髋臼假体放置角度对髋臼周围应力分布的影响

发布时间：2018-05-03 06:14

本文选题：全髋关节置换 + 髋臼重建　；参考：《医用生物力学》2014年04期

【摘要】：目的研究全髋关节置换(total hip arthroplasty,THA)髋臼侧重建中不同髋臼假体安放角度对髋臼周围内外应力分布的影响,探索提高THA术后髋臼假体稳定性的方法。方法基于材料属性的非均匀赋值模型和由不同髋臼假体前倾角(15°,20°,25°)与外展角(40°,45°,50°)的9种组合方式构建包括正常髋模型在内的10种有限元模型,并以正常步行模式单支撑相中的髋关节最大接触力为载荷条件进行求解。以正常髋模型分析结果为对照,按照从定性到定量原则对比分析各模型的内外应力。结果当髋臼假体的放置角度与正常髋臼的解剖角度(前倾19°、外展46°)最接近时,髋臼周围的应力遮挡现象最明显。此外,当髋臼假体的外展角放置于45°,前倾角在15°~25°变化不会对模型整体应力分布造成较大的影响;而且在15°前倾角条件下,模型不仅在应力分布方面具有良好稳定性,同时在皮质骨和松质骨上应力遮挡现象相比于处于正常髋臼解剖角度时明显改善。结论对于髋臼的正常解剖形态未发生明显改变且需要接受THA手术的患者,应把髋臼假体放置在正常外展角45°,而前倾角应小于正常解剖前倾角5°左右并居于15°~20°之间。
[Abstract]:Objective to study the effect of different angles of acetabular prosthesis placement on the stress distribution around the acetabulum in total hip arthroplasty (THA), and to explore ways to improve the stability of acetabular prosthesis after THA. Methods Ten finite element models, including normal hip models, were constructed by non-uniform assignment model based on material properties and 9 combinations of different acetabular anteversion angles (15 掳/ 20 掳/ 25 掳) and abduction angle (40 掳/ 45 掳/ 50 掳). The maximum contact force of the hip joint in the single support phase of the normal walking mode is taken as the load condition. The internal and external stresses of the models were analyzed according to the qualitative and quantitative principles. Results when the placement angle of acetabular prosthesis was closest to that of normal acetabular anatomic angle (19 掳forward, 46 掳abduction), the stress occlusion around acetabular was the most obvious. In addition, when the abduction angle of the acetabular prosthesis is placed at 45 掳, the variation of the anteversion angle at 15 掳and 25 掳does not have a great influence on the overall stress distribution of the model, and the model has good stability in the stress distribution under the condition of 15 掳anteversion angle. At the same time, the stress occlusion in cortical bone and cancellous bone was significantly improved compared with the normal acetabular anatomic angle. Conclusion the acetabular prosthesis should be placed at the normal abduction angle of 45 掳, and the antegrade angle should be less than 5 掳of the normal antegrade angle and stay between 15 掳and 20 掳for the patients who have no obvious change in normal acetabular anatomy and need to undergo THA operation.
【作者单位】：四川大学华西医院骨科;
【基金】：卫生部2013卫生行业科研专项(201302007)
【分类号】：R318.01

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