坏死股骨头内部空间结构及生物力学性能研究
发布时间：2018-07-23 11:15
【摘要】：目的:股骨头坏死是骨科常见病、难治病,其预后较差,给患者和社会带来巨大经济和社会负担。目前对股骨头坏死的治疗主要是髓芯减压、游离带蒂腓骨移植、旋转截骨以及最终的部分或全髋关节置换术,治疗效果不明确。明确的发病机制是良好治疗的前提,目前,股骨头坏死的发病机制尚不明确。髋关节作为全身的主要承重关节,近年来,生物力学因素在股骨头坏死发生发展中的作用越来越受到重视。本研究旨在探究股骨头坏死发生发展过程中其内部空间结构及骨小梁生物力学性能的变化,为研究股骨头坏死生物力学机制及临床治疗提供有价值的理论依据。方法:(1)选用因股骨颈骨折及股骨头坏死行全髋关节置换术治疗后的新鲜人股骨头标本各15个,排除畸形、骨肿瘤等病变,通过Siemens,Inveon~TM系统对各个标本行Micro-CT扫描、三维重建,观察对比正常股骨头与坏死股骨头内部空间结构,并计算比较正常股骨头与坏死股骨头内部相应区域骨计量学参数(2)行Micro-CT扫描后的股骨头标本,用硬组织切片机于正常股骨头与坏死股骨头各区域切出统一大小(1cm×1cm×1cm)的骨小块,通过BOSE-ELF3510生物力学性能测试系统测得各骨小块的生物力学性能,对比分析正常股骨头与坏死股骨头相应区域的生物力学性能。结果:(1)正常股骨头各区域骨小梁排列规则有序,坏死股骨头坏死区及硬化区骨小梁排列紊乱无序(2)与正常股骨头近端压力小梁区相比,坏死股骨头坏死区内相对骨体积分数(BV/TV)明显降低,平均骨小梁数目(Tb.N)减少,平均骨小梁间距(Tb.Sp)显著增宽;与正常股骨头压力张力小梁交界区相比,坏死股骨头硬化区的BV/TV增大,平均骨小梁厚度(Tb.Th)显著增大,Tb.Sp变窄;坏死股骨头远端压力小梁区BV/TV、Tb.N、Tb.Sp、Tb.Th度与正常股骨头远端压力小梁区均无差异;坏死股骨头非承重张力小梁区BV/TV及Tb.Th与正常股骨头非承重张力小梁区均无差异。(3)与正常股骨头近端压力小梁区相比,坏死股骨头坏死区骨小块的生物力学性能明显降低,其弹性模量下降近70%,屈服强度下降35%,极限强度下降35%;与正常股骨头压力张力小梁交界区相比,坏死股骨头硬化区骨小块弹性模量、屈服强度及极限强度均增大;坏死股骨头远端压力小梁区及非承重张力小梁区,与正常股骨头的远端压力小梁区及非承重张力小梁区相比,生物力学性能均无差异。结论:晚期股骨头坏死患者股骨头坏死区及硬化区空间结构及生物力学性能发生显著改变。笔者认为股骨头坏死发生发展实质为股骨头内部空间结构及生物力学性能的改变,是结构与功能不统一的结果。笔者提出以下猜想:髋关节为全身主要负重关节,作用于股骨头的应力较大,激素使用、酗酒等非创伤性因素导致股骨头骨强度下降,引起骨小梁疲劳骨折;对于创伤性股骨头坏死,内(或外)固定之后,很多并不能达到解剖复位,骨小梁的走行方向发生改变,出现结构与功能的不统一,长期应力刺激下骨小梁也发生疲劳骨折;骨小梁疲劳骨折后,形成了最初的小范围的坏死区,机体启动修复反应,加强原有骨小梁的生物力学性能或产生新的骨小梁,在坏死区周围形成硬化带,硬化带的形成虽然能给坏死区提供力学保护,但修复与骨小梁疲劳骨折之间不平衡,坏死区中正常骨小梁组织的逐渐减少,纤维结缔组织替代原有的骨小梁组织,坏死区与硬化区形成应力遮挡,作用于硬化区的应力增加,硬化区骨小梁逐渐出现微骨折,机体进一步修复,如此恶性循环,坏死区逐渐扩大,最终出现塌陷。
[Abstract]:Objective: osteonecrosis of the femoral head is a common disease in the Department of orthopedics. It is difficult to cure the disease. The prognosis is poor and it brings great economic and social burden to the patients and society. The treatment of femoral head necrosis is mainly core decompression, free Pedicled Fibula Transplantation, rotary osteotomy, and final partial or total hip arthroplasty. The treatment effect is not clear. Clear pathogenesis. At present, the pathogenesis of osteonecrosis of the femoral head is not clear. The hip joint is the main bearing joint of the whole body. In recent years, the role of biomechanical factors in the occurrence and development of femoral head necrosis is becoming more and more important. This study aims to explore the internal spatial structure and bone in the process of the occurrence and development of the femoral head. The changes in biomechanical properties of trabeculae provide valuable theoretical basis for the study of biomechanical mechanism and clinical treatment of femoral head necrosis. Methods: (1) 15 fresh human femoral head specimens after total hip replacement for femoral neck fracture and femoral head necrosis were selected, excluding deformity, bone tumor and other lesions, through Siemens, Inveon~TM Micro-CT scanning, three-dimensional reconstruction, observation and comparison of the internal spatial structure of the normal femoral head and necrotic femoral head, and the calculation and comparison of the bone bone measurement parameters (2) of the normal femoral head and the necrotic femoral head (2) after Micro-CT scanning, and using the hard tissue slice machine in the normal femoral head and the necrotic femoral head. The bone fragments of the United size (1cm x 1cm x 1cm) were cut out in each region. The biomechanical properties of the bone fragments were measured by the BOSE-ELF3510 biomechanical performance test system. The biomechanical properties of the normal femoral head and the necrotic femoral head were compared and analyzed. Results: (1) the bone trabecula in the normal femoral head was arranged orderly and necrotic femoral head. The disordered and disordered arrangement of trabecular bone in the necrotic and sclerosing areas (2) compared with the normal femoral head pressure trabecular area, the relative bone volume fraction (BV/TV) in the necrotic femoral head necrotic area was significantly reduced, the average small Liang Shumu (Tb.N) decreased, and the average small bone Liang Jianju (Tb.Sp) widened significantly; the necrosis was compared with the normal femoral head pressure trabecular junction area. The BV/TV of the femoral head sclerosis area increased, and the average small bone Liang Houdu (Tb.Th) increased significantly and the Tb.Sp narrowed. The BV/TV, Tb.N, Tb.Sp, Tb.Th degree of the distal pressure trabecular region of the necrotic femoral head were not different from the normal distal pressure trabecular region of the femoral head, and the BV/TV and Tb.Th in the non load-bearing tension trabecular region of the necrotic femoral head and the normal femoral head non load-bearing tension trabecular region were neither. (3) compared with the normal femoral head proximal pressure trabecular region, the biomechanical properties of the bone fragments in the necrotic femoral head necrotic area decreased significantly, the modulus of elasticity decreased by nearly 70%, the yield strength decreased by 35%, and the ultimate strength decreased by 35%. Compared with the normal femoral head pressure tension trabecular junction, the elastic modulus of the bone fragments in the necrotic femoral head area was yielded. The strength and ultimate strength increased, and there was no difference in biomechanical properties of the distal pressure trabecular and non load-bearing trabecular regions of the necrotic femoral head compared with the distal pressure trabecular and non load-bearing trabecular regions of the normal femoral head. Conclusion: the spatial structure and biomechanical properties of the femoral head necrosis area and the hardened area in the patients with advanced femoral head necrosis. The author believes that the following conjecture is that the hip joint is the main weight joint of the whole body, the stress of the femoral head, the use of the femoral head and the non traumatic factors such as the use of hormone and alcoholism. The bone strength of the femoral head is reduced and the bone trabecular fatigue fracture is caused. For the traumatic femoral head necrosis, the internal (or external) fixation can not reach the anatomical reduction, the walking direction of the trabecular bone is changed, the structure and function are not unified, the bone trabecula also has fatigue fracture under the long-term stress stimulation; after the tiredness fracture of the trabecular bone, the shape of the trabecular bone is formed. In the initial small area of necrotic area, the body starts the repair reaction, strengthens the biomechanical properties of the original trabecular bone, produces a new bone trabecula, forms a sclerotic zone around the necrotic area, and the formation of the hardened zone provides mechanical protection to the necrotic area, but the repair is unbalance between the small Liang Pi's fracture and the normal trabecular bone in the necrotic area. The tissue was gradually reduced. The fibrous connective tissue replaced the original bone trabecular tissue, the necrotic area and the hardened area formed stress occlusion, the stress in the hardened area increased, the bone trabecula gradually appeared micro fracture in the hardened area, and the body was further repaired. The necrotic area was gradually enlarged and finally collapsed.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R681.8
本文编号：2139227
[Abstract]:Objective: osteonecrosis of the femoral head is a common disease in the Department of orthopedics. It is difficult to cure the disease. The prognosis is poor and it brings great economic and social burden to the patients and society. The treatment of femoral head necrosis is mainly core decompression, free Pedicled Fibula Transplantation, rotary osteotomy, and final partial or total hip arthroplasty. The treatment effect is not clear. Clear pathogenesis. At present, the pathogenesis of osteonecrosis of the femoral head is not clear. The hip joint is the main bearing joint of the whole body. In recent years, the role of biomechanical factors in the occurrence and development of femoral head necrosis is becoming more and more important. This study aims to explore the internal spatial structure and bone in the process of the occurrence and development of the femoral head. The changes in biomechanical properties of trabeculae provide valuable theoretical basis for the study of biomechanical mechanism and clinical treatment of femoral head necrosis. Methods: (1) 15 fresh human femoral head specimens after total hip replacement for femoral neck fracture and femoral head necrosis were selected, excluding deformity, bone tumor and other lesions, through Siemens, Inveon~TM Micro-CT scanning, three-dimensional reconstruction, observation and comparison of the internal spatial structure of the normal femoral head and necrotic femoral head, and the calculation and comparison of the bone bone measurement parameters (2) of the normal femoral head and the necrotic femoral head (2) after Micro-CT scanning, and using the hard tissue slice machine in the normal femoral head and the necrotic femoral head. The bone fragments of the United size (1cm x 1cm x 1cm) were cut out in each region. The biomechanical properties of the bone fragments were measured by the BOSE-ELF3510 biomechanical performance test system. The biomechanical properties of the normal femoral head and the necrotic femoral head were compared and analyzed. Results: (1) the bone trabecula in the normal femoral head was arranged orderly and necrotic femoral head. The disordered and disordered arrangement of trabecular bone in the necrotic and sclerosing areas (2) compared with the normal femoral head pressure trabecular area, the relative bone volume fraction (BV/TV) in the necrotic femoral head necrotic area was significantly reduced, the average small Liang Shumu (Tb.N) decreased, and the average small bone Liang Jianju (Tb.Sp) widened significantly; the necrosis was compared with the normal femoral head pressure trabecular junction area. The BV/TV of the femoral head sclerosis area increased, and the average small bone Liang Houdu (Tb.Th) increased significantly and the Tb.Sp narrowed. The BV/TV, Tb.N, Tb.Sp, Tb.Th degree of the distal pressure trabecular region of the necrotic femoral head were not different from the normal distal pressure trabecular region of the femoral head, and the BV/TV and Tb.Th in the non load-bearing tension trabecular region of the necrotic femoral head and the normal femoral head non load-bearing tension trabecular region were neither. (3) compared with the normal femoral head proximal pressure trabecular region, the biomechanical properties of the bone fragments in the necrotic femoral head necrotic area decreased significantly, the modulus of elasticity decreased by nearly 70%, the yield strength decreased by 35%, and the ultimate strength decreased by 35%. Compared with the normal femoral head pressure tension trabecular junction, the elastic modulus of the bone fragments in the necrotic femoral head area was yielded. The strength and ultimate strength increased, and there was no difference in biomechanical properties of the distal pressure trabecular and non load-bearing trabecular regions of the necrotic femoral head compared with the distal pressure trabecular and non load-bearing trabecular regions of the normal femoral head. Conclusion: the spatial structure and biomechanical properties of the femoral head necrosis area and the hardened area in the patients with advanced femoral head necrosis. The author believes that the following conjecture is that the hip joint is the main weight joint of the whole body, the stress of the femoral head, the use of the femoral head and the non traumatic factors such as the use of hormone and alcoholism. The bone strength of the femoral head is reduced and the bone trabecular fatigue fracture is caused. For the traumatic femoral head necrosis, the internal (or external) fixation can not reach the anatomical reduction, the walking direction of the trabecular bone is changed, the structure and function are not unified, the bone trabecula also has fatigue fracture under the long-term stress stimulation; after the tiredness fracture of the trabecular bone, the shape of the trabecular bone is formed. In the initial small area of necrotic area, the body starts the repair reaction, strengthens the biomechanical properties of the original trabecular bone, produces a new bone trabecula, forms a sclerotic zone around the necrotic area, and the formation of the hardened zone provides mechanical protection to the necrotic area, but the repair is unbalance between the small Liang Pi's fracture and the normal trabecular bone in the necrotic area. The tissue was gradually reduced. The fibrous connective tissue replaced the original bone trabecular tissue, the necrotic area and the hardened area formed stress occlusion, the stress in the hardened area increased, the bone trabecula gradually appeared micro fracture in the hardened area, and the body was further repaired. The necrotic area was gradually enlarged and finally collapsed.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R681.8
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