全髋关节置换术对股骨近端骨重建的影响
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1.天津理工大学;2.天津理工大学 机械工程学院 天津市先进机电系统设计与智能控制重点实验室;3.机电工程国家级实验教学示范中心天津理工大学;4.吉林大学 机械与航空航天工程学院;5.吉林大学;6.北斗(天津)夹具装备有限公司

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Q66

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Effect of total hip arthroplasty on proximal femoral remodeling
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    摘要:

    目的 针对全髋置换术后中远期可能出现的假体松动、脱位等问题,采用Wolff骨重建理论分析全髋置换术对股骨近端骨重建进程的影响。方法 根据骨重建控制方程,利用Python语言编写骨重建程序。在ABAQUS软件中分别建立术前股骨模型与术后股骨及假体有限元模型。对比术前和术后的骨重建进程,分析假体植入对术后中远期股骨力学性能的影响作用。结果 股骨应力分布和密度分布对比表明:假体植入后股骨近端应力持续降低,受力点由股骨头转移到假体,出现了明显的应力遮挡现象。应力遮挡区域内骨丢失现象严重。股骨干皮质骨变薄,应力遮挡有所缓解。假体底端内侧受挤压,应力显著高于外侧,此处骨质分布不均。结论 全髋关节置换术后,股骨近端内侧出现明显的应力遮挡,导致骨丢失,造成假体松动;假体底端两侧应力水平存在差异,引起骨质分布不均,导致假体与股骨配合不紧密,造成术后患者大腿中段的疼痛。

    Abstract:

    Objective Aiming at the problems of prosthesis loosening and dislocation after total hip arthroplasty in the medium and long term, the Wolff bone remodeling theory was used to analyze the influence of total hip arthroplasty on the process of proximal femoral bone remodeling. Methods According to the control equation of bone remodeling, the program of bone remodeling was written in Python language. Preoperative femur model and postoperative femur and prosthesis finite element model were established respectively in ABAQUS software. Results The comparison of stress and density distribution showed that the stress in the proximal femur continued to decrease after the prosthesis was implanted, and the stress site was transferred from the femoral head to the prosthesis, resulting in obvious stress shielding phenomenon. The bone loss in the stress shielding area is serious. The femoral shaft cortical bone thinned and the stress shielding was relieved. The medial side of the bottom of the prosthesis was compressed, and the stress was significantly higher than that of the lateral side, where the bone was unevenly distributed. Conclusions After total hip arthroplasty, the proximal medial side of femur appears obvious stress shielding, leading to bone loss and prosthesis loosening. The difference in stress levels on both sides of the bottom of the prosthesis resulted in uneven bone distribution, which resulted in the discordance between the prosthesis and the femur, resulting in postoperative pain in the middle part of the thigh.

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  • 收稿日期:2020-11-29
  • 最后修改日期:2021-03-21
  • 录用日期:2021-03-24
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