本文關(guān)鍵詞： 脛骨近端 骨腫瘤 骨缺損 應(yīng)力 步態(tài)分析　出處：《南方醫(yī)科大學》2017年碩士論文　論文類型：學位論文

【摘要】：[目的]1.分析脛骨近端不同大小、水平、位置的皮質(zhì)缺損模型的應(yīng)力狀況,探討脛骨近端骨缺損與骨折風險的關(guān)系;2.分析不同假體髓內(nèi)柄長度條件下的脛骨-假體的應(yīng)力和位移,為選擇腫瘤型脛骨近端假體柄長度提供參考;3.分析保肢治療原發(fā)性脛骨近端骨腫瘤患者術(shù)后的肢體功能及步態(tài),探討不同重建方式術(shù)后患者的生物力學特點;[方法]1.使用數(shù)字醫(yī)學方法對脛骨進行三維重建,建立不同大小、水平、位置的脛骨近端骨腫瘤圓形骨缺損模型,分析各模型應(yīng)力大小及分布特征;2.使用數(shù)字醫(yī)學方法對脛骨進行三維重建,建立不同柄長的脛骨近段腫瘤型假體-脛骨的三維模型,分析步行載荷下,模型的應(yīng)力大小及分布特征;3.利用新型膝關(guān)節(jié)三維分析系統(tǒng)opti_Knee(?)采集脛骨近端骨腫瘤術(shù)后患者的三維步態(tài),分析膝關(guān)節(jié)6個自由度和5個運動學參數(shù)。[結(jié)果]1.在步行載荷下,各骨缺損模型的應(yīng)力均大于無缺損脛骨模型的應(yīng)力45.38MPa,外側(cè)壁缺損缺損Φ50mm模型的應(yīng)力為186.2MPa;后側(cè)壁缺損Φ40mm、Φ50mm模型的應(yīng)力為:133.5-144.7MPa;余缺損模型的應(yīng)力均小于脛骨屈服應(yīng)力125MPa;2.在步行載荷下,截骨12cm的脛骨近端腫瘤型假體-脛骨模型,不同柄長假體-脛骨模型可產(chǎn)生應(yīng)力及位移差異,應(yīng)力范圍為34.34-95.22MPa,柄長度與假體、骨水泥應(yīng)力呈正相關(guān)(R2=0.97及R2=0.82),與位移程度呈負相關(guān)(R2=0.95);3.1.脛骨近端骨腫瘤假體置換術(shù)后,患膝的承重反應(yīng)期最大屈曲角較健膝小,膝關(guān)節(jié)的三維位移在站立期均輕微改變,明顯小于健膝(P0.05);3.2.脛骨近端骨腫瘤微波消融術(shù)后,患膝屈伸度小于健側(cè)(P0.05),內(nèi)外旋和內(nèi)外翻度大于健膝(P0.05);脛骨最大內(nèi)旋角度大于健膝(P0.05);[結(jié)論]1.缺損程度及部位是影響脛骨骨折風險的重要因素,當缺損程度超過Φ20mm會增加骨折風險,缺損超過30mm骨折風險明顯增高;相同的缺損程度,前內(nèi)側(cè)壁缺損的骨折風險更小;2.當脛骨上段截骨約120mm時,選擇柄長120mm的假體可減輕位移過大及應(yīng)力集中兩種影響,可能是一種較好的選擇。3.1.脛骨近端骨腫瘤假體重建的患者術(shù)后可獲良好膝關(guān)節(jié)功能及穩(wěn)定的步態(tài),步行過程中膝關(guān)節(jié)自由與假體相適應(yīng)。3.2.脛骨近端骨腫瘤微波消融術(shù)后患者術(shù)后有較好的膝功能及接近正常的穩(wěn)定步態(tài),屈伸度不及健膝。
[Abstract]:[Objective: 1. To analyze the stress status of cortical defect model with different size, level and position of proximal tibia, and to explore the relationship between proximal tibial bone defect and fracture risk. 2. The stress and displacement of tibial-prosthesis under different length of intramedullary pedicle of prosthesis were analyzed to provide reference for selecting the length of proximal tibial prosthesis of tumor type. 3. To analyze the limb function and gait of patients with primary proximal tibial bone tumor treated by limb salvage, and to discuss the biomechanical characteristics of patients with different reconstruction methods. [Methods: 1. The three-dimensional reconstruction of tibia was carried out by digital medicine, and the circular bone defect model of proximal tibial bone tumor with different size, level and position was established, and the stress size and distribution characteristics of each model were analyzed. 2. Three-dimensional reconstruction of tibia was carried out with digital medical method, and a three-dimensional model of the proximal tibial prosthesis with different shank lengths was established. The stress size and distribution characteristics of the model under walking load were analyzed. 3. Using a new three-dimensional analysis system for knee joint, Optix Kneea? The three-dimensional gait of patients with proximal tibial bone tumor was collected and 6 degrees of freedom and 5 kinematics parameters were analyzed. [Results 1. Under walking load, the stress of each bone defect model was higher than that of the tibial model without defect (45.38 MPA), and the stress of 桅 50 mm model with lateral wall defect was 186.2 MPA. The stress of 桅 40mm and 桅 50mm model was 133.5-144.7MPa; The stress of residual defect model was less than that of tibia yield stress (125 MPA). 2. Under walking load, the tumor prosthetic tibial model of proximal tibia with osteotomy 12cm could produce different stresses and displacements with different pedicle length prosthetic tibial models. The stress range was 34.34-95.22 MPA, and the stem length was positively correlated with the prosthesis, and the stress of bone cement was positively correlated with R20.97 and R20.82). There was a negative correlation with the degree of displacement. 3.1.After the proximal tibial bone tumor prosthesis replacement, the maximal flexion angle of the affected knee in the load-bearing reaction period was smaller than that of the healthy knee, and the three-dimensional displacement of the knee joint was slightly changed during the standing period, which was obviously smaller than that of the healthy knee. 3.2.After microwave ablation of proximal tibial bone tumor, the degree of flexion and extension of the affected knee was lower than that of the contralateral bone, and the degree of internal and external rotation and internal and external rotation was higher than that of the healthy knee. The maximal internal rotation angle of tibia was greater than that of healthy knee (P0.05). [Conclusion: 1. The degree and position of defect is an important factor influencing tibial fracture risk. When the defect degree exceeds 桅 20mm, the fracture risk will increase, and the fracture risk of defect more than 30mm will increase obviously. With the same degree of defect, the fracture risk of anterior and medial wall defect was lower. 2. When the proximal tibia osteotomy is about 120mm, selecting the prosthesis with the stem length of 120mm can reduce the effects of excessive displacement and stress concentration. May be a better choice .3.1. Patients with proximal tibial bone tumor prosthesis reconstruction can obtain good knee function and stable gait after operation. After microwave ablation of proximal tibial bone tumor, the patients had better knee function and close to normal stable gait, and the flexion and extension were not as good as the healthy knee.
【學位授予單位】：南方醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R738

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