步态下弧形髋臼周围截骨术术前规划的有限元研究
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1.云南省昆明市呈贡区昆明理工大学机电工程学院;2.昆明医科大学第二附属医院 骨科

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Finite element analysis of preoperative planning for curved periacetabular osteotomy during gait
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    摘要:

    目的 研究在完整步态周期受力环境下髋关节周围软骨的应力分布情况,探求弧形髋臼周围截骨术(Curved periacetabular osteotomy, CPO)术中所截骨块的最佳矫正角度,为临床手术提供理论依据。方法 利用CT扫描技术获取一名髋关节发育不良(Development dysplasia of hip, DDH)患者和一名健康志愿者的骨盆及股骨近端DICOM数据并构建三维有限元模型。采用基于Mask的划分方法为三维有限元模型赋予材料属性。对DDH模型模拟CPO,旋转截骨块得到100个不同的术后模型。根据完整步态周期中的髋关节受力情况为模型分别施加载荷,分析对比术前、术后和正常髋臼软骨的受力变化。结果 DDH模型模拟术后的髋臼软骨在完整步态周期中五个时相的最小接触应力峰值分别为5.273Mpa、6.128Mpa、7.463Mpa、6.347Mpa、6.582Mpa,分别比术前减少了2.159 Mpa、2.724 Mpa、2.249 Mpa、2.164 Mpa、2.119 Mpa,且术后的头臼接触面积较术前明显增加,但仍小于正常志愿者。结论 利用有限元方法可以得到LCEA和ACEA的最佳矫正角度,对不同患者模拟CPO手术对提高手术精准度和手术效率具有重要意义。

    Abstract:

    Objective To study the stress distribution of the cartilage around the hip joint in the stress environment of the complete gait cycle, and to explore the best correction angle of the bone block in the curved periacetabular osteotomy (CPO), so as to provide a theoretical basis for clinical operation. Methods Based on CT scans of a healthy volunteer and a patient with development dysplasia of hip (DDH), the three-dimensional model including pelvis and proximal femur was reconstructed. Material attributes were assigned to the 3D finite element model by the method of Mask. To simulate CPO with DDH model, and 100 different postoperative models were obtained by rotating osteotomy. According to the stress of hip joint in the complete gait cycle, the model was loaded respectively, and the stress changes of normal, preoperative and postoperative of the acetabular cartilage were analyzed and compared. Results The minimum contact stresses of acetabular cartilage of DDH patient after simulated CPO operation in the whole gait cycle at five time phases were 5.273Mpa、6.128Mpa、7.463Mpa、6.347Mpa、6.582Mpa, which were 2.159 MPa, 2.724 MPa, 2.249 MPa, 2.164 MPa and 2.119 MPa less than those before operation, respectively. The contact area between femoral head and acetabulum was significantly increased after operation, but it was still smaller than that of normal volunteers. Conclusion The best correction angle of LCEA and ACEA can be obtained by using finite element method, and it is of great significance to simulate CPO surgery for different patients to improve surgical accuracy and efficiency.

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  • 收稿日期:2021-11-03
  • 最后修改日期:2021-11-14
  • 录用日期:2021-11-16
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