通过腰椎生物力学变化对弧形髋臼截骨术进行术前规划
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昆明医科大学第二附属医院基金项目(2020yn1c008),云南省科技人才与平台计划(院士专家工作站)(202205AF150009)


Preoperative Planning of Curved Periacetabular Osteotomy by Biomechanical Changes in the Lumbar Spine
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    摘要:

    目的 研究患者在慢走步态中单腿支撑中期相的受力环境下L1~5、纤维环与髓核的应力分布情况,确定弧形髋臼截骨术中截骨块的最佳矫正角度,为临床手术提供个体化方案。方法 利用CT扫描获取患者及健康志愿者股骨-骨盆-腰椎DICOM数据,构建三维有限元模型。利用建模软件划分出皮质骨、松质骨以及一系列软骨,利用仿真软件对模型进行有限元分析。患者外侧中心边缘角(lateral center edge angle,LCEA)和前方中心边缘角(anterior center edge angle, ACEA)均为15°,通过计算机模拟手术截骨过程,分别得到LCEA=15°、25°、35°、45°以及ACEA=15°、25°、35°、45°共计16组模型。对比分析模型感兴趣区域应力差异,同时与患者术前、健康志愿者对比,得出最佳手术方案。结果 腰椎所受应力随着LCEA和ACEA角度增大而减小,其中LCEA=35°、ACEA=35°模型L1~5、髓核与纤维环所受应力最小,之后所受应力随着角度增加而增加。结论 利用有限元方法可以得到LCEA与ACEA的最佳矫正角度,本文方法对不同患者提高弧形髋臼截骨术手术精准度和手术效率具有重要意义。

    Abstract:

    Objective The stress distribution of the lumbar spine L1–5, fibrous rings and nucleus pulposus of the patient in mid-phase of single-leg support under slow-walking gait was studied, to determine the optimal correction angle of the osteotomy block in curved periacetabular osteotomy (CPO), and provide an individualized plan for clinical surgery. Methods The femur-pelvis-lumbar spine DICOM data of a patient and a healthy volunteer were obtained using CT scanning to construct a three-dimensional finite element model. The cortical bone, cancellous bone, and a series of cartilages were delineated using the modeling software, and the model was analyzed by finite element method using simulation software. The patient’s lateral center edge angle (LCEA) and anterior center edge angle (ACEA) were 15°, and 16 different postoperative models (LCEA=15°,25°,35°,45°and ACEA=15°, 25°, 35°, 45°) were obtained by computer simulation of the surgical osteotomy process. The stress differences in the regions of interest of the model were compared and analyzed, which were also compared with those of patient before surgery and the healthy volunteer, so as to obtain the optimal surgical plan. Results The stresses applied to the lumbar spine decreased with increasing LCEA and ACEA angles, with the lowest stresses applied to the lumbar cones, nucleus pulposus, and annulus fibrosus in the LCEA=35°, ACEA=35°models; then, the stresses applied increased with increasing angles. Conclusions The optimal correction angle for LCEA and ACEA can be obtained using the finite element method, this method is of great significance to improve the accuracy and efficiency of CPO for different patients.

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许世森,鲁宁,许平,李文金.通过腰椎生物力学变化对弧形髋臼截骨术进行术前规划[J].医用生物力学,2025,40(1):80-85

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  • 收稿日期:2024-04-19
  • 最后修改日期:2024-05-17
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  • 在线发布日期: 2025-02-26
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