股骨头骨缺损模型打压植骨应力与软骨下骨承受能力的相关性研究
发布时间：2019-06-25 13:06
【摘要】：研究目的:打压植骨是治疗股骨头坏死的一种有效方法。但是既往打压植骨术中,打压应力的大小没有标准,缺少确定植骨充分的方法,术者往往通过自身的经验进行打压,既有可能因为打压应力过大造成软骨下骨穿孔,又有可能因为打压应力不足造成支撑效果不佳最终导致股骨头塌陷。本实验通过制作猪的股骨头骨缺损模型,测量植入不同数目体积的松质骨粒时软骨下骨可承受的打压植骨应力,从而得出股骨头软骨下骨可承受的安全应力,并探讨合适的打压植骨方式,最后通过影像学评定打压植骨后股骨头的情况,为进一步探索髓芯减压加打压植骨治疗股骨头坏死,提供生物力学上的实验依据和理论准备。研究方法:选取健康的8月龄长白猪新鲜股骨30具,进行骨密度测试,对股骨头标本采用随机区组设计。区组内序号从A-D的依次按照不植骨、植1g松质骨、植2g松质骨、植3g松质骨来进行打压植骨的力学测试,序号为E的待A-D组测试完成分析出安全打压应力结果后,用安全打压应力植3g松质骨,作为对安全应力的评估。将股骨大转子顶点下6cm位置确定为钻孔入口处,然后确定股骨头负重面。用游标卡尺测量从股骨头负重面至钻孔入口长度,在钻头上做出限深标记后,用直径为9mm的环钻从确定的入口处钻入,直至股骨头负重面下软骨下骨厚度为3mm处,刮出孔道内的松质骨。制作好股骨头骨缺损模型后,用X线检验模型软骨下骨厚度。将A-D组股骨头骨缺损模型依次按照不填充植骨颗粒、填充1g植骨颗粒、填充2g植骨颗粒、填充3g植骨颗粒进行生物力学试验,致股骨头软骨下骨变形穿孔,同步记录位移和压力曲线。E组股骨头骨缺损模型用于评估采用安全打压应力值打压植骨的结果。观察打压植骨后股骨头的完整性。用Micro-CT评估安全应力打压植骨后的股骨头软骨下骨。结果:1、骨密度测量结果所有股骨头标本Ward’s三角区的骨密度结果:骨密度测量值在0.537~1.228g/cm2之间,均数±标准差为0.874±0.117g/cm2。2、模型制作完成后影像学结果X线机拍摄平片后通过Orthoview软件测量分析,所有股骨头骨缺损标本软骨下骨厚度均为3mm。3、生物力学测试后的股骨头大体结果A-D组所有标本经过生物力学测试,股骨头软骨下骨断裂,股骨头穿孔。E组所有标本经过生物力学测试,股骨头形态完整。4、生物力学测试结果A-D组的股骨头穿透时的应力依次为:1196.833±124.646N、2395.667±657.941N、1990.167±617.326N、2230.333±370.238N。根据生物力学测量的结果发现股骨头标本临界应力的应力为1060N,因此当打压应力小于等于1000N时,可以视为安全的打压植骨应力。5、安全应力打压植骨后的影像学结果Micro-CT可观察到安全应力打压植骨后的股骨头软骨下骨骨小梁均整齐排列有序,未出现软骨下骨骨小梁变形和断裂,且植骨紧密。6、统计分析B、C、D组(打压植骨1g、2g、3g组)与A组(未植骨)之间差异具有统计学意义;BC组之间、CD组之间、BD组之间尚不能认为有统计学差异。结论:1、在精密仪器的辅助下和影像设备的验证下可以制作出股骨头软骨下骨厚度为3mm的股骨头骨缺损模型。2、软骨下骨厚度为3mm以上的股骨头,用直径为9mm的圆形平面顶棒打压植入颗粒状松质骨时,1000N以下的打压应力是安全的。3、软骨下骨厚度为3mm以上的股骨头,植骨可以有效增强软骨下骨对打压应力的承受能力。不同植骨量时,可以承受的打压应力无差别,因此在打压植骨的过程无需调整打压应力。合适的打压植骨方式应当是以一个均匀的力打压植骨。
[Abstract]:Objective: To suppress bone graft is an effective method to treat femoral head necrosis. However, in the prior suppression of bone grafting, the size of the pressing stress is not standard, and the method for determining the full bone grafting is lacking, and the operator is often impacted by the experience of the self, which can not only cause the subchondral bone to be perforated due to the excessive pressing stress, It is also possible to cause the femoral head to collapse due to poor support effect due to insufficient pressure stress. In this experiment, the bone defect model of the femoral head of the pig was made, and the stress of the bone and bone in the subchondral bone was measured with different volume of cancellous bone, so as to obtain the safe stress that the bone of the head of the femoral head can bear, and to discuss the appropriate method of suppressing the bone grafting. And finally, the condition of the femoral head after the bone grafting is pressed by the imaging evaluation, and the experimental basis and the theoretical preparation of the biomechanics are provided for further exploring the decompression of the nucleus pulposus and the compression bone grafting for the treatment of the femoral head necrosis. The method of the study was to select healthy 8-month old pig fresh femur 30, to test the bone density, and to design the femoral head specimen by the random zone group. 3 g of cancellous bone is implanted by the safety pressing stress after the test of the A-D group to be A-D of the E is completed and the safety pressure stress result is analyzed after the test of the A-D group of the group E is completed and analyzed, As an assessment of the safety stress. The position of the 6 cm at the apex of the femoral large rotor was determined as the bore entrance and the bearing surface of the femoral head was then determined. A vernier caliper was used to measure the length of the bearing surface from the head of the femoral head to the bore of the bore, and after a depth-limited mark was made on the drill, a 9-mm diameter ring was used to drill from the identified entrance until the thickness of the subchondral bone at the bearing surface of the femoral head was 3 mm, and the cancellous bone in the channel was scraped out. After the model of bone defect of the femoral head was made, the thickness of the subchondral bone was examined by X-ray. The bone defect model of the femoral head of A-D group was filled with bone graft granules, filled with 1 g of bone graft granules, filled with 2 g of bone graft granules,3 g of bone graft granules were filled for biomechanical test, and the deformation and perforation of the subchondral bone of the femoral head were induced, and the displacement and pressure curves were recorded synchronously. The model of the bone defect of the femoral head in the E group was used to evaluate the results of using the safety pressure stress to suppress the bone graft. To observe the integrity of the femoral head after suppression of bone graft. Micro-CT was used to evaluate the lower bone of the head of the femoral head after the safety stress was applied to the bone graft. Results:1. The results of bone mineral density measurement in the Ward's triangle area of all femoral head specimens: the measured value of bone mineral density was 0.537-1.228g/ cm2, the standard deviation of the mean square deviation was 0.874-0.117 g/ cm2. The thickness of the subchondral bone of all the femoral head of the femoral head was 3 mm.3. All the specimens of the A-D group after the biomechanical test were subjected to the biomechanical test, the fracture of the bone of the femoral head and the perforation of the femoral head. All the specimens of the E group were tested by biomechanics and the shape of the femoral head was complete.4. The stress of the femoral head of the A-D group in the biomechanical test was 1196.833-124.646 N, 2395.667-657.941 N, 1990.167-617.326 N,2223.333-370.238 N. According to the results of the biomechanics measurement, the stress of the critical stress of the head of the femoral head is 1060N. Therefore, when the pressing stress is less than or equal to 1000N, the stress of the bone graft can be regarded as safety. The results showed that the bone trabeculae in the subchondral bone of the femoral head after the safety stress and the bone grafting were orderly and orderly, and the bone trabeculae of the subchondral bone were not deformed and broken, and the bone graft was tight.6. The group B, C and D (1 g,2 g) were statistically analyzed. There was a statistically significant difference between the Group A and the Group A (no bone graft); there was no statistically significant difference between the BC groups, between the CD groups, and between the BD groups. Conclusion:1. The bone defect model of the femoral head with the thickness of 3 mm can be made under the aid of the precision instrument and the image equipment.2. The thickness of the subchondral bone is 3 mm or more, and when the granular cancellous bone is implanted with a circular planar top rod with a diameter of 9 mm, The pressure stress below 1000N is safe.3. The thickness of the subchondral bone is 3 mm or more, and the bone graft can effectively enhance the bearing capacity of the subchondral bone on the stress. When the bone mass is different, the pressure stress can bear no difference, and therefore, the pressing stress is not needed to be adjusted during the process of pressing the bone graft. A suitable method of suppression of bone graft should be to press bone graft with a uniform force.
【学位授予单位】：第二军医大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3
[Abstract]:Objective: To suppress bone graft is an effective method to treat femoral head necrosis. However, in the prior suppression of bone grafting, the size of the pressing stress is not standard, and the method for determining the full bone grafting is lacking, and the operator is often impacted by the experience of the self, which can not only cause the subchondral bone to be perforated due to the excessive pressing stress, It is also possible to cause the femoral head to collapse due to poor support effect due to insufficient pressure stress. In this experiment, the bone defect model of the femoral head of the pig was made, and the stress of the bone and bone in the subchondral bone was measured with different volume of cancellous bone, so as to obtain the safe stress that the bone of the head of the femoral head can bear, and to discuss the appropriate method of suppressing the bone grafting. And finally, the condition of the femoral head after the bone grafting is pressed by the imaging evaluation, and the experimental basis and the theoretical preparation of the biomechanics are provided for further exploring the decompression of the nucleus pulposus and the compression bone grafting for the treatment of the femoral head necrosis. The method of the study was to select healthy 8-month old pig fresh femur 30, to test the bone density, and to design the femoral head specimen by the random zone group. 3 g of cancellous bone is implanted by the safety pressing stress after the test of the A-D group to be A-D of the E is completed and the safety pressure stress result is analyzed after the test of the A-D group of the group E is completed and analyzed, As an assessment of the safety stress. The position of the 6 cm at the apex of the femoral large rotor was determined as the bore entrance and the bearing surface of the femoral head was then determined. A vernier caliper was used to measure the length of the bearing surface from the head of the femoral head to the bore of the bore, and after a depth-limited mark was made on the drill, a 9-mm diameter ring was used to drill from the identified entrance until the thickness of the subchondral bone at the bearing surface of the femoral head was 3 mm, and the cancellous bone in the channel was scraped out. After the model of bone defect of the femoral head was made, the thickness of the subchondral bone was examined by X-ray. The bone defect model of the femoral head of A-D group was filled with bone graft granules, filled with 1 g of bone graft granules, filled with 2 g of bone graft granules,3 g of bone graft granules were filled for biomechanical test, and the deformation and perforation of the subchondral bone of the femoral head were induced, and the displacement and pressure curves were recorded synchronously. The model of the bone defect of the femoral head in the E group was used to evaluate the results of using the safety pressure stress to suppress the bone graft. To observe the integrity of the femoral head after suppression of bone graft. Micro-CT was used to evaluate the lower bone of the head of the femoral head after the safety stress was applied to the bone graft. Results:1. The results of bone mineral density measurement in the Ward's triangle area of all femoral head specimens: the measured value of bone mineral density was 0.537-1.228g/ cm2, the standard deviation of the mean square deviation was 0.874-0.117 g/ cm2. The thickness of the subchondral bone of all the femoral head of the femoral head was 3 mm.3. All the specimens of the A-D group after the biomechanical test were subjected to the biomechanical test, the fracture of the bone of the femoral head and the perforation of the femoral head. All the specimens of the E group were tested by biomechanics and the shape of the femoral head was complete.4. The stress of the femoral head of the A-D group in the biomechanical test was 1196.833-124.646 N, 2395.667-657.941 N, 1990.167-617.326 N,2223.333-370.238 N. According to the results of the biomechanics measurement, the stress of the critical stress of the head of the femoral head is 1060N. Therefore, when the pressing stress is less than or equal to 1000N, the stress of the bone graft can be regarded as safety. The results showed that the bone trabeculae in the subchondral bone of the femoral head after the safety stress and the bone grafting were orderly and orderly, and the bone trabeculae of the subchondral bone were not deformed and broken, and the bone graft was tight.6. The group B, C and D (1 g,2 g) were statistically analyzed. There was a statistically significant difference between the Group A and the Group A (no bone graft); there was no statistically significant difference between the BC groups, between the CD groups, and between the BD groups. Conclusion:1. The bone defect model of the femoral head with the thickness of 3 mm can be made under the aid of the precision instrument and the image equipment.2. The thickness of the subchondral bone is 3 mm or more, and when the granular cancellous bone is implanted with a circular planar top rod with a diameter of 9 mm, The pressure stress below 1000N is safe.3. The thickness of the subchondral bone is 3 mm or more, and the bone graft can effectively enhance the bearing capacity of the subchondral bone on the stress. When the bone mass is different, the pressure stress can bear no difference, and therefore, the pressing stress is not needed to be adjusted during the process of pressing the bone graft. A suitable method of suppression of bone graft should be to press bone graft with a uniform force.
【学位授予单位】：第二军医大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3
【参考文献】
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1 孙蕴;贺丽英;马兆坤;潘克h，
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