本文選題：跟骨骨折　切入點：跟骨解剖參數(shù)　出處：《南方醫(yī)科大學》2017年碩士論文

【摘要】：目的:分析成人正常跟骨解剖參數(shù)及跟骨骨折影像學資料,設計一款微型、可調(diào)節(jié)的跟骨骨折外固定支架,并通過有限元分析法驗證其可行性。方法:1、收集跟骨骨折影像學結果,分析、歸納跟骨骨折類型,為跟骨骨折的治療方式提供參考依據(jù)。連續(xù)性納入自2012年10月至2016年12月在我院收治的跟骨骨折患者共計347例(382足),均做X線及CT檢查確診。由三名高年資骨科醫(yī)師對患者影像學資料進行分型評價及選擇治療方式。2、獲取成人正常跟骨X線片及CT掃描圖像,利用Mimics 15.0軟件測量成人正常跟骨的解剖參數(shù),為新型跟骨外固定支架的設計提供參考數(shù)據(jù)。收集40例(男性20例,女性20例)成人正常跟骨CT掃描圖像,將圖像數(shù)據(jù)導入Mimics 15.0軟件,三維重建后測量跟骨長度、寬度、高度等參數(shù),通過公式計算跟骨各部位骨密度值,劃定骨密度較高區(qū)域為可靠進針點,依據(jù)上述解剖參數(shù)設計出新型可調(diào)式跟骨外固定支架。3、通過有限元分析法建立跟骨Sanders Ⅱ、Ⅲ型骨折術后有限元模型,加載壓應力,分析該模型的穩(wěn)定性及應力分布情況:征集成年男性志愿者一名,獲取該男子足踝部CT掃描圖像,依據(jù)新型外固定支架設計圖,通過計算機軟件建立Sanders Ⅱ、Ⅲ型跟骨骨折術后有限元模型,加載應力,記錄骨折塊位移,分析其應力分布情況。結果:1、最終納入病例共計337足,依據(jù)CT Sanders分型:Ⅰ型78足(23.15%),Ⅱ型 167 足(49.55%)、Ⅲ型 61 例(18.10%)、Ⅳ型 31 足(9.20%)。259 足(76.85%)需要手術干預。2、男性組跟骨全長、寬度及高度分別為(74.52±5.01)、(29.56±2.94)、(44.21±4.26)mm;女性組分別為(71.28±5.25)、(26.85±3.21)、(40.16±4.38)mm,以上項目兩組間比較差異均具有統(tǒng)計學意義(P0.05)。經(jīng)計算,跟骨前部、結節(jié)部、丘部、載距突處骨質(zhì)較密,為可靠進針點。3、模型加載載荷后,新型外固定支架治療跟骨Sanders Ⅱ和Sanders Ⅲ型骨折的兩種模型總體位移峰值分別為:0.2483mm,0.2747mm,應力峰值為:110.3MPa,125.4MPa;兩種模型支架鋼釘位移峰值分別為:0.1504mm,0.1736mm,應力峰值為:110.3MPa,125.4MPa;兩種模型跟骨位移峰值分別為:0.2483mm,0.2747mm,應力峰值為:40.33MPa,38.13MPa。結論:1、建立的跟骨三維模型骨折形態(tài)清晰、符合實驗要求,所測得相關跟骨解剖參數(shù)精確、可靠,為外固定支架的設計提供有效參考。2、新型可調(diào)式跟骨外固定支架均能為跟骨Sanders Ⅱ、Ⅲ型骨折提供足夠的生物力學穩(wěn)定性,足踝部各骨塊應力分布較為合理,外固定支架克式針存在應力集中,在理想范圍之內(nèi)。應用該外固定支架固定Sanders Ⅱ型骨折時位移峰值及應力峰值更小,該外固定支架更適用于跟骨Sanders Ⅱ型骨折。
[Abstract]:Objective: to analyze the anatomical parameters of normal calcaneus and the imaging data of calcaneal fracture in adults, and to design a miniature, adjustable external fixator for calcaneal fracture. The feasibility was verified by finite element analysis. Methods: 1. The imaging results of calcaneal fractures were collected, and the types of calcaneal fractures were summarized. From October 2012 to December 2016, 347 patients with calcaneal fracture were admitted in our hospital. All patients were diagnosed by X-ray and CT. In order to obtain the normal calcaneal X-ray and CT scan images of adult calcaneal bone, the physician evaluated the imaging data of the patients and selected the treatment method. The anatomical parameters of normal calcaneus in adults were measured by Mimics 15.0 software to provide reference data for the design of new external fixation scaffolds of calcaneus. Ct scanning images of normal calcaneus were collected in 40 adults (20 males and 20 females). The image data were imported into Mimics 15.0 software. The length, width and height of calcaneus were measured after 3D reconstruction. The bone mineral density of various parts of calcaneus was calculated by formula. According to the above anatomical parameters, a new adjustable calcaneal external fixator was designed. The finite element model of calcaneal Sanders 鈪，

本文編號：1680780