【摘要】：研究目的:打壓植骨是治療股骨頭壞死的一種有效方法。但是既往打壓植骨術(shù)中,打壓應(yīng)力的大小沒(méi)有標(biāo)準(zhǔn),缺少確定植骨充分的方法,術(shù)者往往通過(guò)自身的經(jīng)驗(yàn)進(jìn)行打壓,既有可能因?yàn)榇驂簯?yīng)力過(guò)大造成軟骨下骨穿孔,又有可能因?yàn)榇驂簯?yīng)力不足造成支撐效果不佳最終導(dǎo)致股骨頭塌陷。本實(shí)驗(yàn)通過(guò)制作豬的股骨頭骨缺損模型,測(cè)量植入不同數(shù)目體積的松質(zhì)骨粒時(shí)軟骨下骨可承受的打壓植骨應(yīng)力,從而得出股骨頭軟骨下骨可承受的安全應(yīng)力,并探討合適的打壓植骨方式,最后通過(guò)影像學(xué)評(píng)定打壓植骨后股骨頭的情況,為進(jìn)一步探索髓芯減壓加打壓植骨治療股骨頭壞死,提供生物力學(xué)上的實(shí)驗(yàn)依據(jù)和理論準(zhǔn)備。研究方法:選取健康的8月齡長(zhǎng)白豬新鮮股骨30具,進(jìn)行骨密度測(cè)試,對(duì)股骨頭標(biāo)本采用隨機(jī)區(qū)組設(shè)計(jì)。區(qū)組內(nèi)序號(hào)從A-D的依次按照不植骨、植1g松質(zhì)骨、植2g松質(zhì)骨、植3g松質(zhì)骨來(lái)進(jìn)行打壓植骨的力學(xué)測(cè)試,序號(hào)為E的待A-D組測(cè)試完成分析出安全打壓應(yīng)力結(jié)果后,用安全打壓應(yīng)力植3g松質(zhì)骨,作為對(duì)安全應(yīng)力的評(píng)估。將股骨大轉(zhuǎn)子頂點(diǎn)下6cm位置確定為鉆孔入口處,然后確定股骨頭負(fù)重面。用游標(biāo)卡尺測(cè)量從股骨頭負(fù)重面至鉆孔入口長(zhǎng)度,在鉆頭上做出限深標(biāo)記后,用直徑為9mm的環(huán)鉆從確定的入口處鉆入,直至股骨頭負(fù)重面下軟骨下骨厚度為3mm處,刮出孔道內(nèi)的松質(zhì)骨。制作好股骨頭骨缺損模型后,用X線檢驗(yàn)?zāi)Ｐ蛙浌窍鹿呛穸取-D組股骨頭骨缺損模型依次按照不填充植骨顆粒、填充1g植骨顆粒、填充2g植骨顆粒、填充3g植骨顆粒進(jìn)行生物力學(xué)試驗(yàn),致股骨頭軟骨下骨變形穿孔,同步記錄位移和壓力曲線。E組股骨頭骨缺損模型用于評(píng)估采用安全打壓應(yīng)力值打壓植骨的結(jié)果。觀察打壓植骨后股骨頭的完整性。用Micro-CT評(píng)估安全應(yīng)力打壓植骨后的股骨頭軟骨下骨。結(jié)果:1、骨密度測(cè)量結(jié)果所有股骨頭標(biāo)本W(wǎng)ard’s三角區(qū)的骨密度結(jié)果:骨密度測(cè)量值在0.537~1.228g/cm2之間,均數(shù)±標(biāo)準(zhǔn)差為0.874±0.117g/cm2。2、模型制作完成后影像學(xué)結(jié)果X線機(jī)拍攝平片后通過(guò)Orthoview軟件測(cè)量分析,所有股骨頭骨缺損標(biāo)本軟骨下骨厚度均為3mm。3、生物力學(xué)測(cè)試后的股骨頭大體結(jié)果A-D組所有標(biāo)本經(jīng)過(guò)生物力學(xué)測(cè)試,股骨頭軟骨下骨斷裂,股骨頭穿孔。E組所有標(biāo)本經(jīng)過(guò)生物力學(xué)測(cè)試,股骨頭形態(tài)完整。4、生物力學(xué)測(cè)試結(jié)果A-D組的股骨頭穿透時(shí)的應(yīng)力依次為:1196.833±124.646N、2395.667±657.941N、1990.167±617.326N、2230.333±370.238N。根據(jù)生物力學(xué)測(cè)量的結(jié)果發(fā)現(xiàn)股骨頭標(biāo)本臨界應(yīng)力的應(yīng)力為1060N,因此當(dāng)打壓應(yīng)力小于等于1000N時(shí),可以視為安全的打壓植骨應(yīng)力。5、安全應(yīng)力打壓植骨后的影像學(xué)結(jié)果Micro-CT可觀察到安全應(yīng)力打壓植骨后的股骨頭軟骨下骨骨小梁均整齊排列有序,未出現(xiàn)軟骨下骨骨小梁變形和斷裂,且植骨緊密。6、統(tǒng)計(jì)分析B、C、D組(打壓植骨1g、2g、3g組)與A組(未植骨)之間差異具有統(tǒng)計(jì)學(xué)意義;BC組之間、CD組之間、BD組之間尚不能認(rèn)為有統(tǒng)計(jì)學(xué)差異。結(jié)論:1、在精密儀器的輔助下和影像設(shè)備的驗(yàn)證下可以制作出股骨頭軟骨下骨厚度為3mm的股骨頭骨缺損模型。2、軟骨下骨厚度為3mm以上的股骨頭,用直徑為9mm的圓形平面頂棒打壓植入顆粒狀松質(zhì)骨時(shí),1000N以下的打壓應(yīng)力是安全的。3、軟骨下骨厚度為3mm以上的股骨頭,植骨可以有效增強(qiáng)軟骨下骨對(duì)打壓應(yīng)力的承受能力。不同植骨量時(shí),可以承受的打壓應(yīng)力無(wú)差別,因此在打壓植骨的過(guò)程無(wú)需調(diào)整打壓應(yīng)力。合適的打壓植骨方式應(yīng)當(dāng)是以一個(gè)均勻的力打壓植骨。
[Abstract]:Objective: To suppress bone graft is an effective method to treat femoral head necrosis. However, in the prior suppression of bone grafting, the size of the pressing stress is not standard, and the method for determining the full bone grafting is lacking, and the operator is often impacted by the experience of the self, which can not only cause the subchondral bone to be perforated due to the excessive pressing stress, It is also possible to cause the femoral head to collapse due to poor support effect due to insufficient pressure stress. In this experiment, the bone defect model of the femoral head of the pig was made, and the stress of the bone and bone in the subchondral bone was measured with different volume of cancellous bone, so as to obtain the safe stress that the bone of the head of the femoral head can bear, and to discuss the appropriate method of suppressing the bone grafting. And finally, the condition of the femoral head after the bone grafting is pressed by the imaging evaluation, and the experimental basis and the theoretical preparation of the biomechanics are provided for further exploring the decompression of the nucleus pulposus and the compression bone grafting for the treatment of the femoral head necrosis. The method of the study was to select healthy 8-month old pig fresh femur 30, to test the bone density, and to design the femoral head specimen by the random zone group. 3 g of cancellous bone is implanted by the safety pressing stress after the test of the A-D group to be A-D of the E is completed and the safety pressure stress result is analyzed after the test of the A-D group of the group E is completed and analyzed, As an assessment of the safety stress. The position of the 6 cm at the apex of the femoral large rotor was determined as the bore entrance and the bearing surface of the femoral head was then determined. A vernier caliper was used to measure the length of the bearing surface from the head of the femoral head to the bore of the bore, and after a depth-limited mark was made on the drill, a 9-mm diameter ring was used to drill from the identified entrance until the thickness of the subchondral bone at the bearing surface of the femoral head was 3 mm, and the cancellous bone in the channel was scraped out. After the model of bone defect of the femoral head was made, the thickness of the subchondral bone was examined by X-ray. The bone defect model of the femoral head of A-D group was filled with bone graft granules, filled with 1 g of bone graft granules, filled with 2 g of bone graft granules,3 g of bone graft granules were filled for biomechanical test, and the deformation and perforation of the subchondral bone of the femoral head were induced, and the displacement and pressure curves were recorded synchronously. The model of the bone defect of the femoral head in the E group was used to evaluate the results of using the safety pressure stress to suppress the bone graft. To observe the integrity of the femoral head after suppression of bone graft. Micro-CT was used to evaluate the lower bone of the head of the femoral head after the safety stress was applied to the bone graft. Results:1. The results of bone mineral density measurement in the Ward's triangle area of all femoral head specimens: the measured value of bone mineral density was 0.537-1.228g/ cm2, the standard deviation of the mean square deviation was 0.874-0.117 g/ cm2. The thickness of the subchondral bone of all the femoral head of the femoral head was 3 mm.3. All the specimens of the A-D group after the biomechanical test were subjected to the biomechanical test, the fracture of the bone of the femoral head and the perforation of the femoral head. All the specimens of the E group were tested by biomechanics and the shape of the femoral head was complete.4. The stress of the femoral head of the A-D group in the biomechanical test was 1196.833-124.646 N, 2395.667-657.941 N, 1990.167-617.326 N,2223.333-370.238 N. According to the results of the biomechanics measurement, the stress of the critical stress of the head of the femoral head is 1060N. Therefore, when the pressing stress is less than or equal to 1000N, the stress of the bone graft can be regarded as safety. The results showed that the bone trabeculae in the subchondral bone of the femoral head after the safety stress and the bone grafting were orderly and orderly, and the bone trabeculae of the subchondral bone were not deformed and broken, and the bone graft was tight.6. The group B, C and D (1 g,2 g) were statistically analyzed. There was a statistically significant difference between the Group A and the Group A (no bone graft); there was no statistically significant difference between the BC groups, between the CD groups, and between the BD groups. Conclusion:1. The bone defect model of the femoral head with the thickness of 3 mm can be made under the aid of the precision instrument and the image equipment.2. The thickness of the subchondral bone is 3 mm or more, and when the granular cancellous bone is implanted with a circular planar top rod with a diameter of 9 mm, The pressure stress below 1000N is safe.3. The thickness of the subchondral bone is 3 mm or more, and the bone graft can effectively enhance the bearing capacity of the subchondral bone on the stress. When the bone mass is different, the pressure stress can bear no difference, and therefore, the pressing stress is not needed to be adjusted during the process of pressing the bone graft. A suitable method of suppression of bone graft should be to press bone graft with a uniform force.
【學(xué)位授予單位】：第二軍醫(yī)大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R687.3

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 孫蘊(yùn);賀麗英;馬兆坤;潘克h，

本文編號(hào)：2505707