本文選題：股骨頭壞死 + 有限元分析�。� 參考：《中國(guó)組織工程研究》2017年31期

【摘要】：背景:研究報(bào)道股骨頭前外側(cè)柱對(duì)保髖的療效起到關(guān)鍵性的作用,而中日友好醫(yī)院分型(CJFH分型)強(qiáng)調(diào)前外側(cè)柱的重要性,目前此分型中L型鉭棒置入治療的三維有限元研究不多。目的:以鉭棒置入術(shù)為例,建立正常、壞死和L型壞死區(qū)前外側(cè)柱鉭棒置入的髖關(guān)節(jié)仿真的三維有限元模型,并進(jìn)行有限元分析及力學(xué)效能對(duì)比,探討前外側(cè)柱的完整性對(duì)保髖療效的重要性,為CJFH分型的治療提供生物力學(xué)依據(jù)。方法:股骨頭壞死的CJFH分型中L1、L2、L3型的壞死髖關(guān)節(jié)三維模型和正常髖關(guān)節(jié)三維模型選用團(tuán)隊(duì)已經(jīng)做好的模型。在此基礎(chǔ)上建立鉭棒置入壞死股骨頭的三維有限元模型,進(jìn)行有限元分析。觀察正常股骨頭、壞死股骨頭和鉭棒置入壞死股骨頭皮質(zhì)骨殼應(yīng)力分布及最大Mises應(yīng)力值,對(duì)比并進(jìn)行統(tǒng)計(jì)分析。結(jié)果與結(jié)論:(1)L型壞死股骨頭負(fù)重區(qū)皮質(zhì)骨殼的最大Mises應(yīng)力均較正常股骨頭升高,其中L1型升高21.76%,L2型升高31.02%,L3型升高42.79%;(2)鉭棒置入術(shù)后股骨頭負(fù)重區(qū)皮質(zhì)骨殼的最大Mises應(yīng)力較術(shù)前下降,其中L1型下降13.38%,L2型下降8.81%,L3型下降11.45%;(3)表明當(dāng)股骨頭發(fā)生壞死時(shí),因壞死骨承載應(yīng)力下降,導(dǎo)致股骨頭皮質(zhì)骨殼應(yīng)力集中,所以壞死較正常的最大應(yīng)力大,而分型程度越高,皮質(zhì)骨殼所要承載的應(yīng)力集中就越大;鉭棒置入后承載了一部分應(yīng)力,分型程度越低,糾正越明顯;(4)結(jié)果表明,鉭棒置入術(shù)糾正了壞死股骨頭皮質(zhì)骨殼部分應(yīng)力,鉭棒在一定程度范圍內(nèi)可以進(jìn)行塌陷預(yù)防及起到支撐軟骨下骨的生物力學(xué)作用;壞死股骨頭外側(cè)柱的完整性影響保髖療效,可能外側(cè)柱的存留越多,保髖療效越好,而CJFH分型程度越高,塌陷風(fēng)險(xiǎn)越高,保髖療效也越差。
[Abstract]:Background: it is reported that the anterolateral column of femoral head plays a key role in the curative effect of hip preservation, while CJFH classification in Sino-Japanese Friendship Hospital emphasizes the importance of anterolateral column. At present, there are few three-dimensional finite element studies on L-type tantalum rod implantation in this classification. Objective: taking tantalum rod implantation as an example, a three dimensional finite element model of hip joint simulation was established for normal, necrotic and L-type necrotic areas with anterior and lateral column tantalum rods, and the finite element analysis and mechanical effectiveness comparison were carried out. To explore the importance of the integrity of anterolateral column for hip preservation, and to provide biomechanical basis for the treatment of CJFH classification. Methods: in the CJFH classification of femoral head necrosis, the three dimensional model of the necrotic hip joint of L1 and L2 and L3 type and the 3D model of the normal hip joint were used to select the model that had been made by the team. On this basis, a three-dimensional finite element model of tantalum rod implantation into the necrotic femoral head was established and analyzed by finite element method. The stress distribution and maximum Mises stress of cortical shell of necrotic femoral head and tantalum rod were observed and compared and analyzed statistically. Results and conclusion the maximum Mises stress of cortical bone shell in the load-bearing zone of the femoral head in the L-type necrosis of the femoral head was higher than that in the normal femoral head. The maximum Mises stress in the cortical shell of the loaded area of the femoral head was decreased after tantalum rod implantation, and the decrease of the L1 type was 13.38%, the decrease of the L2 type was 8.81% and the decrease of the L3 type was 11.453), which indicated that when the femoral head was necrotic, the maximum Mises stress of the femoral head was decreased by 42.79% and 42.79% respectively, and the maximum Mises stress of the cortical shell in the loaded area of the femoral head decreased by 8.81% and 11.453% after the implantation of tantalum rod. The stress concentration of the cortical shell of the femoral head is higher than the normal maximum stress because the stress of the necrotic bone decreases, and the higher the degree of classification is, the greater the stress concentration of the cortical bone shell is. The results showed that tantalum rod implantation corrected the partial stress of cortical shell of the necrotic femoral head. Tantalum bars can be used to prevent collapse and to support the subchondral bone in a certain extent. The integrity of the lateral column of necrotic femoral head affects the curative effect of hip preservation. The higher the degree of CJFH typing, the higher the risk of collapse and the worse the curative effect of hip preservation.
【作者單位】： 廣西中醫(yī)藥大學(xué)附屬桂林醫(yī)院(桂林市中醫(yī)醫(yī)院);玉林市中西醫(yī)結(jié)合骨科醫(yī)院;廣西中醫(yī)藥大學(xué);
【基金】：廣西壯族自治區(qū)衛(wèi)計(jì)委(2014年)自籌經(jīng)費(fèi)科研課題項(xiàng)目(Z2014556)~~
【分類號(hào)】：R687.3
，

本文編號(hào)：2041926