胫骨近端骨肿瘤手术重建方式的生物力学研究

发布时间：2018-01-25 16:23

本文关键词： 胫骨近端骨肿瘤骨缺损应力步态分析　出处：《南方医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：[目的]1.分析胫骨近端不同大小、水平、位置的皮质缺损模型的应力状况,探讨胫骨近端骨缺损与骨折风险的关系;2.分析不同假体髓内柄长度条件下的胫骨-假体的应力和位移,为选择肿瘤型胫骨近端假体柄长度提供参考;3.分析保肢治疗原发性胫骨近端骨肿瘤患者术后的肢体功能及步态,探讨不同重建方式术后患者的生物力学特点;[方法]1.使用数字医学方法对胫骨进行三维重建,建立不同大小、水平、位置的胫骨近端骨肿瘤圆形骨缺损模型,分析各模型应力大小及分布特征;2.使用数字医学方法对胫骨进行三维重建,建立不同柄长的胫骨近段肿瘤型假体-胫骨的三维模型,分析步行载荷下,模型的应力大小及分布特征;3.利用新型膝关节三维分析系统opti_Knee(?)采集胫骨近端骨肿瘤术后患者的三维步态,分析膝关节6个自由度和5个运动学参数。[结果]1.在步行载荷下,各骨缺损模型的应力均大于无缺损胫骨模型的应力45.38MPa,外侧壁缺损缺损Φ50mm模型的应力为186.2MPa;后侧壁缺损Φ40mm、Φ50mm模型的应力为:133.5-144.7MPa;余缺损模型的应力均小于胫骨屈服应力125MPa;2.在步行载荷下,截骨12cm的胫骨近端肿瘤型假体-胫骨模型,不同柄长假体-胫骨模型可产生应力及位移差异,应力范围为34.34-95.22MPa,柄长度与假体、骨水泥应力呈正相关(R2=0.97及R2=0.82),与位移程度呈负相关(R2=0.95);3.1.胫骨近端骨肿瘤假体置换术后,患膝的承重反应期最大屈曲角较健膝小,膝关节的三维位移在站立期均轻微改变,明显小于健膝(P0.05);3.2.胫骨近端骨肿瘤微波消融术后,患膝屈伸度小于健侧(P0.05),内外旋和内外翻度大于健膝(P0.05);胫骨最大内旋角度大于健膝(P0.05);[结论]1.缺损程度及部位是影响胫骨骨折风险的重要因素,当缺损程度超过Φ20mm会增加骨折风险,缺损超过30mm骨折风险明显增高;相同的缺损程度,前内侧壁缺损的骨折风险更小;2.当胫骨上段截骨约120mm时,选择柄长120mm的假体可减轻位移过大及应力集中两种影响,可能是一种较好的选择。3.1.胫骨近端骨肿瘤假体重建的患者术后可获良好膝关节功能及稳定的步态,步行过程中膝关节自由与假体相适应。3.2.胫骨近端骨肿瘤微波消融术后患者术后有较好的膝功能及接近正常的稳定步态,屈伸度不及健膝。
[Abstract]:[Objective: 1. To analyze the stress status of cortical defect model with different size, level and position of proximal tibia, and to explore the relationship between proximal tibial bone defect and fracture risk. 2. The stress and displacement of tibial-prosthesis under different length of intramedullary pedicle of prosthesis were analyzed to provide reference for selecting the length of proximal tibial prosthesis of tumor type. 3. To analyze the limb function and gait of patients with primary proximal tibial bone tumor treated by limb salvage, and to discuss the biomechanical characteristics of patients with different reconstruction methods. [Methods: 1. The three-dimensional reconstruction of tibia was carried out by digital medicine, and the circular bone defect model of proximal tibial bone tumor with different size, level and position was established, and the stress size and distribution characteristics of each model were analyzed. 2. Three-dimensional reconstruction of tibia was carried out with digital medical method, and a three-dimensional model of the proximal tibial prosthesis with different shank lengths was established. The stress size and distribution characteristics of the model under walking load were analyzed. 3. Using a new three-dimensional analysis system for knee joint, Optix Kneea? The three-dimensional gait of patients with proximal tibial bone tumor was collected and 6 degrees of freedom and 5 kinematics parameters were analyzed. [Results 1. Under walking load, the stress of each bone defect model was higher than that of the tibial model without defect (45.38 MPA), and the stress of 桅 50 mm model with lateral wall defect was 186.2 MPA. The stress of 桅 40mm and 桅 50mm model was 133.5-144.7MPa; The stress of residual defect model was less than that of tibia yield stress (125 MPA). 2. Under walking load, the tumor prosthetic tibial model of proximal tibia with osteotomy 12cm could produce different stresses and displacements with different pedicle length prosthetic tibial models. The stress range was 34.34-95.22 MPA, and the stem length was positively correlated with the prosthesis, and the stress of bone cement was positively correlated with R20.97 and R20.82). There was a negative correlation with the degree of displacement. 3.1.After the proximal tibial bone tumor prosthesis replacement, the maximal flexion angle of the affected knee in the load-bearing reaction period was smaller than that of the healthy knee, and the three-dimensional displacement of the knee joint was slightly changed during the standing period, which was obviously smaller than that of the healthy knee. 3.2.After microwave ablation of proximal tibial bone tumor, the degree of flexion and extension of the affected knee was lower than that of the contralateral bone, and the degree of internal and external rotation and internal and external rotation was higher than that of the healthy knee. The maximal internal rotation angle of tibia was greater than that of healthy knee (P0.05). [Conclusion: 1. The degree and position of defect is an important factor influencing tibial fracture risk. When the defect degree exceeds 桅 20mm, the fracture risk will increase, and the fracture risk of defect more than 30mm will increase obviously. With the same degree of defect, the fracture risk of anterior and medial wall defect was lower. 2. When the proximal tibia osteotomy is about 120mm, selecting the prosthesis with the stem length of 120mm can reduce the effects of excessive displacement and stress concentration. May be a better choice .3.1. Patients with proximal tibial bone tumor prosthesis reconstruction can obtain good knee function and stable gait after operation. After microwave ablation of proximal tibial bone tumor, the patients had better knee function and close to normal stable gait, and the flexion and extension were not as good as the healthy knee.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R738

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