【摘要】：目的1.通過臨床前瞻性分析不同骨密度與老年股骨頸骨折類型及骨折程度的關(guān)系,找出骨密度對股骨頸骨折影響的規(guī)律,是否可有效預(yù)測骨折類型和骨折程度,為預(yù)治骨折提供臨床依據(jù)和方法。2.為了更好的驗證骨密度對老年股骨頸骨折類型和破裂程度的影響,建立具有不同骨密度屬性且更加貼近真實人體生物力學(xué)結(jié)構(gòu)的股骨近端三維有限元模型,利用有限元軟件進行斷裂力學(xué)實驗,驗證對比兩個模型之間的斷裂類型、破壞程度等斷裂力學(xué)結(jié)果,得出不同材料屬性影響骨折力學(xué)變化的規(guī)律,為老年疏松性股骨頸骨折的生物力學(xué)機制研究打下實驗基礎(chǔ)。方法1.臨床研究選取自2016年7月至2017年2月期間入住廣州中醫(yī)藥大學(xué)第一附屬醫(yī)院創(chuàng)傷骨科老年股骨頸骨折病人50例,入院后經(jīng)DXA骨密度測定儀行腰椎骨密度測定,分別設(shè)立 A 組(T-Score≤-2.5g/cm2)和 B 組(T-Score-2.5g/cm2),每組 25 人(25髖),男24例,女26例,年齡60-91歲,平均年齡(76.38±9.57)歲。均為閉合性骨折,左髖20例,右髖30例。經(jīng)髖部X線、CT檢查確診骨折分型(Garden分型),記錄患者年齡、性別、受傷側(cè)、骨折分型和骨密度等,利用SPSS17.0軟件進行統(tǒng)計學(xué)分析,分析骨密度與年齡、性別、受傷側(cè)之間的關(guān)系,以及骨密度對骨折類型影響的關(guān)系。2.實驗研究臨床收集1例符合條件老年股骨頸骨折病人的雙側(cè)髖關(guān)節(jié)CT影像數(shù)據(jù),用DICOM格式數(shù)據(jù)保存,利用有限元Mimics15.0軟件進行區(qū)域增長、腔隙填充等步驟創(chuàng)建健側(cè)股骨近端有限元模型,然后導(dǎo)入Hyermeshl3.0軟件四面體網(wǎng)格劃分,分別用兩種不同骨密度材料屬性對模型賦值(C1模型:整體賦值密質(zhì)骨材料屬性;C2模型:賦值松質(zhì)骨、密質(zhì)骨材料屬性,即骨質(zhì)疏松模型),生成兩個貼近真實人體生理特性和力學(xué)結(jié)構(gòu)的股骨近端有限元模型。設(shè)置失效參數(shù)、界面屬性、分析步、邊界約束與載荷后,再導(dǎo)入有限元后處理軟件LS-DYNA計算,得到基于應(yīng)力-應(yīng)變曲線關(guān)系的股骨頸骨折斷裂模型,并跟臨床真實骨折線驗證比對,觀察對比兩種模型斷裂時的應(yīng)力應(yīng)變、裂紋擴展走向和骨折分型情況。結(jié)果1.A、B組平均年齡分別為:(81.7±8.12)歲、(71.2±8.09)歲,根據(jù)組間t檢驗分析,t=-4.520,P0.05,具有統(tǒng)計學(xué)意義;A、B組平均骨密度分別為:(-3.7±0.54)g/cm2、(-1.58士 1.18)g/cm2,根據(jù)組間 t 檢驗分析,t=8.399,P0.05,具有統(tǒng)計學(xué)意義。表明兩組骨密度閾值設(shè)定合理,具有可比性,且骨密度與年齡呈正相關(guān)。2.A組:股骨頸骨折Garden Ⅰ、11型8例,Garden Ⅲ、Ⅳ型17例;B組:Garden Ⅰ、11型15例,Garden Ⅲ、Ⅳ型10例。不同骨密度組間骨折分型比例有一定差異,經(jīng)X2檢驗,X2=3.945,P=0.0470.05,具有統(tǒng)計學(xué)意義。表明骨密度可影響骨折類型,一定程度上預(yù)測骨折類型和嚴重程度,且A組骨折線總體上比B組更平整規(guī)則。3.根據(jù)有限元軟件建立了兩種不同骨密度材料屬性的股骨近端三維有限元模型和股骨頸骨折斷裂模型,并得到有效驗證。4.C1、C2模型骨折時裂紋擴展、裂紋走向不完全一致,且C1模型裂紋擴展、裂紋走向比C2模型更平整規(guī)則,這與臨床研究結(jié)果非常相似。5.在同樣邊界、方向、載荷和單位時間下,C2模型所受等效應(yīng)力明顯比C1模型大,并且C2模型破裂嚴重。說明低密度骨骼更容易骨折或破裂,且破裂程度嚴重。結(jié)論1.通過有限元斷裂力學(xué)分析,基于臨床數(shù)據(jù)的股骨頸骨折的三維有限元模型建立真實可靠,可以很好的模擬股骨頸骨折斷裂情況,動態(tài)下直觀還原股骨頸骨折全過程,并可行斷裂力學(xué)分析,為不同外力下致股骨頸骨折分型的力學(xué)機制研究提供實驗基礎(chǔ)。2.骨密度可有效影響骨質(zhì)應(yīng)力應(yīng)變力學(xué)特性,一定程度上可影響老年股骨頸骨折類型,預(yù)判股骨頸骨折類型和破裂程度,為防治臨床髖部骨折提供依據(jù)和方法。
[Abstract]:Objective 1. To analyze the relationship between different bone mineral density (BMD) and the type and degree of femoral neck fracture in the elderly, find out the regularity of BMD's influence on femoral neck fracture, and whether it can effectively predict the type and degree of fracture, so as to provide clinical evidence and methods for the treatment of fractures. 2. To better verify the effect of BMD on femoral neck fracture in the elderly. The three-dimensional finite element model of proximal femur with different bone mineral density attributes and more close to the biomechanical structure of real human body is established. Fracture mechanics experiments are carried out by using finite element software to verify and compare the fracture mechanics results of the two models, such as fracture types and degree of failure. Methods 1. 50 elderly patients with femoral neck fracture admitted to the Department of Traumatic Orthopedics, First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine from July 2016 to February 2017 were selected for clinical study. After admission, they were performed with DXA bone mineral density analyzer. Bone mineral density (BMD) of lumbar spine was measured in group A (T-Score < 2.5g/cm 2) and group B (T-Score-2.5g/cm 2). Each group consisted of 25 patients (25 hips), 24 males and 26 females, aged 60-91, with an average age of 76.38 [9.57] years. All of them were closed fractures, 20 left hips and 30 right hips. SPSS17.0 software was used to analyze the relationship between bone mineral density and age, sex, injured side, and the effect of bone mineral density on fracture type. 2. The data of bilateral hip CT images of a eligible elderly patient with femoral neck fracture were collected and analyzed in DICOM format. The data were saved and the finite element model of the proximal femur was created by using the finite element software Mimics 15.0. Then the tetrahedron mesh of Hyermeshl 3.0 was imported to divide the data. Two different properties of BMD materials were used to assign values to the model (C1 model: whole assigned dense bone material properties; C2 model: assigned cancellous material properties; C2 model: assigned cancellous material properties). Two finite element models of proximal femur, which are close to the physical and mechanical properties of human body, are generated. Failure parameters, interface properties, analysis steps, boundary constraints and loads are set up, and then the finite element post-processing software LS-DYNA is imported to calculate the femur based on the stress-strain curve. Results The average age of group A and B were (81.7 +8.12) and (71.2 +8.09) respectively. According to the t test analysis, t = - 4.520, P 0.05, there was significant difference between the two models. According to the t-test analysis, t = 8.399, P 0.05, there was statistical significance. The results showed that the thresholds of bone mineral density of the two groups were reasonable and comparable, and bone mineral density was positively correlated with age. 2. Group A: Femoral neck fracture Garden I, 11 in 8 cases, Garden III, IV in 17 cases. There were some differences in the fracture classification ratio among different BMD groups. The results showed that BMD could influence the fracture type and predict the fracture type and severity to some extent. The fracture line of group A was more smooth and regular than that of group B. 3. According to the finite element software, the fracture line of group A was established. Two kinds of three-dimensional finite element model of proximal femur and fracture model of femoral neck fracture with different BMD attributes were established and validated effectively.4.C1 and C2 models showed inconsistent crack propagation and crack orientation when they were fractured. The equivalent stress of C2 model is obviously larger than that of C1 model under the condition of sample boundary, direction, load and unit time, and the fracture of C2 model is more serious. It can simulate the fracture of femoral neck well, visualize the whole process of femoral neck fracture dynamically, and provide experimental basis for the study of mechanical mechanism of femoral neck fracture classification under different external forces. 2. Bone mineral density can effectively affect the mechanical characteristics of bone stress and strain, and to a certain extent, it can affect the elderly. The type of femoral neck fracture and the degree of fracture can be predicted to provide basis and method for prevention and treatment of hip fracture.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R683

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