髋臼发育不良者全髋置换中臼杯置入位置的力学分析
收稿日期: 2013-11-23
网络出版日期: 2014-06-04
The finite element analysis of the total hip replacement with cup invagination in dysplasia of hip
Received date: 2013-11-23
Online published: 2014-06-04
目的 利用三维有限元分析方法,研究髋臼发育不良患者加深磨锉假体置入部位的髋臼骨床、使臼杯假体内移置入对髋臼假体-骨界面间的应力分布情况的影响。 方法 选取髋关节发育不良患者的骨盆为实验对象,螺旋CT做全长连续扫描,然后利用计算机仿真技术对CT图像进行三维重建,建立髋关节发育不良骨盆模型。在计算机环境中对重建模型进行髋臼磨锉，臼杯假体不同程度内移植入的模拟手术，利用有限元分析软件SolidWorks对重建模型进行有限元网格化及力学分析。 结果 臼杯假体的内移使臼杯上缘处获得骨床包容，臼杯接触面积更大，单位面积所受应力相对较少。随内移程度加大，髋臼内壁骨质突破更为明显，使髋臼顶部应力集中及其余部分应力不均愈趋明显。 结论 髋臼加深磨锉臼杯内移植入有助于改善髋关节发育不良病例行髋关节置换臼杯的骨床包容，但随内移程度的加大，髋臼内壁突破，髋臼面的应力集中，髋臼的应力分布情况明显改变，应尽量减少穿破的程度。
许杰 , 马若凡 , 蔡志清 , 李登 , 丁悦 , 刘尚礼 . 髋臼发育不良者全髋置换中臼杯置入位置的力学分析[J]. 中国临床解剖学杂志, 2014 , 32(3) : 343 -347 . DOI: 10.13418/j.issn.1001-165x.2014
Objective Using the three dimensional finite element analysis, the stress distribution in acetabular cup-bone interface in different ranges of cup invagination during total hip replacement (THR) in treating the dysplasia of hip affected was studied. Methods Pelvis in the dysplasia was scanned by CT. Using the computer simulation technology to reconstruct the three-dimensional model of the pelvis for observing the dysplasia of hip from CT scan images. Different ranges of cup invagination in THR in the pelvic model were simulated. Then the pelvis and acetabular cup model were meshed. the mechanics analysis tool in SolidWorks was used to analyze the three-dimensional model, and the stress data in acetabular cup-bone interface was obtained. After the statistical analysis of the experiment result, the different ranges of cup invagination that affected the stress distribution in acetabular cup-bone interface were observed. Results greater contact area and smaller stress per unit area were resulted due to acetabular deepened grinding and cup invagination. With the increasing degree of acetabular deepened grinding, the bone in the acetabular wall broke more obviously, leading to increasing the stress concentration at the top of the acetabulum and uneven stress in the rest. Conclusion Acetabular deepened grinding and cup invagination improve bone bed inclusion of cup during total hip replacement in treating the dysplasia of hip. However, the increasing deepened grinding and perforation of acetabular wall will lead to significant changes of the stress distribution of acetabula and stress concentration. The perforation of acetabular wall should be minimized.
Key words： Dysplasia; Hip; Arthroplasty; Finite element analysis; Biomechanics
[1] Aksoy C, Yilgor C, Demirkiran G, et al. Evaluation of acetabular development after Degaacetabuloplasty in developmental dysplasia of the hip
[J]. J Pediatr Orthop B, 2013, 22(2): 91-95.
[2] Bracken J, Tran T, Ditchfield M. Developmental dysplasia of the hip: controversies and current concepts
[J]. J Paediatr Child Health, 2012, 48(11):963-972, 972-973.
[3] Nemeth B A, Narotam V. Developmental dysplasia of the hip
[J]. Pediatr Rev,2012, 33(12):553-561.
[4] Rogers B A, Garbedian S, Kuchinad R A, et al. Total hip arthroplasty for adult hip dysplasia
[J]. J Bone Joint Surg Am, 2012, 94(19):1809-1821.
[5] Westacott D, Pattison G, Cooke S. Developmental dysplasia of the hip
[J]. Community Pract, 2012, 85(11):42-44.
[6] Hvid I. Neonatal hip instability, developmental dysplasia of the acetabulum, and the risk of early osteoarthrosis
[J]. Acta Orthop, 2008, 79(3):311-312.
[7] Inan M, Chan G, Bowen JR. The correction of leg-length discrepancy after treatment in developmental dysplasia of the hip by using a percutaneous epiphysiodesis
[J]. J Pediatr Orthop B, 2008, 17(1):43-46.
[8] Bozek M, Bielecki T, Nowak R, et al. Arthroplasty in patients with congenital hip dysplasia--early evaluation of a treatment method
[J]. Ortop Traumatol Rehabil, 2013, 15(1):49-59.
[9] Li H, Wang L, Dai K, et al. Autogenous impaction grafting in total hip arthroplasty with developmental dysplasia of the hip
[J]. J Arthroplasty, 2013, 28(4):637-643.
[10]Schofer M D, Pressel T, Schmitt J, et al. Reconstruction of the acetabulum in THA using femoral head autografts in developmental dysplasia of the hip
[J]. J OrthopSurg Res, 2011,6:32.
[11]Yang S, Cui Q. Total hip arthroplasty in developmental dysplasia of the hip: Review of anatomy, techniques and outcomes
[J]. World J Orthop, 2012, 3(5):42-48.
[12]艾进伟，韩叶萍. Zweymüller系统在Crowe-Ⅲ、Ⅳ型髋臼发育不良全髋置换中的应用
[J]. 中国组织工程研究与临床康复, 2008(44):8615-8618.
[13]Mitsuo Niinomi. Recent research and development in titanium alloys for biomedical applications and healthcare goods
[J]. Sci Technol Advan Mater, 2003, 4:445-454.
[14] Ranawat CS, Dorr LD, Inglis AE. Total hip arthroplasty in protrusio acetabuli of rheumatoid arthritis
[J]. J Bone Joint Surg Am,1980,62(7):1059-1065.
[15]赵诗奎. 氧化锆基纳微米复合陶瓷模具材料及其摩擦磨损特性研究
[D]. 山东轻工业学院,2009.
[16]Wei H W, Sun S S, Jao S H, et al. The influence of mechanical properties of subchondral plate, femoral head and neck on dynamic stress distribution of the articular cartilage
[J]. Med Eng Phys,2005,27(4):295-304.
[17]Herman S, Jaklic A, Herman S, et al. Hip stress reduction after Chiariosteotomy
[J]. Med Biol Eng Comput, 2002,40(4):369-375.
[18]Hipp J A, Sugano N, Millis M B, et al. Planning acetabular redirection osteotomies based on joint contact pressures
[J]. Clin Orthop Relat Res,1999, 364:134-143.
[19]Mackenzie J R, Kelley S S, Johnston R C. Total hip replacement for coxarthrosis secondary to congenital dysplasia and dislocation of the hip. Long-term results
[J]. J Bone Joint Surg Am,1996, 78(1):55-61.
[20]Jasty M, Anderson M J, Harris W H. Total hip replacement for developmental dysplasia of the hip
[J]. Clin Orthop Relat Res,1995, 311:40-45.
[21]Shinar AA, Harris W H. Bulk structural autogenous grafts and allografts for reconstruction of the acetabulum in total hip arthroplasty. Sixteen-year-average follow-up
[J]. J Bone Joint Surg Am,1997, 79(2):159-168.
[22]范树枫,刘灿祥. 全髋关节置换治疗成人先天性髋关节发育不良
[J]. 中国实用医药, 2009, 7:108-109.
[23]郑忠，李超雄，李坚，等. 成人髋臼发育不良伴骨性关节炎行全髋置换术不同髋臼安装方法的力学比较
[J]. 中国骨与关节损伤杂志, 2006, 24(2):97-99.
[24]Dorr LD, Tawakkol S, Moorthy M, et al. Medial protrusio technique for placement of a porous-coated, hemispherical acetabular component without cement in a total hip arthroplasty in patients who have acetabular dysplasia
[J]. J Bone Joint Surg Am, 1999,81(1):83-92.
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