發(fā)布時(shí)間：2018-04-28 17:19

  本文選題：漏斗胸合并脊柱側(cè)彎 + 微創(chuàng)矯形��； 參考：《天津理工大學(xué)》2015年碩士論文

【摘要】：漏斗胸是一種先天性疾病,其病癥為胸骨體向內(nèi)凹陷,導(dǎo)致前胸下部成漏斗狀,造成對(duì)心臟壓迫,影響患者的心肺功能,約有30%漏斗胸患者伴有特發(fā)性脊柱側(cè)彎畸形。臨床上已經(jīng)發(fā)現(xiàn),胸腔凹陷畸形與脊柱側(cè)彎的弓形畸形位于同一側(cè)時(shí),進(jìn)行漏斗胸矯形后,多數(shù)患者的脊柱側(cè)彎癥狀得到改善,反之,脊柱側(cè)彎癥狀加重。研究漏斗胸合并脊柱側(cè)彎的矯形過程可以采用實(shí)驗(yàn)方法和數(shù)值模擬方法。受倫理限制,目前無法通過在體的電測(cè)試驗(yàn)獲得胸廓骨骼的應(yīng)變分布規(guī)律,同時(shí)因?yàn)闊o法獲得漏斗胸合并脊柱側(cè)彎的尸體標(biāo)本也無法進(jìn)行尸體的電測(cè)試驗(yàn)。目前對(duì)漏斗胸合并脊柱側(cè)彎微創(chuàng)矯形過程進(jìn)行數(shù)值模擬已經(jīng)成為獲取矯形過程中位移場(chǎng)和應(yīng)力應(yīng)變場(chǎng)的主要方法。本文對(duì)漏斗胸微創(chuàng)矯形過程進(jìn)行數(shù)值模擬的目的是認(rèn)識(shí)漏斗胸合并脊柱側(cè)彎微創(chuàng)矯形的機(jī)理,確定漏斗胸矯形對(duì)脊柱側(cè)彎的影響因素,為臨床NUSS手術(shù)提供合理的理論依據(jù),同時(shí)為人工骨胸廓模型和動(dòng)物胸廓矯形實(shí)驗(yàn)提供參考。文中采用Mimics、Geomagic studio及Pro/E軟件重建了一例漏斗胸合并脊柱側(cè)彎患者的前胸廓模型,模型中包括胸骨、肋骨及胸椎。作者發(fā)展了一種保證間盤與錐體的密切粘接的間盤建模方法,較好地解決了在Mimics軟件中創(chuàng)建椎間盤困難的問題。采用ANSYS軟件模擬了漏斗胸合并脊柱側(cè)彎微創(chuàng)矯形的過程,模擬中考慮了幾何非線性的影響。為解決數(shù)值模擬實(shí)驗(yàn)驗(yàn)證方面的困難,文中還采用ABAQUS軟件對(duì)漏斗胸合并脊柱側(cè)彎的矯形過程進(jìn)行了數(shù)值模擬,對(duì)兩種計(jì)算結(jié)果進(jìn)行了比較。文中分別對(duì)不考慮間盤和考慮間盤的兩種模型進(jìn)行了數(shù)值模擬,分析了間盤對(duì)矯形過程的影響。數(shù)值模擬分析結(jié)果顯示患者經(jīng)矯形后胸骨被抬高,漏斗胸癥狀得到明顯改善,同時(shí)脊柱彎曲程度有所減輕,證實(shí)胸腔凹陷畸形與脊柱側(cè)彎的弓形畸形在同一側(cè)時(shí),漏斗胸矯形有助于改善脊柱側(cè)彎畸形。計(jì)算結(jié)果顯示椎間盤具備吸收脊柱變形的功能。根據(jù)數(shù)值計(jì)算結(jié)果設(shè)計(jì)的手術(shù)方案已經(jīng)在北京軍區(qū)總醫(yī)院的臨床手術(shù)中應(yīng)用,手術(shù)結(jié)果顯示,患者漏斗胸癥狀和脊柱側(cè)彎程度的改善與數(shù)值模擬預(yù)測(cè)的結(jié)果一致。作者根據(jù)數(shù)值模擬得到的胸廓位移場(chǎng)和應(yīng)力應(yīng)變場(chǎng)分布規(guī)律,提出了進(jìn)行人工骨胸廓模型和動(dòng)物胸廓模型電測(cè)試驗(yàn)的指導(dǎo)性建議。
[Abstract]:Funnel chest is a congenital disease, which is caused by the depression of the body of the sternum, leading to the funnel shape of the lower part of the anterior chest, resulting in the compression of the heart and affecting the cardiopulmonary function of the patients. About 30% of the patients with funnel chest have idiopathic scoliosis deformity. It has been found that the deformity of chest cavity and the arch deformity of scoliosis are located on the same side. After correction of funnel chest, the symptoms of scoliosis in most patients have been improved, whereas the symptoms of scoliosis have been aggravated. Experimental method and numerical simulation method can be used to study the orthopedic process of funnel chest combined with scoliosis. Due to the limitation of ethics, it is impossible to obtain the strain distribution law of thoracic skeleton by in vivo electrical test, and it is also impossible to carry out the electrical test of cadaver because of the inability to obtain the specimen of funnel chest combined with scoliosis. At present, numerical simulation of minimally invasive orthopedic process of funnel chest combined with scoliosis has become the main method to obtain displacement field and stress-strain field in orthopedic process. The purpose of numerical simulation of funnel chest minimally invasive correction is to understand the mechanism of funnel chest combined with minimally invasive correction of scoliosis, to determine the influencing factors of funnel chest correction on scoliosis, and to provide a reasonable theoretical basis for clinical NUSS operation. At the same time, it provides reference for the model of artificial bone and animal thoracic orthopedic experiment. The anterior thoracic model of a patient with funnel chest associated with scoliosis was reconstructed by using the Mimicsof Geomagic studio and Pro/E software. The model included sternum, ribs and thoracic vertebrae. In this paper, the author develops a method to ensure the close bonding between the disc and the cone, which solves the problem of creating intervertebral disc in Mimics software. The process of minimally invasive correction of funnel chest combined with scoliosis was simulated by ANSYS software. The effect of geometric nonlinearity was considered in the simulation. In order to solve the difficulty of numerical simulation, the correction process of funnel chest combined with scoliosis was simulated by ABAQUS software, and the two results were compared. In this paper, two kinds of models without and without disc are numerically simulated, and the influence of disc on the orthopedic process is analyzed. The results of numerical simulation showed that the sternum was raised after correction, the pectus funnel symptoms were obviously improved, and the degree of spinal curvature was alleviated. It was proved that the deformity of thoracic cavity and the arcuate deformity of scoliosis were on the same side. Correction of funnel chest helps to improve scoliosis. The results show that the disc absorbs the deformation of the spine. The surgical scheme designed according to the numerical results has been applied in the clinical operation of Beijing military region General Hospital. The results show that the improvement of pectus funnel symptoms and the degree of scoliosis are consistent with the results predicted by the numerical simulation. According to the distribution of displacement field and stress and strain field of thoracic by numerical simulation, the author puts forward some guiding suggestions for the electric measurement test of artificial bone thoracic model and animal thoracic model.
【學(xué)位授予單位】：天津理工大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R682

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