本文關(guān)鍵詞： 髖臼骨折 股骨頭內(nèi)移 創(chuàng)傷性關(guān)節(jié)炎 有限元分析 接觸應(yīng)力　出處：《天津醫(yī)科大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：目的(1)定義髖臼骨折術(shù)后股骨頭內(nèi)移指數(shù)的概念及測(cè)量方法。(2)通過(guò)對(duì)髖臼內(nèi)側(cè)壁截骨建立不同股骨頭內(nèi)移位置下的髖關(guān)節(jié)有限元模型。(3)應(yīng)用有限元分析方法研究髖臼骨折術(shù)后股骨頭內(nèi)移對(duì)臼頂負(fù)重區(qū)接觸應(yīng)力大小及分布的影響,為臨床醫(yī)師研究髖臼骨折術(shù)后患者髖關(guān)節(jié)生物力學(xué)變化提供參考依據(jù),從而預(yù)測(cè)該變化與髖關(guān)節(jié)創(chuàng)傷性骨關(guān)節(jié)炎之間的相關(guān)性。方法(1)對(duì)髖臼骨折術(shù)后患者進(jìn)行隨訪并收集病例資料,篩選出存在不同程度股骨頭內(nèi)移的患者8例,均行骨盆正位X線片及骨盆CT平掃檢查,將所有患者骨盆CT平掃數(shù)據(jù)以DICOM格式導(dǎo)出存入光盤,并在Mimics軟件中重建骨盆三維模型。分別在骨盆平片和三維模型上測(cè)量股骨頭內(nèi)移指數(shù),對(duì)所得數(shù)據(jù)進(jìn)行統(tǒng)計(jì)學(xué)分析,比較兩組數(shù)據(jù)之間的差異有無(wú)統(tǒng)計(jì)學(xué)意義。(2)選擇一健康成年男性(33歲,70kg),提取骨盆CT掃描DICOM數(shù)據(jù),通過(guò)Mimics17.0軟件構(gòu)建該志愿者左側(cè)髖關(guān)節(jié)三維仿真模型,使用該軟件手術(shù)模擬版塊中截骨工具對(duì)髖臼內(nèi)側(cè)壁進(jìn)行截骨,并使股骨頭與所截內(nèi)側(cè)壁骨塊同步內(nèi)移,以2mm為移動(dòng)單位對(duì)不同股骨頭內(nèi)移位置下髖關(guān)節(jié)模型進(jìn)行分組,包括正常髖關(guān)節(jié)共7組。對(duì)模型進(jìn)行一系列處理,如軟骨再造、網(wǎng)格化、賦值等操作后,將模型導(dǎo)入有限元分析軟件ANSYS中進(jìn)行相關(guān)調(diào)整,設(shè)置髖關(guān)節(jié)面間接觸屬性后,建立不同股骨頭內(nèi)移位置下髖關(guān)節(jié)間力學(xué)分析的有限元模型。(3)對(duì)所有模型施加相同的載荷并設(shè)定邊界條件,模擬單足站立位髖臼頂負(fù)重區(qū)應(yīng)力分布情況,通過(guò)比較相同限制條件下股骨頭內(nèi)移后髖關(guān)節(jié)間接觸應(yīng)力的大小及分布變化情況,為臨床上分析股骨頭內(nèi)移與髖臼骨折術(shù)后創(chuàng)傷性關(guān)節(jié)炎之間的相關(guān)性提供理論依據(jù)。結(jié)果(1)應(yīng)用Mimics三維重建軟件基于多層螺旋CT和DICOM技術(shù),建立骨盆及單側(cè)髖關(guān)節(jié)三維仿真模型,其幾何外形與真實(shí)解剖結(jié)構(gòu)相符,可用于進(jìn)一步研究。(2)對(duì)8例髖臼骨折術(shù)后患者骨盆正位X線片及三維重建模型的股骨頭內(nèi)移指數(shù)分別進(jìn)行測(cè)量,將兩組數(shù)據(jù)進(jìn)行配對(duì)設(shè)計(jì)資料的t檢驗(yàn),t值為2.522,P=0.046,P值小于0.05,兩組數(shù)據(jù)有統(tǒng)計(jì)學(xué)差異。(3)可利用Mimics及其配套3-matic軟件對(duì)模型進(jìn)行軟骨再造、面網(wǎng)格、體網(wǎng)格化等操作,形成左側(cè)股骨節(jié)點(diǎn)117402個(gè),四面體單元83714個(gè);髖骨節(jié)點(diǎn)218557個(gè),四面體單元數(shù)為152197個(gè),根據(jù)灰度值對(duì)軟骨之外的模型進(jìn)行賦值并存儲(chǔ)為可導(dǎo)入有限元分析軟件的格式。(4)在ANSYS有限元分析軟件中計(jì)算七組髖關(guān)節(jié)模型臼頂負(fù)重區(qū)應(yīng)力分布,得到相應(yīng)的受力云圖;單腿站立時(shí)正常髖關(guān)節(jié)臼頂負(fù)重區(qū)應(yīng)力峰值為3.01MPa,隨著股骨頭內(nèi)移,髖關(guān)節(jié)臼頂負(fù)重區(qū)與股骨頭接觸區(qū)域出現(xiàn)應(yīng)力集中,且最高峰值可達(dá)16.47MPa,尤其當(dāng)股骨頭內(nèi)移大于6mm時(shí)應(yīng)力峰值超過(guò)正常承受范圍。結(jié)論:(1)標(biāo)準(zhǔn)骨盆正位X線片上股骨頭內(nèi)移指數(shù)的測(cè)量有一定提示意義,但由于受檢者體位、骨折等因素影響很難獲得絕對(duì)標(biāo)準(zhǔn)骨盆正位X片,而骨盆三維重建模型可任意調(diào)整骨盆位置,測(cè)得結(jié)果可靠性更高。(2)基于骨盆CT數(shù)據(jù),通過(guò)三維重建及有限元分析軟件,準(zhǔn)確構(gòu)建出帶有關(guān)節(jié)軟骨的正常髖關(guān)節(jié)和不同股骨頭內(nèi)移位置下的髖關(guān)節(jié)三維有限元力學(xué)分析模型。(3)股骨頭內(nèi)移后髖關(guān)節(jié)力學(xué)環(huán)境發(fā)生改變,隨著股骨頭內(nèi)移臼頂負(fù)重區(qū)應(yīng)力集中區(qū)增大,應(yīng)力峰值增高,這可能是促進(jìn)髖臼骨折術(shù)后創(chuàng)傷性關(guān)節(jié)炎發(fā)生的因素之一。(4)髖臼骨折時(shí),在解剖復(fù)位髖臼頂負(fù)重區(qū)的前提下,應(yīng)盡量復(fù)位并堅(jiān)強(qiáng)固定內(nèi)側(cè)壁骨塊,對(duì)髖臼骨折術(shù)后股骨頭位置的恢復(fù)有一定作用。
[Abstract]:Objective (1) defines the concepts and measurement methods of acetabular fractures after femoral head displacement index. (2) through the establishment of finite element model of different hip femoral head shift location on the medial wall of the acetabulum osteotomy. (3) the contact stress distribution and size of the femoral head shift on acetabular roof weight-bearing area of operation using the finite element analysis method of acetabular fracture, and to provide reference for clinical research in patients with hip biomechanics changes after operative treatment of acetabular fractures, and predict the correlation between the changes and hip traumatic osteoarthritis. Methods (1) of the acetabular fracture patients were followed up and collected clinical data, were screened for the presence of 8 patients with different degree of femoral head displacement patients underwent pelvic radiograph and pelvic CT scan examination, all patients with pelvic CT scan data in DICOM format and stored in CD, and reconstruction of pelvic 3D model in Mimics software Type respectively. The femoral head shift index measurement in pelvic plain films and three-dimensional model, for statistical data analysis, compare the differences between the two groups of data has no statistical significance. (2) choose a healthy adult male (33, 70kg), extraction of pelvic CT scan DICOM data, through the Mimics17.0 software to build the the volunteers left hip 3D simulation model, using the software simulation of operation section osteotomy of acetabular osteotomy tool and the medial wall of the femoral head and the medial wall of the bone in the section of synchronous shift, 2mm group shift hip femoral head position model under different mobile units, including the normal hip joint a total of 7 groups. A series of models, such as cartilage reconstruction, mesh, assignment, model into finite element analysis software ANSYS for related adjustment, setting of hip joint surface contact between properties, establish different femoral Displacement finite element analysis of hip mechanics between the position of the head model. (3) applied the same load on all models and set the boundary conditions, simulation of single leg stance the acetabular dome region of stress distribution, through the comparison of the same limits change the size and distribution of conditions in the femoral head after hip joint contact shift the stress, displacement and provide a theoretical basis and the correlation between acetabular fractures after traumatic arthritis in the femoral head for clinical analysis. Results (1) the application of Mimics software of three-dimensional reconstruction of multi-slice spiral CT and DICOM technology based on the establishment of pelvis and unilateral hip 3D simulation model, the geometric shape and the real anatomy can match for the further study. (2) of 8 cases of acetabular fracture patients with postoperative pelvic radiograph and three-dimensional reconstruction model of femoral head displacement index were measured, and the data of the two groups by paired t test Check the value of T was 2.522, P=0.046, P value is less than 0.05, the data of the two groups had significant difference. (3) the model of cartilage reengineering, using Mimics and 3-matic software supporting surface mesh, mesh and other operations, the formation of the left femur of 117402 nodes, 83714 nodes tetrahedron; hip 218557, tetrahedron unit number 152197, according to the assignment and storage for the finite element analysis software format of cartilage outside the gray value. The model (4) in the ANSYS finite element analysis software to calculate the seven groups of hip acetabular dome model stress distribution, get the stress contours corresponding to normal single leg standing; hip acetabular dome region stress peak is 3.01MPa, with the shift in the femoral head, hip acetabular dome region of femoral head and the contact area of stress concentration, and the highest peak of up to 16.47MPa, especially when more than 6mm peak stress than in the femoral head shift Under normal range. Conclusion: (1) the standard pelvic radiograph on femoral head displacement measurement index has a certain significance, but because of the subject position, influence factors such as fracture is difficult to obtain the absolute standard anteroposterior pelvic X, and pelvic reconstruction of 3D model can be arbitrary pelvic bone position adjustment, measured the results are more reliable. (2) based on the CT data through the pelvis, 3D reconstruction and finite element analysis software, accurate analysis to construct the three-dimensional finite element model of hip mechanics with normal articular cartilage of the hip and femoral head in different positions. The shift (3) in the femoral head after the shift hip mechanics environment changes with the shift in the femoral head, joint stress concentration zone increases bearing area of top, the peak stress increased, which may be one of the factors for the occurrence of traumatic arthritis after acetabular fracture surgery to promote. (4) acetabular fractures, based on anatomical reduction of acetabular dome region under the, It is necessary to restore and firmly fix the bone mass of the medial wall as far as possible. It has some effect on the recovery of the position of the femoral head after the operation of the acetabular fracture.

【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R687.3

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