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成人髋关节高位脱位全髋关节置换术后髋臼三维有限元分析

Three-dimensional Finite Element Analysis of Acetabular Prosthesis in an Adult Patient with Total Hip Arthroplasty for High Dislocation

  • 摘要: 目的 利用三维有限元技术研究高位脱位全髋关节置换术后髋臼假体和骨周围的应力分布。 方法 实验分为4组:A组,加深髋臼+44 mm臼杯;B组,髋臼后外侧结构性植骨+48 mm臼杯;C组,髋臼后外侧钽金属重建块+48 mm臼杯;D组,正常侧髋关节。髋臼侧按照Wasielewski法分4个区,每个区均匀取10个点的Von Mises应力值,在组内和组间进行比较。 结果 A组髋臼骨质1区的应力值大于其他3个组(P<0.05)。A组聚乙烯内表面4个区的应力值均高于B、C两组(P<0.05),其中1、2区最明显。A组臼杯的初始位移为49.18 μm,为B组的19倍、C组的8倍。 结论 加深髋臼+小直径臼杯时,髋臼骨质和内衬应力集中、臼杯发生较大的初始位移;结构性植骨、安放钽金属重建块具有较好的生物力学性能,可以使用较大直径的臼杯。

     

    Abstract: Objective To observe stress distributions around the acetabular prosthesis and the bones of a patient who underwent total hip arthroplasty (THA). Methods Finite element analysis (FEA) was performed with an osteoarthritis patient who underwent THA for her secondary hip high dislocations:Scenario A——deepened acetabulum at the true acetabulum with a small 44 mm cup; Scenario B——structural bone graft at lateral acetabular with a 48 mm cup; Scenario C——place tantalum metal acetabular reconstruction at the lateral acetabular with a 48 mm cup; Scenario D——the normal side of the hip. According to the Wasielewski methods, acetabular was divided into four zones, in the same way on the lining surface. Ten points were taken in each zone for measuring the Von Mises stress values. Results Scenario A generated significantly greater stress values in the bones in zone one than the other three scenarios. Significantly greater stress was also found in the inner surface of polyethylene over all of the four zones under scenario A compared with those of the scenario B and C, especially in zone one and two. The cup initial micro-mobility for scenario A was 49.18 μm, 19 times of that of scenario B and 8 times of that of scenario C. Conclusion ① Deepened acetabulum with small cup can cause stress concentration in the acetabular bones and liner, leading to large cup initial micro-mobility. ② Acetabular lateral structural bone grafting and placement of tantalum metal reconstruction have better biomechanical properties, which can enable the use of bigger cups.

     

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