本文選題：股骨骨折 + 股骨前弓��； 參考：《河北醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的:采用有限元方法模擬不同前弓曲率半徑的股骨,進(jìn)而得到其對(duì)順行髓內(nèi)釘使用的影響。探討中國人股骨前弓與髓內(nèi)釘?shù)钠ヅ湫詥栴},從而制定適合國人的術(shù)前計(jì)劃和治療方案,并提出初步的新設(shè)計(jì)方案。方法:選取正常成年男性志愿者一例,志愿者年齡31歲,通過X線檢查右側(cè)股骨無病理性改變。選用64排螺旋CT機(jī)在管電壓:120KV,管電流:200m A的條件下,掃描志愿者的右側(cè)股骨。設(shè)定掃描條件為:掃描層厚為1mm,層間距為1mm。將掃描所得的Dicom格式數(shù)據(jù)導(dǎo)入交互式醫(yī)學(xué)影像控制系統(tǒng)Mimics14.0,在確定正常方位后根據(jù)軟件設(shè)定的骨骼閾值,利用蒙罩編輯、形態(tài)學(xué)操作等功能將骨骼與其它周圍組織分離,建立完整的右側(cè)股骨包括皮質(zhì)骨及松質(zhì)骨部分的三維空間模型。將此模型轉(zhuǎn)換為STL格式并導(dǎo)入到自動(dòng)化逆向工程軟件Geomagic Studio 12.0中,在表面光順化處理后進(jìn)行網(wǎng)格優(yōu)化。定義正位X線上小轉(zhuǎn)子下緣水平以上部分為股骨上段,側(cè)位X線上內(nèi)收肌結(jié)節(jié)水平以下部分為股骨下段,兩水平中間部分為股骨中段,以此進(jìn)行裁切,并計(jì)算股骨中段模型初始股骨前弓曲率半徑。于Mimics14.0軟件中,在股骨近段自進(jìn)針點(diǎn)沿髓內(nèi)釘插入方向建立一直徑為14mm通道,與髓腔結(jié)合,視為近段通道;在股骨中段以髓腔為基礎(chǔ)建立通道,在股骨髓腔峽部附近沿股骨弧度分別建立直徑為11mm、12mm、13mm通道,模擬擴(kuò)髓后狀態(tài),中段遠(yuǎn)端松質(zhì)骨看做髓腔處理,結(jié)合后視為中段通道;股骨遠(yuǎn)段松質(zhì)骨看做髓腔處理,視為遠(yuǎn)段通道;三部分結(jié)合為髓內(nèi)釘插入過程的通道。導(dǎo)入Geomagic Studio12.0軟件內(nèi)進(jìn)行布爾減運(yùn)算,獲得去除髓內(nèi)釘插入通道的股骨上、中、下三段模型。在美國參數(shù)技術(shù)公司(Parametric Technology Corporation,PTC公司)所研發(fā)的參數(shù)化建模軟件Creo Parametric 2.0中,利用其草繪功能,繪制出施樂輝(Smith-Nephew)公司的?10、11、12mm×350mm3種規(guī)格的右側(cè)股骨重建釘,以及該公司?5mm×90mm股骨近端鎖釘。而后在Mimics14.0軟件的3-matic模塊中依據(jù)其置入原則進(jìn)行組裝,得到置有重建釘及兩枚近端鎖釘?shù)墓晒悄Ｐ?在Creo Parametric 2.0中以股骨中段為選取框分別對(duì)股骨模型進(jìn)行扭曲操作,得到不同曲率半徑的股骨模型。在股骨模型中模擬重建釘插入過程通道,通過微調(diào)股骨前弓及重建釘空間位置,觀察重建釘與股骨髓腔內(nèi)壁的相對(duì)關(guān)系,探討重建釘與股骨前弓的匹配程度。提出股骨前弓正切值的概念,該值為股骨前弓所在圓弧的弦高與1/2現(xiàn)場(chǎng)的比值,因?yàn)橄伺臄zX線的放大率,使結(jié)果更精確并更易得出。通過術(shù)前拍攝健測(cè)股骨正側(cè)位X線,從而預(yù)測(cè)術(shù)中及術(shù)后重建釘與患者股骨髓腔的匹配程度,指導(dǎo)制定臨床治療方案。結(jié)果:在Mimics14.0軟件中從水平面、冠狀面、矢狀面分析結(jié)果,按重建釘不同直徑分組,對(duì)應(yīng)10mm、11mm、12mm的重建釘,股骨前弓曲率半徑分別為75.7647cm、73.0057cm、96.9086cm,股骨前弓正切值分別大于0.915351、0.095056、0.071330的股骨模型,因重建釘遠(yuǎn)端接觸股骨遠(yuǎn)端內(nèi)側(cè)皮質(zhì),將會(huì)造成術(shù)后疼痛及內(nèi)固定周圍應(yīng)力骨折的高風(fēng)險(xiǎn)。直徑為10mm的重建釘因直徑比股骨峽部入口處髓腔內(nèi)徑小,在調(diào)整股骨前弓曲率半徑至42.1221cm、在釘頭達(dá)到此處時(shí)仍不會(huì)出現(xiàn)插入困難,而直徑為11mm、12mm的重建釘,在股骨前弓曲率半徑分別為63.7519cm、95.7433cm,股骨前弓正切值分別大于0.101646、0.072207的股骨模型,在釘頭達(dá)到股骨峽部入口處時(shí)插入困難,股骨前弓曲率半徑分別為66.3759cm、75.7665cm、96.9086cm,股骨前弓正切值分別大于0.104751、0.091535、0.071330的股骨模型,在釘頭達(dá)到股骨峽部最狹窄處時(shí)插入困難,股骨前弓曲率半徑分別為74.3592cm、77.2252cm、99.3351cm,股骨前弓正切值分別大于0.093295、0.089775、0.069570的股骨模型,在釘頭達(dá)到股骨峽部最下端時(shí)插入困難,如強(qiáng)行暴力置入,將引起醫(yī)源性骨折。股骨前弓曲率半徑分別為57.0168cm、64.7568cm、66.9274cm,股骨前弓正切值分別大于0.122430、0.107398、0.103869的股骨模型,由于髓內(nèi)釘偏前插入,將撞擊股骨近端前側(cè)皮質(zhì),或因患者合并其他股骨近端骨折時(shí),無法順利置入近端股骨頸方向鎖釘。結(jié)論:較大股骨前弓弧度的股骨將會(huì)造成髓腔與重建釘?shù)牟黄ヅ?產(chǎn)生諸多并發(fā)癥。重建釘遠(yuǎn)端接觸股骨遠(yuǎn)端內(nèi)側(cè)皮質(zhì),將造成術(shù)后疼痛及內(nèi)固定周圍應(yīng)力骨折的高風(fēng)險(xiǎn);在釘頭達(dá)到股骨峽部時(shí)插入困難,如強(qiáng)行暴力置入,將引起醫(yī)源性骨折�？梢酝ㄟ^適當(dāng)向前調(diào)整進(jìn)針點(diǎn)便于重建釘?shù)牟迦爰氨苊馍鲜霾l(fā)癥,但由于髓內(nèi)釘偏前插入,將撞擊股骨近端前側(cè)皮質(zhì),或因患者合并其他股骨近端骨折時(shí),無法順利置入近端股骨頸方向鎖釘。
[Abstract]:Objective: the finite element method was used to simulate the femur with different radius of curvature of anterior arch, and then the effect on the use of intramedullary nail was obtained. The matching problem between the anterior and intramedullary nails of the Chinese femur was discussed, and the pre operation plan and treatment plan suitable for the Chinese people were established, and the preliminary new design scheme was put forward. Method: select the normal adult male chronicles. A volunteer, a volunteer, was 31 years old and had no pathological changes in the right femur by X-ray. A 64 row spiral CT was selected to scan the right femur of the right femur under the condition of 120KV and 200m A. The scanning condition was set as: the scanning layer thickness was 1mm, and the interval between the layers was 1mm. and the scanned Dicom format data were introduced into interactive medical shadow. Like the control system Mimics14.0, the three-dimensional spatial model of the complete right femur, including the cortical bone and the cancellous bone, is established by using the mask editing, morphological operation and other functions to establish a three-dimensional space model of the complete right femur, including the cortical bone and the cancellous bone. The model is converted into the STL format and imported into automation. In the reverse engineering software Geomagic Studio 12, the mesh was optimized after the surface light reduction. The upper part of the lower margin of the small trochanter was defined as the upper part of the femur, the lateral X ray of the adductor nodule was below the lower part of the femur, and the middle part of the two level was the middle part of the femur, and the middle femoral model was calculated. The radius of curvature of the initial anterior femoral arch. In Mimics14.0 software, a 14mm channel was established in the direction of intramedullary nail insertion at the proximal femur point, which was combined with the medullary cavity and considered as the proximal passage; the middle femoral segment was based on the medullary cavity, and the diameter of the femoral medullary isthmus near the femoral medullary isthmus was 11mm, 12mm, and 13mm through the femoral medullary isthmus. The distal cancellous bone of the middle segment was treated as the medullary cavity, combined with the posterior passage, and the distal femur cancellous bone was treated as the medullary cavity and regarded as the distal passage; the three part was combined as a channel for intramedullary nail insertion process. The Boolean operation was carried out in the Geomagic Studio12.0 software to obtain the strands of the insertion of intramedullary nails. Bone, middle, and lower three segments. In the parameterized modeling software Creo Parametric 2 developed by the Parametric Technology Corporation Ptc (Parametric Technology Corporation, PTC), using its sketching function, the right femur reconstruction nails of the Shi Lehui (Smith-Nephew) company, 10,11,12mm x 350mm3 specifications, and the company 5mm x 90mm share The proximal bone locking nail was assembled in the 3-matic module of Mimics14.0 software, and the femur model was built with the reconstructive nail and two proximal locking nails. In the Creo Parametric 2, the femur model was distorted by the middle femur section, and the femur model with different radius of curvature was obtained. The relative relationship between the reconstruction nail and the inner wall of the femoral medullary cavity was observed through the reconstruction of the insertion process channel of the nail. The matching degree of the reconstruction nail and the anterior femoral arch was observed. The concept of the anterior arch of the femur was proposed. The value is the ratio of the height of the arc to the 1/2 site in the anterior arch of the femur, because the elimination of the value is the elimination of the value of the anterior arch of the femur. The magnification of the X-ray was taken to make the results more accurate and easier to be obtained. Through the preoperative shooting of the orthographic X-ray of the femur, the matching degree between the intraoperative and postoperative reconstructive nails and the femoral medullary cavity of the patients was predicted, and the clinical treatment plan was drawn up. Results: the results of the analysis of the horizontal, coronal and sagittal plane in the Mimics14.0 software were not determined according to the reconstructive nails. The same diameter group, corresponding to the 10mm, 11mm, and 12mm reconstructive nails, the radius of the anterior arch of the femur is 75.7647cm, 73.0057cm, 96.9086cm, and the anterior femoral arch is greater than the femur model of 0.915351,0.095056,0.071330, respectively, because the distal contact of the distal femur to the medial cortex of the distal femur will cause the postoperative pain and the high wind of the internal fixation of the surrounding stress fracture. The diameter of the 10mm was smaller than the intramedullary diameter of the femoral isthmus, and the radius of the anterior arch of the femur was adjusted to 42.1221cm, and the insertion was not difficult when the nail head was reached. The diameter of the reconstruction nail of the 11mm and 12mm was 63.7519cm, 95.7433cm, and the anterior arch of the femur were respectively greater than that of the anterior arch of the femur. 0.101646,0.072207's femur model is difficult to insert when the nail head reaches the femoral isthmus entrance. The radius of the anterior arch of the femur is 66.3759cm, 75.7665cm, 96.9086cm, and the anterior femoral arch is greater than the 0.104751,0.091535,0.071330 in the femoral model. The insertion of the femoral head is difficult when the femoral isthmus is most narrow, and the anterior arch of the femur is half curvature. The diameter of the femoral anterior arch is 74.3592cm, 77.2252cm, 99.3351cm, the femoral anterior arch tangent value is greater than that of the 0.093295,0.089775,0.069570. The insertion of the femoral head is difficult when the nail head reaches the lowest end of the femur isthmus. If the force is forced, it will cause iatrogenic fracture. The radius of the anterior arch of the femur is divided into 57.0168cm, 64.7568cm, 66.9274cm, and anterior arch of femur. The femoral neck of the proximal femur could not be successfully inserted into the proximal femur neck locking nail when the intramedullary nail was inserted before the insertion of the intramedullary nail, or when the patient combined with other proximal femoral fractures. Conclusion: the larger femur of the anterior arch of the femur will cause the mismatch between the medullary cavity and the reconstructive nail. There are many complications. The reconstruction of the distal end of the nail with the medial cortex of the distal end of the femur will cause the high risk of postoperative pain and internal fixation of stress fractures; difficulties in the insertion of the nail head to the femoral isthmus, such as strong violence, will cause iatrogenic fractures. Complications, however, can not be successfully inserted into the proximal femoral neck locking nail when the intramedullary nail is inserted into the anterior proximal cortex of the femur or the patient is combined with other proximal femoral fractures.

【學(xué)位授予單位】：河北醫(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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本文編號(hào)：1843284