本文選題：發(fā)育性髖關(guān)節(jié)發(fā)育不良 + 髖臼軟骨�。� 參考：《吉林大學(xué)》2017年博士論文

【摘要】：目的意義:髖關(guān)節(jié)發(fā)育不良是引起青少年和成人髖關(guān)節(jié)疼痛和關(guān)節(jié)炎的一個重要病因。髖臼周圍截骨術(shù)通過重定位髖臼來為股骨頭提供理想的骨性覆蓋,廣泛用于治療輕度髖臼發(fā)育不良患者。但是即使在足夠年輕時行髖臼周圍截骨術(shù)治療,有部分患者短期內(nèi)也可能進展為骨關(guān)節(jié)炎。這可能由眾多原因?qū)е?其中針對發(fā)育不良髖臼月狀面軟骨的研究逐漸引起重視。髖臼周圍截骨術(shù)重點在如何確定髖臼截骨塊的最適旋轉(zhuǎn)角度,增加股骨頭一個部位的覆蓋率可能會使股骨頭另一個部位覆蓋率低于正常,然而任何方向的過度覆蓋又將導(dǎo)致股骨髖臼撞擊。所以術(shù)前掌握髖臼負重面即月狀面的精確三維信息至關(guān)重要。三維有限元分析技術(shù)近年來越來越多的應(yīng)用于髖臼周圍截骨術(shù)治療髖關(guān)節(jié)發(fā)育不良的生物力學(xué)試驗中,通過對術(shù)前與術(shù)后髖臼軟骨等的接觸應(yīng)力分析,預(yù)估術(shù)中矯正度數(shù)的范圍,提高手術(shù)操作的精確程度。本研究將基于Crowe I型女性髖關(guān)節(jié)發(fā)育不良患者CT數(shù)據(jù)對髖臼月狀面進行三維重建,精確測量,并根據(jù)不同方向缺損對髖臼軟骨進行形態(tài)學(xué)分型,通過對不同缺損類型軟骨模型的有限元技術(shù)分析,驗證本分型的理論意義及探索術(shù)中髖臼截骨塊最適旋轉(zhuǎn)角度,為治療發(fā)育性髖關(guān)節(jié)發(fā)育不良及探討髖關(guān)節(jié)骨性關(guān)節(jié)炎的發(fā)生發(fā)展機制提供有價值的臨床和理論依據(jù)。材料與方法:發(fā)育不良組67個髖和正常組61個髖均接受標(biāo)準(zhǔn)前后位骨盆X線片和偽側(cè)位X線片、三維CT掃描。骨盆正位片測量LCEA、AI,偽側(cè)位片測量ACEA。將CT數(shù)據(jù)以DICOM格式導(dǎo)入Mimics及3-matic軟件中對正常和發(fā)育不良髖臼月狀面進行形態(tài)學(xué)比較。正常骨盆CT數(shù)據(jù)用Mimics軟件對骨盆和股骨近端三維重建,導(dǎo)入MSC.Marc有限元分析軟件,劃分面網(wǎng)格與體網(wǎng)格,生成一個具有骨盆皮質(zhì)骨、松質(zhì)骨、髖臼軟骨、髖臼盂唇、股骨頭軟骨、股骨頭皮質(zhì)骨松質(zhì)骨、骶髂關(guān)節(jié)和恥骨聯(lián)合的正常髖有限元模型,均被定義為各向同性線性彈性材料,共600,000左右個四面體單元,120,000左右個節(jié)點。髖臼軟骨除去髖臼切跡后表面積為2070.1mm2。關(guān)節(jié)面定義為非線性、無摩擦的三維接觸模型。根據(jù)文獻賦予不同組織不同的彈性模量和泊松比。通過對正常髖關(guān)節(jié)有限元模型髖臼緣向后內(nèi)側(cè)縮進和賦予不同月狀面缺損的軟骨模型,生成DDH-1 normal、DDH-2 SD、DDH-3ASD和DDH-4 GD模型,分別以10°、15°、20°行髖臼周圍截骨術(shù)旋轉(zhuǎn)髖臼截骨塊得到PAO-1 Normal 20、PAO-1 Normal 25、PAO-1 Normal 30;PAO-2 SD20、PAO-2 SD 25、PAO-2 SD 30;PAO-3 ASD 20、PAO-3 ASD 25、PAO-3 ASD30;PAO-4 GD 20、PAO-4 GD 25、PAO-4 GD 30,共16個有限元模型。在骶骨上關(guān)節(jié)面中心處,施加一個垂直向下的重力約為620N,外展肌力為460N。以force control作為數(shù)值計算方案,采用Newton-Raphson迭代方法分20步逐漸增量加載負荷。研究結(jié)果:將DDH組分為上方面積減小組(10.44%)、前上方面積減小組(40.3%)、整體面積減小組(32.84%)和整體面積增加組(16.42%)。發(fā)育不良髖臼月狀面在骨盆中的三維位置較正常者偏向內(nèi)下旋轉(zhuǎn)。整體DDH組月狀面相對和絕對面積較正常組顯著減小。針對DDH各分組術(shù)前術(shù)后的有限元分析結(jié)果,表明在正常髖關(guān)節(jié)髖臼側(cè),von Mises應(yīng)力均勻的分布在月狀面的上方區(qū)域,大部分集中于髖臼月狀面的中心。峰值應(yīng)力為13.06 MPa。然而,4個DDH模型術(shù)前von Mises分布密集的集中在髖臼邊緣,DDH-1normal模型,術(shù)前峰值應(yīng)力為24.14 MPa,PAO旋轉(zhuǎn)10°、15°、20°術(shù)后峰值應(yīng)力分別為22.87 MPa、18.94 MPa、19.64MPa。DDH-2 SD模型,術(shù)前峰值應(yīng)力為40.36 MPa,PAO術(shù)后峰值應(yīng)力分別為35.56 MPa、33.22MPa、29.45 MPa。DDH-3 ASD模型,術(shù)前峰值應(yīng)力為43.35 MPa,PAO術(shù)后峰值應(yīng)力分別降低至40.34 MPa、37.99 MPa、30.79 MPa。DDH-4 GD模型,術(shù)前峰值應(yīng)力為46.67 MPa,PAO術(shù)后峰值應(yīng)力分別降低至35.81 MPa、36.28 MPa、30.10 MPa。研究結(jié)論:本試驗通過對DDH患者髖臼月狀面三維重建,精確測量,首次將髖臼月狀面分為:上方面積減小型、前上方面積減小型、整體面積減小型和整體面積增加型。有限元分析表明,即使術(shù)前放射線學(xué)參數(shù)一致,但是不同類型髖臼月狀面缺損模型術(shù)前及術(shù)后矯正度數(shù)的不同,其髖臼側(cè)接觸應(yīng)力的分布也不盡相同,這為驗證分型的臨床意義和對PAO術(shù)中髖臼截骨塊的精確旋轉(zhuǎn)再定位、個體化截骨提供了非常重要的理論依據(jù),同時對于DDH髖關(guān)節(jié)骨關(guān)節(jié)炎發(fā)生發(fā)展機制的研究和保證良好的長期療效及預(yù)防骨關(guān)節(jié)炎的進展有重要的臨床意義。
[Abstract]:Objective: dysplasia of the hip is an important cause of hip pain and arthritis in adolescents and adults. Peri acetabular osteotomy provides an ideal bone cover for the femoral head by repositioning the acetabulum to treat patients with mild acetabular dysplasia. Some patients may also advance to osteoarthritis in the short term. This may be caused by a number of reasons, of which research on the dysplasia of the acetabular moon cartilage is becoming more and more important. The focus of the acetabular osteotomy is to determine the optimum rotation angle of the acetabular osteotomy block, and the increase of the coverage rate of the one part of the femoral head may cause the femoral head to make the stock. The cover rate of the other part of the bone is lower than that of the normal, but the over coverage of any direction will lead to the impact of the femur acetabulum. Therefore, it is essential to master the accurate three-dimensional information of the acetabular weight surface, that is, the monthly surface, and the three-dimensional finite element analysis technique is used in the treatment of hip dysplasia in the treatment of hip joint osteotomy in recent years. In the biomechanical test, the range of preoperative and postoperative acetabular cartilage contact stress analysis is used to predict the extent of correction in the operation and to improve the accuracy of operation. This study will be based on the three dimensional reconstruction of the acetabular moon surface based on the CT data of the Crowe I female hip dysplasia. The morphological classification of acetabular cartilage was carried out. Through the finite element analysis of the cartilage model of different types of defects, the theoretical significance and the optimal rotation angle of the acetabular osteotomy block were explored to provide valuable clinical treatment for developmental dysplasia of the hip and the mechanism of the development of the osteoarthritis of the hip joint. Materials and methods: 67 hip and 61 hips in 67 hips and normal groups in the dysplasia group received standard anterior and posterior X ray films and pseudoralateral X ray films, three-dimensional CT scan. Pelvic positive tablets were measured by LCEA, AI, and pseudo lateral radiograph was used to measure CT data in DICOM format into Mimics and 3-matic software for normal and dysplasia acetabular lunar surface. Morphological comparison. Normal pelvic CT data were reconstructed by Mimics software for three-dimensional reconstruction of the pelvis and proximal femur. MSC.Marc finite element analysis software was introduced to divide surface meshes and body meshes to produce a pelvic cortical bone, cancellous bone, acetabular cartilage, acetabular labia, femoral head cartilage, femoral head cortical bone, sacroiliac joint and pubic bone. The finite element model of the normal hip is defined as an isotropic linear elastic material, with a total of about 600000 tetrahedral elements and about 120000 nodes. The acetabular cartilage is defined as a nonlinear, frictionless, three-dimensional contact model after the acetabular cartilage is removed from the acetabular notch. The different modulus of elasticity is given to different tissues according to the literature. Poisson ratio. The DDH-1 normal, DDH-2 SD, DDH-3ASD and DDH-4 GD models were generated by indentation of the acetabular edge of the finite element model of the normal hip joint and endowed with different lunar surface defects. The acetabular osteotomy block around the acetabulum was rotated by the acetabular osteotomy for PAO-1 Normal 20, PAO-1 Normal 25 and PAO-1 30, respectively, by the 10 degrees, 15 degrees, and 20 degrees respectively. AO-2 SD20, PAO-2 SD 25, PAO-2 SD 30; PAO-3 ASD 20, PAO-3 ASD 25, PAO-3 ASD30; 20, 25, 30, a total of 16 finite element models. The method was divided into 20 step incremental loading load. The results were divided into group DDH subtraction group (10.44%), area reduction group (40.3%), total area reduction group (32.84%) and overall area increase group (16.42%). The three dimensional position of dysplastic acetabular surface in pelvis was more than normal people, and the overall DDH group was monthly. According to the results of the finite element analysis of the DDH groups before and after the operation, it was shown that the stress of the von Mises was evenly distributed over the upper part of the lunar surface at the acetabular side of the normal hip joint. The peak stress was 13.06 MPa., but the von Mises distribution before the 4 DDH models. Concentrated concentration at the acetabular edge, DDH-1normal model, the peak stress of 24.14 MPa, PAO rotation 10, 15, 20 degrees, 22.87 MPa, 18.94 MPa, 19.64MPa.DDH-2 SD model, pre operation peak stress of 40.36 MPa, and peak stress of 35.56 MPa, 33.22MPa, 29.45 MPa.DDH-3 model, peak stress. For 43.35 MPa, the peak stress after PAO was reduced to 40.34 MPa, 37.99 MPa, and 30.79 MPa.DDH-4 GD model, the peak stress was 46.67 MPa, and the peak stress after PAO was reduced to 35.81 MPa, 36.28 MPa, 30.10 MPa.. The size of the upper area was reduced, the area of the anterior upper area was reduced, the overall area was reduced and the overall area was increased. The finite element analysis showed that, even if the preoperative radiological parameters were consistent, the distribution of the acetabular side contact stress in the acetabular model of different types of acetabular models was different, which was proved to be different. The clinical significance of the classification and the accurate rotation and repositioning of the acetabular osteotomy block in PAO provides a very important theoretical basis for the individualized osteotomy. At the same time, it has important clinical significance for the study of the pathogenesis and development mechanism of the osteoarthritis of the hip joint in DDH and the good long-term effect and the prevention of osteoarthritis.

【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2017
【分類號】：R684

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1 許猛;CroweⅠ型發(fā)育不良髖臼月狀面三維形態(tài)學(xué)分型及髖臼周圍截骨術(shù)的有限元研究[D];吉林大學(xué);2017年

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本文編號：1868274