股骨干前弓对联合加压交锁髓内钉系统使用的影响的有限元分析

发布时间：2018-05-04 14:17

本文选题：股骨骨折 + 股骨前弓　；参考：《河北医科大学》2015年硕士论文

【摘要】：目的:采用有限元方法模拟不同前弓曲率半径的股骨,进而得到其对顺行髓内钉使用的影响。探讨中国人股骨前弓与髓内钉的匹配性问题,从而制定适合国人的术前计划和治疗方案,并提出初步的新设计方案。方法:选取正常成年男性志愿者一例,志愿者年龄31岁,通过X线检查右侧股骨无病理性改变。选用64排螺旋CT机在管电压:120KV,管电流:200m A的条件下,扫描志愿者的右侧股骨。设定扫描条件为:扫描层厚为1mm,层间距为1mm。将扫描所得的Dicom格式数据导入交互式医学影像控制系统Mimics14.0,在确定正常方位后根据软件设定的骨骼阈值,利用蒙罩编辑、形态学操作等功能将骨骼与其它周围组织分离,建立完整的右侧股骨包括皮质骨及松质骨部分的三维空间模型。将此模型转换为STL格式并导入到自动化逆向工程软件Geomagic Studio 12.0中,在表面光顺化处理后进行网格优化。定义正位X线上小转子下缘水平以上部分为股骨上段,侧位X线上内收肌结节水平以下部分为股骨下段,两水平中间部分为股骨中段,以此进行裁切,并计算股骨中段模型初始股骨前弓曲率半径。于Mimics14.0软件中,在股骨近段自进针点沿髓内钉插入方向建立一直径为14mm通道,与髓腔结合,视为近段通道;在股骨中段以髓腔为基础建立通道,在股骨髓腔峡部附近沿股骨弧度分别建立直径为11mm、12mm、13mm通道,模拟扩髓后状态,中段远端松质骨看做髓腔处理,结合后视为中段通道;股骨远段松质骨看做髓腔处理,视为远段通道;三部分结合为髓内钉插入过程的通道。导入Geomagic Studio12.0软件内进行布尔减运算,获得去除髓内钉插入通道的股骨上、中、下三段模型。在美国参数技术公司(Parametric Technology Corporation,PTC公司)所研发的参数化建模软件Creo Parametric 2.0中,利用其草绘功能,绘制出施乐辉(Smith-Nephew)公司的?10、11、12mm×350mm3种规格的右侧股骨重建钉,以及该公司?5mm×90mm股骨近端锁钉。而后在Mimics14.0软件的3-matic模块中依据其置入原则进行组装,得到置有重建钉及两枚近端锁钉的股骨模型,在Creo Parametric 2.0中以股骨中段为选取框分别对股骨模型进行扭曲操作,得到不同曲率半径的股骨模型。在股骨模型中模拟重建钉插入过程通道,通过微调股骨前弓及重建钉空间位置,观察重建钉与股骨髓腔内壁的相对关系,探讨重建钉与股骨前弓的匹配程度。提出股骨前弓正切值的概念,该值为股骨前弓所在圆弧的弦高与1/2现场的比值,因为消除了拍摄X线的放大率,使结果更精确并更易得出。通过术前拍摄健测股骨正侧位X线,从而预测术中及术后重建钉与患者股骨髓腔的匹配程度,指导制定临床治疗方案。结果:在Mimics14.0软件中从水平面、冠状面、矢状面分析结果,按重建钉不同直径分组,对应10mm、11mm、12mm的重建钉,股骨前弓曲率半径分别为75.7647cm、73.0057cm、96.9086cm,股骨前弓正切值分别大于0.915351、0.095056、0.071330的股骨模型,因重建钉远端接触股骨远端内侧皮质,将会造成术后疼痛及内固定周围应力骨折的高风险。直径为10mm的重建钉因直径比股骨峡部入口处髓腔内径小,在调整股骨前弓曲率半径至42.1221cm、在钉头达到此处时仍不会出现插入困难,而直径为11mm、12mm的重建钉,在股骨前弓曲率半径分别为63.7519cm、95.7433cm,股骨前弓正切值分别大于0.101646、0.072207的股骨模型,在钉头达到股骨峡部入口处时插入困难,股骨前弓曲率半径分别为66.3759cm、75.7665cm、96.9086cm,股骨前弓正切值分别大于0.104751、0.091535、0.071330的股骨模型,在钉头达到股骨峡部最狭窄处时插入困难,股骨前弓曲率半径分别为74.3592cm、77.2252cm、99.3351cm,股骨前弓正切值分别大于0.093295、0.089775、0.069570的股骨模型,在钉头达到股骨峡部最下端时插入困难,如强行暴力置入,将引起医源性骨折。股骨前弓曲率半径分别为57.0168cm、64.7568cm、66.9274cm,股骨前弓正切值分别大于0.122430、0.107398、0.103869的股骨模型,由于髓内钉偏前插入,将撞击股骨近端前侧皮质,或因患者合并其他股骨近端骨折时,无法顺利置入近端股骨颈方向锁钉。结论:较大股骨前弓弧度的股骨将会造成髓腔与重建钉的不匹配,产生诸多并发症。重建钉远端接触股骨远端内侧皮质,将造成术后疼痛及内固定周围应力骨折的高风险;在钉头达到股骨峡部时插入困难,如强行暴力置入,将引起医源性骨折。可以通过适当向前调整进针点便于重建钉的插入及避免上述并发症,但由于髓内钉偏前插入,将撞击股骨近端前侧皮质,或因患者合并其他股骨近端骨折时,无法顺利置入近端股骨颈方向锁钉。
[Abstract]:Objective: the finite element method was used to simulate the femur with different radius of curvature of anterior arch, and then the effect on the use of intramedullary nail was obtained. The matching problem between the anterior and intramedullary nails of the Chinese femur was discussed, and the pre operation plan and treatment plan suitable for the Chinese people were established, and the preliminary new design scheme was put forward. Method: select the normal adult male chronicles. A volunteer, a volunteer, was 31 years old and had no pathological changes in the right femur by X-ray. A 64 row spiral CT was selected to scan the right femur of the right femur under the condition of 120KV and 200m A. The scanning condition was set as: the scanning layer thickness was 1mm, and the interval between the layers was 1mm. and the scanned Dicom format data were introduced into interactive medical shadow. Like the control system Mimics14.0, the three-dimensional spatial model of the complete right femur, including the cortical bone and the cancellous bone, is established by using the mask editing, morphological operation and other functions to establish a three-dimensional space model of the complete right femur, including the cortical bone and the cancellous bone. The model is converted into the STL format and imported into automation. In the reverse engineering software Geomagic Studio 12, the mesh was optimized after the surface light reduction. The upper part of the lower margin of the small trochanter was defined as the upper part of the femur, the lateral X ray of the adductor nodule was below the lower part of the femur, and the middle part of the two level was the middle part of the femur, and the middle femoral model was calculated. The radius of curvature of the initial anterior femoral arch. In Mimics14.0 software, a 14mm channel was established in the direction of intramedullary nail insertion at the proximal femur point, which was combined with the medullary cavity and considered as the proximal passage; the middle femoral segment was based on the medullary cavity, and the diameter of the femoral medullary isthmus near the femoral medullary isthmus was 11mm, 12mm, and 13mm through the femoral medullary isthmus. The distal cancellous bone of the middle segment was treated as the medullary cavity, combined with the posterior passage, and the distal femur cancellous bone was treated as the medullary cavity and regarded as the distal passage; the three part was combined as a channel for intramedullary nail insertion process. The Boolean operation was carried out in the Geomagic Studio12.0 software to obtain the strands of the insertion of intramedullary nails. Bone, middle, and lower three segments. In the parameterized modeling software Creo Parametric 2 developed by the Parametric Technology Corporation Ptc (Parametric Technology Corporation, PTC), using its sketching function, the right femur reconstruction nails of the Shi Lehui (Smith-Nephew) company, 10,11,12mm x 350mm3 specifications, and the company 5mm x 90mm share The proximal bone locking nail was assembled in the 3-matic module of Mimics14.0 software, and the femur model was built with the reconstructive nail and two proximal locking nails. In the Creo Parametric 2, the femur model was distorted by the middle femur section, and the femur model with different radius of curvature was obtained. The relative relationship between the reconstruction nail and the inner wall of the femoral medullary cavity was observed through the reconstruction of the insertion process channel of the nail. The matching degree of the reconstruction nail and the anterior femoral arch was observed. The concept of the anterior arch of the femur was proposed. The value is the ratio of the height of the arc to the 1/2 site in the anterior arch of the femur, because the elimination of the value is the elimination of the value of the anterior arch of the femur. The magnification of the X-ray was taken to make the results more accurate and easier to be obtained. Through the preoperative shooting of the orthographic X-ray of the femur, the matching degree between the intraoperative and postoperative reconstructive nails and the femoral medullary cavity of the patients was predicted, and the clinical treatment plan was drawn up. Results: the results of the analysis of the horizontal, coronal and sagittal plane in the Mimics14.0 software were not determined according to the reconstructive nails. The same diameter group, corresponding to the 10mm, 11mm, and 12mm reconstructive nails, the radius of the anterior arch of the femur is 75.7647cm, 73.0057cm, 96.9086cm, and the anterior femoral arch is greater than the femur model of 0.915351,0.095056,0.071330, respectively, because the distal contact of the distal femur to the medial cortex of the distal femur will cause the postoperative pain and the high wind of the internal fixation of the surrounding stress fracture. The diameter of the 10mm was smaller than the intramedullary diameter of the femoral isthmus, and the radius of the anterior arch of the femur was adjusted to 42.1221cm, and the insertion was not difficult when the nail head was reached. The diameter of the reconstruction nail of the 11mm and 12mm was 63.7519cm, 95.7433cm, and the anterior arch of the femur were respectively greater than that of the anterior arch of the femur. 0.101646,0.072207's femur model is difficult to insert when the nail head reaches the femoral isthmus entrance. The radius of the anterior arch of the femur is 66.3759cm, 75.7665cm, 96.9086cm, and the anterior femoral arch is greater than the 0.104751,0.091535,0.071330 in the femoral model. The insertion of the femoral head is difficult when the femoral isthmus is most narrow, and the anterior arch of the femur is half curvature. The diameter of the femoral anterior arch is 74.3592cm, 77.2252cm, 99.3351cm, the femoral anterior arch tangent value is greater than that of the 0.093295,0.089775,0.069570. The insertion of the femoral head is difficult when the nail head reaches the lowest end of the femur isthmus. If the force is forced, it will cause iatrogenic fracture. The radius of the anterior arch of the femur is divided into 57.0168cm, 64.7568cm, 66.9274cm, and anterior arch of femur. The femoral neck of the proximal femur could not be successfully inserted into the proximal femur neck locking nail when the intramedullary nail was inserted before the insertion of the intramedullary nail, or when the patient combined with other proximal femoral fractures. Conclusion: the larger femur of the anterior arch of the femur will cause the mismatch between the medullary cavity and the reconstructive nail. There are many complications. The reconstruction of the distal end of the nail with the medial cortex of the distal end of the femur will cause the high risk of postoperative pain and internal fixation of stress fractures; difficulties in the insertion of the nail head to the femoral isthmus, such as strong violence, will cause iatrogenic fractures. Complications, however, can not be successfully inserted into the proximal femoral neck locking nail when the intramedullary nail is inserted into the anterior proximal cortex of the femur or the patient is combined with other proximal femoral fractures.

【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

【参考文献】