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中华损伤与修复杂志(电子版) ›› 2017, Vol. 12 ›› Issue (01) : 39 -45. doi: 10.3877/cma.j.issn.1673-9450.2017.01.007

所属专题: 文献

论著

多种髓芯减压术治疗股骨头坏死的有限元研究
杨宾宾1, 刘耀升1, 刘蜀彬1,(), 苏秀云1, 孙培栋2, 周诗国3   
  1. 1. 100071 北京,解放军第三〇七医院骨科
    2. 510515 广州,南方医科大学人体解剖学教研室
    3. 100050 首都医科大学附属北京友谊医院统计室
  • 收稿日期:2016-11-01 出版日期:2017-02-01
  • 通信作者: 刘蜀彬
  • 基金资助:
    北京市科委首都临床特色应用研究(z121107001012093)

Finite element analysis of the multiple drilling technique for early osteonecrosis of the femoral head

Binbin Yang1, Yaosheng Liu1, Shubin Liu1,(), Xiuyun Su1, Peidong Sun2, Shiguo Zhou3   

  1. 1. Department of Orthopedic Surgery, the 307th Hospital of Chinese People′s Liberation Army, Beijing 100071, China
    2. Department of Human Anatomy, Southern Medical University, Guangzhou 510515, China
    3. Department of Statistics; Beijing Friendship Hospital Affiliated to Capital Medical University, Beijing 100050, China
  • Received:2016-11-01 Published:2017-02-01
  • Corresponding author: Shubin Liu
  • About author:
    Corresponding author: Liu Shubin, Email:
引用本文:

杨宾宾, 刘耀升, 刘蜀彬, 苏秀云, 孙培栋, 周诗国. 多种髓芯减压术治疗股骨头坏死的有限元研究[J]. 中华损伤与修复杂志(电子版), 2017, 12(01): 39-45.

Binbin Yang, Yaosheng Liu, Shubin Liu, Xiuyun Su, Peidong Sun, Shiguo Zhou. Finite element analysis of the multiple drilling technique for early osteonecrosis of the femoral head[J]. Chinese Journal of Injury Repair and Wound Healing(Electronic Edition), 2017, 12(01): 39-45.

目的

运用三维有限元分析的方法,探讨多种改良多孔道小直径髓芯减压术与传统单孔道大直径髓芯减压术,在早期股骨头坏死治疗中的应力变化规律。

方法

选择健康成人右侧股骨头为研究对象,经螺旋CT扫描获得各断面图像,输入计算机识别和提取股骨轮廓并行三维重建。根据生理状态下股骨头载荷的三维空间分布,股骨远端采用完全固定的设置方式,在股骨头上方施加与股骨干呈25°夹角、方向向下的570 N压力。建立坏死范围分别为15%与30%的多组髓芯减压三维有限元模型,通过运算得到股骨头不同部位皮质骨、松质骨的应力分布状况。

结果

减压方法与孔道数目不同,得到的应力值也随之不同;髓芯减压术后股骨头内均出现应力集中,传统单孔道大直径髓芯减压术较改良多孔道小直径髓芯减压术术后有较强的应力集中(如坏死范围15%时大直径减压模型与6孔道减压模型股骨头承力点区皮质骨应力值分别为:16.3 MPa,15.5 MPa);几种髓芯减压术减压后皮质骨(坏死范围30%时大直径减压模型股骨头皮质骨应力峰值为:17.3 MPa)、松质骨(坏死范围30%时大直径减压模型股骨头松质骨应力峰值为:0.29 MPa)应力峰值均小于股骨头自身的抗拉强度(松质骨:3.5 MPa;皮质骨:122 MPa)。

结论

与传统大直径单孔道减压术相比,改良多孔道髓芯减压术治疗早中期股骨头坏死可降低股骨头内应力集中,其生物力学优势更加明显。

Objective

To explore the influencing factors in traditional single large channel core decompression and multiple drilling technique in the treatment of early osteonecrosis of the femoral head with the methods of finite element analysis.

Methods

The right femur of healthy adults were choosen as the research object, and CT scanning was conducted to get the images of cross sections.The images were then inputted into computer to get contour of femur and rebuild 3D model.Distal end of femur was completely fixed, and 570N pressure on the femoral head was applied according to the three-dimensional space distribution of femur force under physiological state. Three-dimensional finite element models were founded with the necrotic range of 15% and 30%, then the stress distributions of cancellous bone and cortical bone of femoral head were obtained through the models.

Results

Different methods of decompression and different numbers of channel cores would lead to a different stress value: stress concentration would appear on femoral head after core decompression. Multiple drilling technique would get a more stress concentration comparing to traditional single large channel core decompression, the stress value was summit of cortical bone and cancellous bone would both less than their yield strength and tensile strength of femoral hard.

Conclusions

Multiple drilling technique is more effective and feasible in the treatment of early osteonecrosis of the femoral head comparing to traditional single large channel core decompression.

表1 应用于有限元分析的材料属性
图1 股骨头坏死三维有限元模型
图2 坏死范围15%时股骨头有限元模型
图3 坏死范围30%时股骨头有限元模型
表2 模拟坏死范围15%时股骨头对应区域皮质骨与松质骨平均应力分布情况
表3 模拟坏死范围30%时股骨头对应区域皮质骨与松质骨平均应力分布情况
图4 坏死范围15%时股骨头有限元模型截面
图5 坏死范围30%时股骨头有限元模型截面
图6 坏死范围15%时股骨头对应区域皮质骨与松质骨应力分布
图7 坏死范围30%时股骨头对应区域皮质骨与松质骨应力分布
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