三维有限元分析在髋臼骨缺损臼杯重建中的应用

发布时间：2018-06-01 14:58

本文选题：髋臼骨缺损 + 旋转中心上移　；参考：《吉林大学》2015年博士论文

【摘要】：随着我国全髋关节置换(total hip arthroplasty, THA)患者数量的不断增加,因各种原因导致THA术后假体固定失败需要翻修的患者数量也存与日俱增。需要翻修的髋臼多存在不同程度的骨缺损。同样发育性髋关节发育不良(Developmental dysplasia of the hip, DDH)的患者髋臼也同样存在骨缺损,当处理这些类型的患者髋关节置换和翻修术时,髋臼骨缺损的处理往往是最具挑战性的难题之一。成功的髋臼翻修要达到髋臼假体与髋臼骨面紧密接触,假体稳定固定,具有稳定的力学构造,使应力能够分散在假体周围骨；重建的髋臼位置良好。对于髋臼骨缺损的病例,临床上有很多种方法处理。临床随访效果也不尽一样。为此本文着重对其中两种处理方法：旋转中心上移技术和使用加强杯(Ganz环)技术进行相关解剖及生物力学研究。而传统的生物力学研究方法对于复杂髋臼臼杯重建产生了一定制约,限制其研究的深入发展。作为生物医学领域中广泛应用的一种数学物理方法,有限元分析技术具有不受具体实验条件限制、科学性强、应用广泛等优点,尤其是可以不通过人体或动物实验就可以得出结论,在当前的骨科生物力学研究中占有十分重要的地位,具有广阔的发展前景。旋转中心上移技术在文献中的临床效果喜忧参半,且文献中没有指出旋转中心上移技术最大上移程度,也没有相关的国人解剖学数据结合臼杯覆盖率的分析以及相关有限元生物力学的研究,所以在本文的第二章中我们通过Mimics16.01软件测量国人髂骨的解剖学数据,并计算旋转中心上移不同程度的臼杯覆盖率,从解剖学基础上提供旋转中心上移的最大程度的参考。第三章中,我们通过有限元方法分析旋转中心上移对骨盆,臼杯位移以及髋臼,臼杯应力的影响,从生物力学的角度上提供旋转中心上移技术的上移理论基础。近年来加强杯(Ganz环)在髋臼骨缺损的臼杯重建中也得到了很好的应用,现在多为中期随访结果显示良好,长期随访结果有待研究,为了更好的使加强杯在临床应用,本文的第四章通过有限元方法分析使用加强杯重建臼杯中根据骨缺损的程度,螺钉的位置和数量以及移植材料的种类对臼杯稳定性的影响。我们希望得出的结果能够为临床医生在相关方面的决策提供有价值的参考。
[Abstract]:With the increasing number of patients with total hip arthroplasty, THA) after total hip arthroplasty in China, the number of patients who need revision due to various reasons for the failure of prosthesis fixation after THA is also increasing. Most acetabular defects in need of revision have varying degrees of bone defect. Acetabular defects also exist in patients with developmental dysplasia of the hip, DDH), and the treatment of acetabular defects is often one of the most challenging problems in the treatment of these types of hip replacement and revision. The successful acetabular revision should achieve close contact between the acetabular prosthesis and the acetabular surface, the prosthesis is fixed stably and has a stable mechanical structure, so that the stress can be dispersed in the surrounding bone of the prosthesis, and the reconstructed acetabular is in a good position. There are many methods for the treatment of acetabular bone defect. The clinical follow-up effect is also not the same. Therefore, this paper focuses on the related anatomical and biomechanical studies on two processing methods: the technique of moving up the center of rotation and the technique of using the enhanced cup Ganz ring. Traditional biomechanical research methods restrict the development of acetabular cup reconstruction. As a widely used mathematical and physical method in the field of biomedicine, finite element analysis has the advantages of not being restricted by specific experimental conditions, being scientific and widely used. Especially, we can draw a conclusion without human or animal experiments, which plays a very important role in the research of orthopedic biomechanics and has a broad prospect of development. The clinical effect of rotating center upward shift technique in literature is mixed, and it is not pointed out in the literature that the maximum upward shift degree of rotation center upward movement technique. There is no related Chinese anatomical data combined with the analysis of cup coverage and the study of finite element biomechanics, so in the second chapter of this paper, we measure the anatomical data of Chinese iliac bone by Mimics16.01 software. The percentage of cup cover of different degrees of upward shift of rotating center was calculated, and the maximum reference of upward movement of rotating center was provided on the basis of anatomy. In chapter 3, we analyze the effect of upward shift of rotating center on pelvis, cup displacement and stress of acetabular and acetabular cup by finite element method, and provide the theoretical basis of upward shift of rotating center from the point of view of biomechanics. In recent years, the reinforced cup Ganz ring has also been used in the reconstruction of acetabular bone defect. Now, the results of mid-term follow-up show good results, and the long-term follow-up results need to be studied, in order to make the reinforcement cup better in clinical application. In the fourth chapter, the effects of the degree of bone defect, the position and quantity of screws and the type of graft materials on the stability of acetabular cup were analyzed by finite element method. We hope that the results can provide a valuable reference for clinicians in the relevant decisions.
【学位授予单位】：吉林大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R687.4

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