壞死股骨頭內(nèi)部空間結(jié)構(gòu)及生物力學(xué)性能研究
發(fā)布時(shí)間：2018-07-23 11:15
【摘要】：目的:股骨頭壞死是骨科常見(jiàn)病、難治病,其預(yù)后較差,給患者和社會(huì)帶來(lái)巨大經(jīng)濟(jì)和社會(huì)負(fù)擔(dān)。目前對(duì)股骨頭壞死的治療主要是髓芯減壓、游離帶蒂腓骨移植、旋轉(zhuǎn)截骨以及最終的部分或全髖關(guān)節(jié)置換術(shù),治療效果不明確。明確的發(fā)病機(jī)制是良好治療的前提,目前,股骨頭壞死的發(fā)病機(jī)制尚不明確。髖關(guān)節(jié)作為全身的主要承重關(guān)節(jié),近年來(lái),生物力學(xué)因素在股骨頭壞死發(fā)生發(fā)展中的作用越來(lái)越受到重視。本研究旨在探究股骨頭壞死發(fā)生發(fā)展過(guò)程中其內(nèi)部空間結(jié)構(gòu)及骨小梁生物力學(xué)性能的變化,為研究股骨頭壞死生物力學(xué)機(jī)制及臨床治療提供有價(jià)值的理論依據(jù)。方法:(1)選用因股骨頸骨折及股骨頭壞死行全髖關(guān)節(jié)置換術(shù)治療后的新鮮人股骨頭標(biāo)本各15個(gè),排除畸形、骨腫瘤等病變,通過(guò)Siemens,Inveon~TM系統(tǒng)對(duì)各個(gè)標(biāo)本行Micro-CT掃描、三維重建,觀察對(duì)比正常股骨頭與壞死股骨頭內(nèi)部空間結(jié)構(gòu),并計(jì)算比較正常股骨頭與壞死股骨頭內(nèi)部相應(yīng)區(qū)域骨計(jì)量學(xué)參數(shù)(2)行Micro-CT掃描后的股骨頭標(biāo)本,用硬組織切片機(jī)于正常股骨頭與壞死股骨頭各區(qū)域切出統(tǒng)一大小(1cm×1cm×1cm)的骨小塊,通過(guò)BOSE-ELF3510生物力學(xué)性能測(cè)試系統(tǒng)測(cè)得各骨小塊的生物力學(xué)性能,對(duì)比分析正常股骨頭與壞死股骨頭相應(yīng)區(qū)域的生物力學(xué)性能。結(jié)果:(1)正常股骨頭各區(qū)域骨小梁排列規(guī)則有序,壞死股骨頭壞死區(qū)及硬化區(qū)骨小梁排列紊亂無(wú)序(2)與正常股骨頭近端壓力小梁區(qū)相比,壞死股骨頭壞死區(qū)內(nèi)相對(duì)骨體積分?jǐn)?shù)(BV/TV)明顯降低,平均骨小梁數(shù)目(Tb.N)減少,平均骨小梁間距(Tb.Sp)顯著增寬;與正常股骨頭壓力張力小梁交界區(qū)相比,壞死股骨頭硬化區(qū)的BV/TV增大,平均骨小梁厚度(Tb.Th)顯著增大,Tb.Sp變窄;壞死股骨頭遠(yuǎn)端壓力小梁區(qū)BV/TV、Tb.N、Tb.Sp、Tb.Th度與正常股骨頭遠(yuǎn)端壓力小梁區(qū)均無(wú)差異;壞死股骨頭非承重張力小梁區(qū)BV/TV及Tb.Th與正常股骨頭非承重張力小梁區(qū)均無(wú)差異。(3)與正常股骨頭近端壓力小梁區(qū)相比,壞死股骨頭壞死區(qū)骨小塊的生物力學(xué)性能明顯降低,其彈性模量下降近70%,屈服強(qiáng)度下降35%,極限強(qiáng)度下降35%;與正常股骨頭壓力張力小梁交界區(qū)相比,壞死股骨頭硬化區(qū)骨小塊彈性模量、屈服強(qiáng)度及極限強(qiáng)度均增大;壞死股骨頭遠(yuǎn)端壓力小梁區(qū)及非承重張力小梁區(qū),與正常股骨頭的遠(yuǎn)端壓力小梁區(qū)及非承重張力小梁區(qū)相比,生物力學(xué)性能均無(wú)差異。結(jié)論:晚期股骨頭壞死患者股骨頭壞死區(qū)及硬化區(qū)空間結(jié)構(gòu)及生物力學(xué)性能發(fā)生顯著改變。筆者認(rèn)為股骨頭壞死發(fā)生發(fā)展實(shí)質(zhì)為股骨頭內(nèi)部空間結(jié)構(gòu)及生物力學(xué)性能的改變,是結(jié)構(gòu)與功能不統(tǒng)一的結(jié)果。筆者提出以下猜想:髖關(guān)節(jié)為全身主要負(fù)重關(guān)節(jié),作用于股骨頭的應(yīng)力較大,激素使用、酗酒等非創(chuàng)傷性因素導(dǎo)致股骨頭骨強(qiáng)度下降,引起骨小梁疲勞骨折;對(duì)于創(chuàng)傷性股骨頭壞死,內(nèi)(或外)固定之后,很多并不能達(dá)到解剖復(fù)位,骨小梁的走行方向發(fā)生改變,出現(xiàn)結(jié)構(gòu)與功能的不統(tǒng)一,長(zhǎng)期應(yīng)力刺激下骨小梁也發(fā)生疲勞骨折;骨小梁疲勞骨折后,形成了最初的小范圍的壞死區(qū),機(jī)體啟動(dòng)修復(fù)反應(yīng),加強(qiáng)原有骨小梁的生物力學(xué)性能或產(chǎn)生新的骨小梁,在壞死區(qū)周圍形成硬化帶,硬化帶的形成雖然能給壞死區(qū)提供力學(xué)保護(hù),但修復(fù)與骨小梁疲勞骨折之間不平衡,壞死區(qū)中正常骨小梁組織的逐漸減少,纖維結(jié)締組織替代原有的骨小梁組織,壞死區(qū)與硬化區(qū)形成應(yīng)力遮擋,作用于硬化區(qū)的應(yīng)力增加,硬化區(qū)骨小梁逐漸出現(xiàn)微骨折,機(jī)體進(jìn)一步修復(fù),如此惡性循環(huán),壞死區(qū)逐漸擴(kuò)大,最終出現(xiàn)塌陷。
[Abstract]:Objective: osteonecrosis of the femoral head is a common disease in the Department of orthopedics. It is difficult to cure the disease. The prognosis is poor and it brings great economic and social burden to the patients and society. The treatment of femoral head necrosis is mainly core decompression, free Pedicled Fibula Transplantation, rotary osteotomy, and final partial or total hip arthroplasty. The treatment effect is not clear. Clear pathogenesis. At present, the pathogenesis of osteonecrosis of the femoral head is not clear. The hip joint is the main bearing joint of the whole body. In recent years, the role of biomechanical factors in the occurrence and development of femoral head necrosis is becoming more and more important. This study aims to explore the internal spatial structure and bone in the process of the occurrence and development of the femoral head. The changes in biomechanical properties of trabeculae provide valuable theoretical basis for the study of biomechanical mechanism and clinical treatment of femoral head necrosis. Methods: (1) 15 fresh human femoral head specimens after total hip replacement for femoral neck fracture and femoral head necrosis were selected, excluding deformity, bone tumor and other lesions, through Siemens, Inveon~TM Micro-CT scanning, three-dimensional reconstruction, observation and comparison of the internal spatial structure of the normal femoral head and necrotic femoral head, and the calculation and comparison of the bone bone measurement parameters (2) of the normal femoral head and the necrotic femoral head (2) after Micro-CT scanning, and using the hard tissue slice machine in the normal femoral head and the necrotic femoral head. The bone fragments of the United size (1cm x 1cm x 1cm) were cut out in each region. The biomechanical properties of the bone fragments were measured by the BOSE-ELF3510 biomechanical performance test system. The biomechanical properties of the normal femoral head and the necrotic femoral head were compared and analyzed. Results: (1) the bone trabecula in the normal femoral head was arranged orderly and necrotic femoral head. The disordered and disordered arrangement of trabecular bone in the necrotic and sclerosing areas (2) compared with the normal femoral head pressure trabecular area, the relative bone volume fraction (BV/TV) in the necrotic femoral head necrotic area was significantly reduced, the average small Liang Shumu (Tb.N) decreased, and the average small bone Liang Jianju (Tb.Sp) widened significantly; the necrosis was compared with the normal femoral head pressure trabecular junction area. The BV/TV of the femoral head sclerosis area increased, and the average small bone Liang Houdu (Tb.Th) increased significantly and the Tb.Sp narrowed. The BV/TV, Tb.N, Tb.Sp, Tb.Th degree of the distal pressure trabecular region of the necrotic femoral head were not different from the normal distal pressure trabecular region of the femoral head, and the BV/TV and Tb.Th in the non load-bearing tension trabecular region of the necrotic femoral head and the normal femoral head non load-bearing tension trabecular region were neither. (3) compared with the normal femoral head proximal pressure trabecular region, the biomechanical properties of the bone fragments in the necrotic femoral head necrotic area decreased significantly, the modulus of elasticity decreased by nearly 70%, the yield strength decreased by 35%, and the ultimate strength decreased by 35%. Compared with the normal femoral head pressure tension trabecular junction, the elastic modulus of the bone fragments in the necrotic femoral head area was yielded. The strength and ultimate strength increased, and there was no difference in biomechanical properties of the distal pressure trabecular and non load-bearing trabecular regions of the necrotic femoral head compared with the distal pressure trabecular and non load-bearing trabecular regions of the normal femoral head. Conclusion: the spatial structure and biomechanical properties of the femoral head necrosis area and the hardened area in the patients with advanced femoral head necrosis. The author believes that the following conjecture is that the hip joint is the main weight joint of the whole body, the stress of the femoral head, the use of the femoral head and the non traumatic factors such as the use of hormone and alcoholism. The bone strength of the femoral head is reduced and the bone trabecular fatigue fracture is caused. For the traumatic femoral head necrosis, the internal (or external) fixation can not reach the anatomical reduction, the walking direction of the trabecular bone is changed, the structure and function are not unified, the bone trabecula also has fatigue fracture under the long-term stress stimulation; after the tiredness fracture of the trabecular bone, the shape of the trabecular bone is formed. In the initial small area of necrotic area, the body starts the repair reaction, strengthens the biomechanical properties of the original trabecular bone, produces a new bone trabecula, forms a sclerotic zone around the necrotic area, and the formation of the hardened zone provides mechanical protection to the necrotic area, but the repair is unbalance between the small Liang Pi's fracture and the normal trabecular bone in the necrotic area. The tissue was gradually reduced. The fibrous connective tissue replaced the original bone trabecular tissue, the necrotic area and the hardened area formed stress occlusion, the stress in the hardened area increased, the bone trabecula gradually appeared micro fracture in the hardened area, and the body was further repaired. The necrotic area was gradually enlarged and finally collapsed.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R681.8
本文編號(hào)：2139227
[Abstract]:Objective: osteonecrosis of the femoral head is a common disease in the Department of orthopedics. It is difficult to cure the disease. The prognosis is poor and it brings great economic and social burden to the patients and society. The treatment of femoral head necrosis is mainly core decompression, free Pedicled Fibula Transplantation, rotary osteotomy, and final partial or total hip arthroplasty. The treatment effect is not clear. Clear pathogenesis. At present, the pathogenesis of osteonecrosis of the femoral head is not clear. The hip joint is the main bearing joint of the whole body. In recent years, the role of biomechanical factors in the occurrence and development of femoral head necrosis is becoming more and more important. This study aims to explore the internal spatial structure and bone in the process of the occurrence and development of the femoral head. The changes in biomechanical properties of trabeculae provide valuable theoretical basis for the study of biomechanical mechanism and clinical treatment of femoral head necrosis. Methods: (1) 15 fresh human femoral head specimens after total hip replacement for femoral neck fracture and femoral head necrosis were selected, excluding deformity, bone tumor and other lesions, through Siemens, Inveon~TM Micro-CT scanning, three-dimensional reconstruction, observation and comparison of the internal spatial structure of the normal femoral head and necrotic femoral head, and the calculation and comparison of the bone bone measurement parameters (2) of the normal femoral head and the necrotic femoral head (2) after Micro-CT scanning, and using the hard tissue slice machine in the normal femoral head and the necrotic femoral head. The bone fragments of the United size (1cm x 1cm x 1cm) were cut out in each region. The biomechanical properties of the bone fragments were measured by the BOSE-ELF3510 biomechanical performance test system. The biomechanical properties of the normal femoral head and the necrotic femoral head were compared and analyzed. Results: (1) the bone trabecula in the normal femoral head was arranged orderly and necrotic femoral head. The disordered and disordered arrangement of trabecular bone in the necrotic and sclerosing areas (2) compared with the normal femoral head pressure trabecular area, the relative bone volume fraction (BV/TV) in the necrotic femoral head necrotic area was significantly reduced, the average small Liang Shumu (Tb.N) decreased, and the average small bone Liang Jianju (Tb.Sp) widened significantly; the necrosis was compared with the normal femoral head pressure trabecular junction area. The BV/TV of the femoral head sclerosis area increased, and the average small bone Liang Houdu (Tb.Th) increased significantly and the Tb.Sp narrowed. The BV/TV, Tb.N, Tb.Sp, Tb.Th degree of the distal pressure trabecular region of the necrotic femoral head were not different from the normal distal pressure trabecular region of the femoral head, and the BV/TV and Tb.Th in the non load-bearing tension trabecular region of the necrotic femoral head and the normal femoral head non load-bearing tension trabecular region were neither. (3) compared with the normal femoral head proximal pressure trabecular region, the biomechanical properties of the bone fragments in the necrotic femoral head necrotic area decreased significantly, the modulus of elasticity decreased by nearly 70%, the yield strength decreased by 35%, and the ultimate strength decreased by 35%. Compared with the normal femoral head pressure tension trabecular junction, the elastic modulus of the bone fragments in the necrotic femoral head area was yielded. The strength and ultimate strength increased, and there was no difference in biomechanical properties of the distal pressure trabecular and non load-bearing trabecular regions of the necrotic femoral head compared with the distal pressure trabecular and non load-bearing trabecular regions of the normal femoral head. Conclusion: the spatial structure and biomechanical properties of the femoral head necrosis area and the hardened area in the patients with advanced femoral head necrosis. The author believes that the following conjecture is that the hip joint is the main weight joint of the whole body, the stress of the femoral head, the use of the femoral head and the non traumatic factors such as the use of hormone and alcoholism. The bone strength of the femoral head is reduced and the bone trabecular fatigue fracture is caused. For the traumatic femoral head necrosis, the internal (or external) fixation can not reach the anatomical reduction, the walking direction of the trabecular bone is changed, the structure and function are not unified, the bone trabecula also has fatigue fracture under the long-term stress stimulation; after the tiredness fracture of the trabecular bone, the shape of the trabecular bone is formed. In the initial small area of necrotic area, the body starts the repair reaction, strengthens the biomechanical properties of the original trabecular bone, produces a new bone trabecula, forms a sclerotic zone around the necrotic area, and the formation of the hardened zone provides mechanical protection to the necrotic area, but the repair is unbalance between the small Liang Pi's fracture and the normal trabecular bone in the necrotic area. The tissue was gradually reduced. The fibrous connective tissue replaced the original bone trabecular tissue, the necrotic area and the hardened area formed stress occlusion, the stress in the hardened area increased, the bone trabecula gradually appeared micro fracture in the hardened area, and the body was further repaired. The necrotic area was gradually enlarged and finally collapsed.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R681.8
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