本文選題：脛骨延長桿　切入點(diǎn)：有限元分析　出處：《鄭州大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的隨著人民生活水平的提高,患有膝關(guān)節(jié)骨性關(guān)節(jié)炎的肥胖患者人群的數(shù)量逐漸增加。膝關(guān)節(jié)置換術(shù)是治療骨性關(guān)節(jié)炎的有效手段。在肥胖患者進(jìn)行膝關(guān)節(jié)置換過程中使用脛骨延長桿可以有效降低術(shù)后無菌性松動的發(fā)生率。但是,對不同長度的脛骨延長桿對脛骨應(yīng)力分布的影響研究較少。本研究旨在通過有限元素分析的方法研究患有骨性關(guān)節(jié)炎的肥胖患者在膝關(guān)節(jié)置換中,脛骨側(cè)使用不同長度延長桿對脛骨平臺應(yīng)力分布以及脛骨應(yīng)力遮擋的影響。方法1.對一女性骨性關(guān)節(jié)炎患者行脛骨計(jì)算機(jī)斷層掃描,利用Mimics15.0進(jìn)行影像學(xué)數(shù)據(jù)處理以及三維重建,導(dǎo)出其脛骨三維實(shí)體模型并以STL格式導(dǎo)入U(xiǎn)nigraphics NX8.5中按照膝關(guān)節(jié)置換操作進(jìn)行模擬手術(shù),建立其脛骨截骨后的三維實(shí)體模型,并在軟件中導(dǎo)入膝關(guān)節(jié)假體脛骨側(cè)及30mm、60mm和100mm延長桿。通過FEMAP有限元軟件對各組三維模型進(jìn)行網(wǎng)格劃分、各部分材料屬性賦值、確定坐標(biāo)系、加載載荷和邊界條件,建立三維動態(tài)有限元模型。2.虛擬脛骨假體與不同長度延長桿配對的模型,對照組A為標(biāo)準(zhǔn)脛骨平臺,平臺下端無延長桿連接,實(shí)驗(yàn)組B用標(biāo)準(zhǔn)脛骨平臺假體與30mm延長桿連接。實(shí)驗(yàn)組C為標(biāo)準(zhǔn)脛骨平臺假體與60mm延長桿連接。實(shí)驗(yàn)組D為標(biāo)準(zhǔn)平臺假體與100mm延長桿相連接。各組模型相互獨(dú)立。通過FEMAP有限元軟件計(jì)算四組三維動態(tài)有限元模型假體接觸的生物力學(xué)特性。結(jié)果1.在標(biāo)準(zhǔn)平臺與3組不同長度的實(shí)驗(yàn)組中,各組脛骨假體翼面與平臺底面相交外側(cè)局部應(yīng)力最高。脛骨假體翼兩側(cè)應(yīng)力較高,在標(biāo)準(zhǔn)平臺上(0mm)其應(yīng)力最大,44.32±2.26MPa。在使用30mm、60mm、及100mm延長桿時,應(yīng)力值分別為37.93±1.25MPa、34.62±3.85MPa和36.70±2.97MPa。三組實(shí)驗(yàn)組比對照組應(yīng)力值明顯減小,差異有統(tǒng)計(jì)學(xué)意義(P0.05),各組實(shí)驗(yàn)組之間無統(tǒng)計(jì)學(xué)差異。2.在對照組A、實(shí)驗(yàn)組B與實(shí)驗(yàn)組C的模型中,脛骨平臺內(nèi)側(cè)應(yīng)力分別指4.09±0.85MPa,3.98±0.73MPa和3.88±0.80MPa,三組模型中差異無統(tǒng)計(jì)學(xué)意義,而在實(shí)驗(yàn)組D(100mm延長桿)中,內(nèi)側(cè)平臺應(yīng)力明顯下降為1.55±0.29MPa,與其他其他三組之間差異有統(tǒng)計(jì)學(xué)意義。在對照組A和實(shí)驗(yàn)組B模型中,脛骨后側(cè)平臺所受應(yīng)力為11.68±1.01MPa和10.34±2.05,兩組之間差異有統(tǒng)計(jì)學(xué)意義(P0.05),A、B兩組分別與實(shí)驗(yàn)組C、D有在后側(cè)平臺應(yīng)力上差異有統(tǒng)計(jì)學(xué)意義(P0.05)。實(shí)驗(yàn)組C、D之間后側(cè)平臺之間無明顯統(tǒng)計(jì)學(xué)差異。3.在對照組A(0mm標(biāo)準(zhǔn)平臺)中,距離脛骨平臺24.2cm處應(yīng)力達(dá)到峰值,為43.3MPa。在實(shí)驗(yàn)組模型中,延長桿的使用并沒有改變這種軸向傳導(dǎo)應(yīng)力模式,但將應(yīng)力峰值的位置向遠(yuǎn)端傳導(dǎo),使用30mm、60mm和100mm延長桿時應(yīng)力峰值逐步增加,分別達(dá)到60.52MPa、66.31MPa和78.61MPa,其位置距離脛骨平臺分別為26.6cm、28.3cm和30.6cm。4.三個實(shí)驗(yàn)組中,不同長度的延長桿置換后脛骨近端骨皮質(zhì)的應(yīng)力相應(yīng)減小,以100mm延長桿組減少最為顯著。100mm延長桿組中應(yīng)力遮擋較大的區(qū)域位于距離基座6cm以內(nèi),最大達(dá)82.39%;60mm延長桿組中,應(yīng)力遮擋最大值的區(qū)域距離基座6cm以內(nèi),最大67.83%;30mm延長桿中,最大應(yīng)力遮擋區(qū)域與基座距離2cm以內(nèi),最大應(yīng)力遮擋率為39.48%。三者具有統(tǒng)計(jì)學(xué)差異。結(jié)論延長桿的使用可以在一定程度上分散脛骨平臺應(yīng)力;延長桿均對脛骨近端形成不同程度的應(yīng)力遮擋,較長延長桿更為明顯;延長桿使應(yīng)力向脛骨遠(yuǎn)端傳導(dǎo),延長桿較長時,會使脛骨中下段應(yīng)力集中,增加術(shù)后脛骨中下段疼痛發(fā)生率;膝關(guān)節(jié)置換中,增加延長桿對脛骨平臺前側(cè)和外側(cè)應(yīng)力無明顯影響,較長延長桿會分散脛骨平臺內(nèi)側(cè)應(yīng)力,而使用較短延長桿就可以明顯減少脛骨平臺后側(cè)應(yīng)力。
[Abstract]:Objective: with the improvement of people's living standard, the number of people with osteoarthritis of the knee in patients with obesity population increased gradually. Knee arthroplasty is an effective therapy for osteoarthritis of knee replacement. The use of tibial lengthening rod can effectively reduce the incidence of aseptic loosening and low postoperative in obese patients. However, for different lengths of tibia lengthening rod of tibial should be less studied stress distribution. The purpose of this study is to research methods through the finite element analysis of the patients with osteoarthritis of the knee arthroplasty in obese patients, the tibia using different length extension rod stress distribution and tibial stress shielding on tibial plateau. Methods 1. the female osteoarthritis underwent tibial computed tomography, using Mimics15.0 imaging data processing and 3D reconstruction, 3D model is derived from the tibia Taking the STL format into Unigraphics NX8.5 in accordance with the knee joint replacement operation for surgical simulation, establish the 3D model of the tibial osteotomy, and imported knee prosthesis tibial and 30mm in software, 60mm and 100mm. The extension rod is used to mesh the three-dimensional model of each group by FEMAP finite element software, the material properties the assignment, determine the coordinates, load and boundary conditions, the establishment of three-dimensional dynamic finite element model of.2. virtual tibial prosthesis with different length extension rod matching model, the control group A as standard tibial plateau, the lower end of long rod connecting platform, the experimental group with B prosthesis and 30mm standard tibial extension rod connection. The experimental group C as the 60mm standard tibial plateau prosthesis and extension rod connection. The experimental group D prosthesis and 100mm standard platform extension rod is connected. All models are independent of each other. Through the finite element software FEMAP calculation of the four group of three The biomechanical properties of prosthesis dimensional dynamic finite element model of contact. Results in the 1. standard platform and 3 groups of different length in the experimental group, each group of tibial wing surface and the bottom surface of the platform outside the intersection of local stress. The highest tibial prosthesis wing on both sides of the stress is higher in the standard platform (0mm) the maximum stress, 44.32. 2.26MPa. in the use of 30mm, 60mm, and 100mm extension rod, the stress values were 37.93 + 1.25MPa, 34.62 + 3.85MPa and 36.70 + 2.97MPa. three group experimental group than the control group significantly reduces stress, the difference was statistically significant (P0.05), the experimental group showed no significant difference between the groups of.2. in the control group A, experiment group B and experimental group C model, medial tibial plateau stress were 4.09 + 0.85MPa, 3.98 + 0.73MPa and 3.88 + 0.80MPa, there was no significant difference between the three groups in the model, while in the experimental group D (100mm extension rod), medial plateau stress decreased to 1.55 + 0.29M Pa, there was statistical significance and other differences between the three groups. In the control group A and experimental group B model, posterior tibial plateau stress was 11.68 + 1.01MPa and 10.34 + 2.05, there were statistically significant differences between the two groups (P0.05), A, B two group were compared with the experimental group C, D there are significant differences in the rear force platform (P0.05). The experimental group C, no statistically significant difference in the control group.3. A between D platform (0mm platform) posterior tibial platform, 24.2cm distance stress peak of 43.3MPa. in the experimental group model, the extension rod is not change the axial stress transmission mode, but the location of peak stress to the distal conduction, using 30mm, 60mm and 100mm extension rod stress peak increased gradually, reached 60.52MPa, 66.31MPa and 78.61MPa, the distance between the tibial plateau were 26.6cm, 28.3cm and 30.6cm.4. three in the experimental group Stress, extension rod after the replacement of different lengths of tibia proximal bone cortex decreased, with prolonged 100mm bar group decreased the most significant prolongation of.100mm stress shielding large area is located in the base within 6cm bar group, up to 82.39%; 60mm extension rod group, within the 6cm region from the base of stress shielding the maximum value of the maximum 67.83%; 30mm extension rod, the maximum stress shielding region and the base distance less than 2cm, the maximum stress shielding rate of 39.48%. three was statistically significant. Conclusion the extension rod can be dispersed in a certain degree of tibial plateau stress; extension rod of the proximal tibia of varying degrees of stress block, long extension rod is more obvious; the extension rod stress conduction to the distal tibia, the extension rod is longer, the lower tibial stress concentration, increased postoperative pain incidence of tibia; knee arthroplasty, increased extension rod There is no significant effect on the tibial plateau's lateral and lateral stresses. Long extension rods will disperse the medial stress of the tibial plateau, while using shorter extension rods can significantly reduce the posterior side stress of tibial plateau.

【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R687.4

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