股骨肿瘤切除术中的定制型假体有限元分析
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摘要
股骨是连接髋关节和膝关节的重要骨骼结构,也是原发性骨肿瘤的多发部位。在外科治疗股骨恶性骨肿瘤的过程中,常采用肿瘤段的整块切除即边缘切除或更广泛的外科边界切除方法,肿瘤切除后,造成大段骨缺损,股骨近段的定制型假体置换是对股骨近段大段骨缺损进行修复重建的最主要方法之一。假体置换保留了患者肢体功能,也容易因应力遮挡和时间的增加导致假体脱粘和松动。
随着计算机技术、有限元方法及计算机图形学等学科的迅猛发展,基于数值模拟的计算机辅助工程技术在医学领域得到了广泛应用,由于有限元方法在分析不规则物体的力学特点方面具有优越性,在骨骼尤其是髋关节置换的生物力学研究中,以及新假体的设计优化中得到广泛应用。本文对股骨进行三维重建,建立三种截骨面长度的三维有限元模型,对应四种不同的髓内柄长度,分析股骨-骨水泥-假体的应力分布以及股骨近段假体髓内柄长度的变化对应力分布的影响,为医生对股骨肿瘤患者临床置换假体的选择提供参考。
有限元分析结果表明假体髓内柄所受应力在外侧假体柄远端达到最大值,应力值均小于假体强度极限;股骨前后侧应力变化规律不明显,内外侧应力由股骨近端向远端逐渐增加,在假体柄末端处达到最大值,但均远小于股骨干强度极限。骨水泥层的内侧近端和外侧远端应力值较大,并且自近端向远端逐渐增大,至假体柄远端时达到最大值。
模拟结果分析得出以下结论:1.假体的植入不能避免股骨近端应力遮挡现象的发生,假体柄长度的变化对股骨的应力遮挡范围的影响不大。2.股骨假体的髓内柄长度要大于截骨面的长度尺寸,过长易导致股骨皮质穿孔或迸裂,过短易发生骨水泥层碎裂或脱粘。3.长柄假体可以明显降低髓内柄远端对骨水泥层产生的应力,但近端骨水泥层的应力水平也相应提高,因此切除的肿瘤段应尽量短。
Femur is one of the most common locations of metastatic or myeloma lytic lesions. The complete tumour resection namely edge resection can be given for surgical treatment, and this causes large bone lost. Custom-prosthesis of hip joint replacement is one of the key methods to repair the bone lost and reconstruction the limb function, but it can also lead to the prosthesis breaking and loosing which due to the stress shielding in the long term.
With the development of computer, the finite element method (FEM) and computer graphics, the computer aided engineering technology based on numerical simulation are increasingly employed in medicine field. As FEM has advantages on analyzing the mechanical property of anomalous objects, it is extending applied in human bones, especially in the biological mechanics of the hip joint replacement and the optimization of new prosthesis design. In this study, with constructed three-dimensional femur, three cases of the length of bone section corresponding with different length of limb stem are determined and analyzed for the stress distribution on bone, cement and prosthesis respectively. The results of simulation will give surgeons useful suggestions about the scheme of operation.
The FEA results show: the max stress of prosthesis stem occurs at about one of three lengths far away bottom stem, less than the limit. Stress on medial and lateral femur is obviously higher than one on anterior and posterior femur, and displays to be increasing gradually from top to bottom. The max magnitude occurs at the bottom of limb stem. Simultaneously, proximal medial cement and bottom lateral cement got higher stress magnitude than other positions.
The simulation mentioned above made several conclusions: 1. Putting in prosthesis produces stress shielding phenomenon on proximal femur, but the change of stem-lengths is independent to the region of stress shielding .2.The prosthesis stem must have a certain length, at least as long as the length of bone section. 3.The long stem prosthesis can reduce the stress magnitude of bone cement bottom, but increase the proximal stress. So short bone section is a better choice.
随着计算机技术、有限元方法及计算机图形学等学科的迅猛发展,基于数值模拟的计算机辅助工程技术在医学领域得到了广泛应用,由于有限元方法在分析不规则物体的力学特点方面具有优越性,在骨骼尤其是髋关节置换的生物力学研究中,以及新假体的设计优化中得到广泛应用。本文对股骨进行三维重建,建立三种截骨面长度的三维有限元模型,对应四种不同的髓内柄长度,分析股骨-骨水泥-假体的应力分布以及股骨近段假体髓内柄长度的变化对应力分布的影响,为医生对股骨肿瘤患者临床置换假体的选择提供参考。
有限元分析结果表明假体髓内柄所受应力在外侧假体柄远端达到最大值,应力值均小于假体强度极限;股骨前后侧应力变化规律不明显,内外侧应力由股骨近端向远端逐渐增加,在假体柄末端处达到最大值,但均远小于股骨干强度极限。骨水泥层的内侧近端和外侧远端应力值较大,并且自近端向远端逐渐增大,至假体柄远端时达到最大值。
模拟结果分析得出以下结论:1.假体的植入不能避免股骨近端应力遮挡现象的发生,假体柄长度的变化对股骨的应力遮挡范围的影响不大。2.股骨假体的髓内柄长度要大于截骨面的长度尺寸,过长易导致股骨皮质穿孔或迸裂,过短易发生骨水泥层碎裂或脱粘。3.长柄假体可以明显降低髓内柄远端对骨水泥层产生的应力,但近端骨水泥层的应力水平也相应提高,因此切除的肿瘤段应尽量短。
Femur is one of the most common locations of metastatic or myeloma lytic lesions. The complete tumour resection namely edge resection can be given for surgical treatment, and this causes large bone lost. Custom-prosthesis of hip joint replacement is one of the key methods to repair the bone lost and reconstruction the limb function, but it can also lead to the prosthesis breaking and loosing which due to the stress shielding in the long term.
With the development of computer, the finite element method (FEM) and computer graphics, the computer aided engineering technology based on numerical simulation are increasingly employed in medicine field. As FEM has advantages on analyzing the mechanical property of anomalous objects, it is extending applied in human bones, especially in the biological mechanics of the hip joint replacement and the optimization of new prosthesis design. In this study, with constructed three-dimensional femur, three cases of the length of bone section corresponding with different length of limb stem are determined and analyzed for the stress distribution on bone, cement and prosthesis respectively. The results of simulation will give surgeons useful suggestions about the scheme of operation.
The FEA results show: the max stress of prosthesis stem occurs at about one of three lengths far away bottom stem, less than the limit. Stress on medial and lateral femur is obviously higher than one on anterior and posterior femur, and displays to be increasing gradually from top to bottom. The max magnitude occurs at the bottom of limb stem. Simultaneously, proximal medial cement and bottom lateral cement got higher stress magnitude than other positions.
The simulation mentioned above made several conclusions: 1. Putting in prosthesis produces stress shielding phenomenon on proximal femur, but the change of stem-lengths is independent to the region of stress shielding .2.The prosthesis stem must have a certain length, at least as long as the length of bone section. 3.The long stem prosthesis can reduce the stress magnitude of bone cement bottom, but increase the proximal stress. So short bone section is a better choice.
引文
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