基金】：衛(wèi)生部2013衛(wèi)生行業(yè)科研專項(201302007)
【分類號】：R318.01

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