本文選題：生物力學 + 保肢　； 參考：《山東大學》2017年碩士論文

【摘要】：目的:分析骨腫瘤保肢術(shù)后定制腫瘤型膝關(guān)節(jié)假體翻修原因,介紹一種適用于定制腫瘤假體髓外柄斷裂翻修的新的、簡單有效的翻修方法,即股骨遠端套接式翻修 SPRS(Socket-type prosthetic revision system,SPRS)假體。通過體外模擬機械測試生物力學實驗方法,評價SPRS假體不同長度套接部分的生物力學穩(wěn)定性,初步確定有效套接固定長度、評價臨床應(yīng)用效果,為其臨床推廣應(yīng)用提供理論依據(jù)。方法:模擬制作SPRS假體套接部分實驗標本共6套,并按固定長度分成6組;采用目前臨床常規(guī)應(yīng)用國產(chǎn)骨水泥及特制的尖頭擠壓螺釘將其重復套接、固定3次,微機控制電子萬能實驗機分別進行生物力學測試;計算機自帶軟件自動收集數(shù)據(jù)、分析各方向的位移變化及轉(zhuǎn)角變化,統(tǒng)計軟件對實驗數(shù)據(jù)進行分析,以此反映其套接部分的生物力學穩(wěn)定性,確定其最短有效固定長度;回顧性分析臨床上應(yīng)用SPRS假體行有限翻修手術(shù)的病例,評價其應(yīng)用效果。2005年8月-2015年11月期間,本科室收治了 2例采用定制腫瘤型膝關(guān)節(jié)假體置換保肢術(shù)后發(fā)生股骨遠端假體髓外柄斷裂的患者。男1例,女1例;年齡分別為25歲、51歲。原發(fā)腫瘤部位均為膝關(guān)節(jié)股骨遠端,病理學確診為骨肉瘤、復發(fā)性骨巨細胞瘤。術(shù)后發(fā)現(xiàn)假體斷裂的時間分別為11個月、34個月,均無明顯外傷史、日常活動時發(fā)生斷裂。假體髓外柄發(fā)生斷裂部位均位于髓內(nèi)柄與髓外柄結(jié)合部,且發(fā)現(xiàn)髓內(nèi)柄均固定牢固、無松動。基于其發(fā)生斷裂后的特點,未按常規(guī)腫瘤假體翻修手術(shù)取出原假體髓內(nèi)柄,而選用本科室自行研制的SPRS假體行有限翻修手術(shù),將SPRS假體套筒部分套接于原假體殘留的髓外柄,骨水泥及4排尖頭擠壓螺釘固定,視術(shù)中情況,必要時更換相應(yīng)的配件、完成翻修手術(shù)。術(shù)后患者早期進行患肢功能鍛煉,定期隨訪、觀察SPRS假體穩(wěn)定性及肢體功能恢復情況。結(jié)果:在2500N靜態(tài)軸向拉伸(壓縮)載荷及16N.m靜態(tài)水平扭轉(zhuǎn)載荷下SPRS假體不同長度的套接部分(10mm、20mm、30mm、40mm、50mm、70mm),產(chǎn)生平均最大拉伸(壓縮)位移分別為(3.34±0.14)×10-1mm、(2.00±0.09)×10-1mm、(1.53±0.05)×10-1mm、(1.37±0.03)×10-1mm、(1.00±0.04)×10-1mm、(0.63±0.02)×10-1mm,平均拉伸(壓縮)剛度分別為7.50±0.31(KN/mm)、12.49±0.56(KN/mm)、16.34±0.51(KN/mm)、18.28±0.44(KN/mm)、25.11 ±0.88(KN/mm)、39.51 ±0.94(KN/mm)組間比較差異有統(tǒng)計學意義(P0.05);產(chǎn)生平均最大扭轉(zhuǎn)轉(zhuǎn)角分別為3.20±0.11(deg)、2.69±0.11(deg)、1.62±0.03(deg)、1.07±0.02(deg)、0.90±0.02(deg)、0.45±0.01(deg),平均扭轉(zhuǎn)剛度分別為 5.01 ±0.17(N.m/deg)、5.95±0.22(N.m/deg)、9.87±0.21(N.m/deg)、14.98±0.32(N.m/deg)、17.84±0.40(N.m/deg)、35.38±1.01(N.m/deg),組間比較差異有統(tǒng)計學意義(P0.05)。固定長度為30mm的標本,行跨距為10cm、載荷區(qū)間為120-1200N,300萬次循環(huán)的三點彎曲疲勞試驗后經(jīng)超聲波掃描檢查發(fā)現(xiàn)未發(fā)生松動及破壞,其平均彎曲疲勞剛度為7.01 ±0.12KN/mm,產(chǎn)生的橈度為1.54×10-1mm;拉伸實驗后經(jīng)檢測發(fā)現(xiàn)固定長度為10、20 mm的標本均自內(nèi)側(cè)金屬-水泥界面發(fā)生明顯骨水泥脫粘,平均最大位移分別為(3.34±0.14)×10-1mm、(2.00±0.09)×10-1mm;雖然結(jié)構(gòu)未發(fā)生明顯松動、螺釘把持力良好,但標本已發(fā)生非彈性形變,未滿足實驗要求,重新固定后行下一項測試。固定長度為10mm的標本平均最大轉(zhuǎn)角為3.20±0.11(deg),大于實驗規(guī)定參數(shù)、未滿足實驗要求;固定長度為30mm及以上的標本滿足實驗要求。本科室收治的應(yīng)用改型假體行有限翻修手術(shù)的病例,術(shù)后分別隨訪26個月、128個月,影像學及�？撇轶w均發(fā)現(xiàn)2例患者SPRS假體均固定牢固、無松動,末次隨訪時2例患者MSTS肢體功能評分分別為63.3%、83.7%。結(jié)論:固定長度為30mm、40mm、50mm、70mm的標本滿足本實驗要求、其各方向彈性剛度隨固定長的增加而增大,能夠為SPRS假體提供較好的套接固定穩(wěn)定性,即髓外柄殘端最短30mm為有效、穩(wěn)定的固定長度。本研究中臨床上運用SPRS假體行有限翻修手術(shù)病例髓外柄殘端固定長度均為70mm,為安全、有效固定。骨腫瘤保肢術(shù)后假體斷裂翻修的病例中,針對于股骨遠端假體髓外柄斷裂、髓內(nèi)柄固定牢固,且髓外柄殘端不少于30mm的病例,可選擇應(yīng)用SPRS假體行有限翻修手術(shù)。與傳統(tǒng)翻修方法相比操作簡單、手術(shù)創(chuàng)傷小、能有效避免相應(yīng)并發(fā)癥,有利于肢體功能早期恢復,雖然臨床應(yīng)用例數(shù)較少,最長近11年的隨訪證實了該假體的可靠性,值得臨床進一步推廣應(yīng)用。
[Abstract]:Objective: to analyze the reasons for the revision of the custom tumor type knee prosthesis after the limb salvage of bone tumor, and introduce a new, simple and effective refurbishment method suitable for the refurbishment of the extramedullary stalk fracture of the custom tumor prosthesis, that is, the SPRS (Socket-type prosthetic revision system, SPRS) prosthesis of the distal femur refurbishment. The mechanical experimental method was used to evaluate the biomechanical stability of the SPRS prosthesis with different length socket parts, to determine the effective set length and evaluate the clinical application effect, and to provide the theoretical basis for its clinical application. Method: a total of 6 sets of experimental specimens of SPRS prosthesis were simulated and divided into 6 groups according to the fixed length. The conventional application of domestic bone cement and special pointed extrusion screw was repeated and fixed for 3 times. The computer controlled electronic universal experimental machine was tested for biomechanics respectively. The computer auto tape software collected data automatically and analyzed the change of displacement and angle of each direction. The statistical software analyzed the experimental data to reflect its connection. Part of the biomechanical stability and determination of the shortest effective fixed length; a retrospective analysis of the clinical application of SPRS prosthesis for limited refurbishment surgery and evaluation of its application effect in August,.2005, -2015 year, August, in the undergraduate room, which had been treated with customized tumor type knee prosthesis replacement for the extramedullary stem of the distal femoral prosthesis. The patients with fracture were 1 male and 1 female, 25 years old and 51 years old. The primary tumor site was the distal femur of the knee joint. The pathological diagnosis was osteosarcoma and recurrent giant cell tumor. The fracture time of the prosthesis was found to be 11 months and 34 months after operation. There was no obvious history of trauma and fracture in daily activities. Fracture of the prosthesis of the prosthesis was found. The intramedullary stalk was located in the combination of the intramedullary stalk and the extramedullary stalk, and found that the intramedullary stalk was firmly fixed and no loosening. Based on the characteristics of the fracture, the intramedullary stem of the original prosthesis was not removed according to the conventional tumor prosthesis, and the SPRS prosthesis developed by the undergraduate room was used for the limited refurbishment operation, and the SPRS prosthesis sleeve was connected to the remnant of the prothesis. The extramedullary handle, bone cement and 4 row of pointed extrusion screws were fixed, depending on the conditions, the necessary replacement parts and the refurbishment operation when necessary. After the operation, the patients underwent early limb function exercise, followed up regularly to observe the stability of SPRS prosthesis and the recovery of limb function. Results: static axial tension (compression) load and 16N.m static level torsion at 2500N Under load (10mm, 20mm, 30mm, 40mm, 50mm, 70mm), the average maximum tensile (compression) displacement of SPRS prosthesis is (3.34 + 0.14) x 10-1mm, (2 + 0.09) * 10-1mm, (1.53 + 0.05) x 10-1mm, (1.37 + 0.03) x 10-1mm, (1 + 0.04) * 10-1mm, (0.63 + 0.02) * *, and the average tensile (compression) stiffness is 7.50 + 0.31 respectively. /mm), the difference between 12.49 + 0.56 (KN/mm), 16.34 + 0.51 (KN/mm), 18.28 + 0.44 (KN/mm), 25.11 + 0.88 (KN/mm) and 39.51 + 0.94 (KN/mm) was statistically significant (P0.05), and the average maximum twisting angle was 3.20 + 0.11 (DEG), 2.69 + 0.11 (DEG), deg (DEG), DEG) The difference between 5.01 + 0.17 (N.m/deg), 5.95 + 0.22 (N.m/deg), 9.87 + 0.21 (N.m/deg), 14.98 + 0.32 (N.m/deg), 17.84 + 0.40 (N.m/deg) and 35.38 + 1.01 (N.m/deg) was statistically significant (P0.05). The fixed length was 30mm, the line span was 10cm, the load interval was 120-1200N, and the three bending fatigue test after 3 million cycles The average bending fatigue stiffness is 7.01 + 0.12KN/mm, and the radial degree is 1.54 x 10-1mm. After the tensile test, the specimens with fixed length of 10,20 mm have obvious bone cement debonding at the inner metal cement interface, and the average maximum displacement is (3.34 + 0.14) x 10-1mm, respectively. (2 + 0.09) x 10-1mm; although the structure has not been loosened obviously, the screw holding force is good, but the specimen has had inelastic deformation, it has not met the experimental requirements and refixed the next test. The average maximum angle of the specimen with a fixed length of 10mm is 3.20 + 0.11 (DEG), which is larger than the experimental parameters, and the fixed length is 30mm. 26 months, 128 months after operation, 2 cases of SPRS prosthesis were fixed firmly and no loosening, and the MSTS limb function score of 2 patients at the last follow-up was 63.3%, respectively, and 83.7%. conclusion: solid conclusion: solid conclusion: The specimens with fixed length of 30mm, 40mm, 50mm, and 70mm meet the requirements of this experiment. The elastic stiffness of each direction increases with the increase of the fixed length. It can provide a better fixation stability for the SPRS prosthesis, that is, the shortest 30mm of the extramedullary stalk is effective and the fixed length is stable. In this study, the SPRS prosthesis was used in the limited revision surgery cases. The fixed length of the remnant end of the extramedullary stalk is 70mm, which is safe and effective. In cases of prosthesis fracture repair after limb salvage, the needle for the fracture of the extramedullary stalk of the distal femoral prosthesis, the fixation of the intramedullary stalk firmly, and the remnant end of the extramedullary stalk of not less than 30mm, the SPRS false body can be selected for the limited revision operation. Simple, small surgical trauma, can effectively avoid the corresponding complications, is conducive to the early recovery of limb function, although the number of clinical applications is less, the last 11 years of follow-up confirmed the reliability of the prosthesis, worthy of further clinical application.
【學位授予單位】：山東大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R738

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10 駱松;新型股骨遠端前外側(cè)入路治療股骨遠端C型骨折的解剖學及臨床應(yīng)用研究[D];南昌大學;2014年

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