支撑应力对骨小梁分布的影响及股骨头坏死因素的研究
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摘要
目的通过犬股骨颈骨折螺钉内固定模型的力学检测及组织学观察,从微观角度认识骨小梁重建对股骨头坏死的影响。方法选取18只成年田园犬制作成股骨颈骨折螺钉内固定模型,于造模后12周确认所有股骨颈骨折已愈合随机分为取钉组、取钉植骨组及不取钉组,于造模后20周分离所有犬的股骨并进行股骨颈力学测试及组织学观察。结果取钉组、取钉植骨组及不取钉组断裂点载荷、最大载荷差异有统计学意义(P<0.05);不取钉组与取钉植骨组的断裂点载荷差异无统计学意义(P>0.05),不取钉组与取钉植骨组断裂点载荷大于取钉组;不取钉组最大载荷大于取钉植骨组与取钉组,取钉植骨组最大载荷大于取钉组。取钉组、取钉植骨组及不取钉组骨小梁宽度与新鲜骨面积差异有统计学意义(P<0.05);不取钉组骨小梁宽度、新鲜骨面积大于取钉植骨组,且取钉植骨组大于取钉组。结论支撑应力的改变将导致骨小梁重新分布,骨小梁再分布是影响股骨头坏死塌陷的重要因素。
Objective To investigate the influence of trabecular bone reconstruction on femoral head necrosis with mechanical tests and histological observation on canine femoral neck fracture nailing internal fixation models. Methods Eighteen adult pastoral dogs were selected, and the femoral neck fracture were made. Healing of all the femoral neck fractures were confirmed after 12 weeks of surgery, and were divided into three groups by randomized control table. The femoral neck was examined mechanically and was observed histologically after 20 weeks of modeling. Results There was significant difference in the break point and maximum load along the taking nail group, the taking nail and making bone graft group and the group without taking nailing(P <0.05). There was no significant difference between the group without taking nailing and the taking nail and making bone graft group in the load of breaking point(P >0.05). The break point of the group without taking nailing and the taking nail and making bone graft group were larger than taking nail group. The maximum load of the group without taking nailing was larger than the taking nail, and the taking nail and making bone graft group was larger than taking nail group. There was significant difference at bone tissue maturation and new bone formation along the groups(P <0.05). The bone tissue maturation and new bone formation of the group without taking nailing were larger than taking nail and making bone graft group, which also larger than the taking nail group. Conclusion The change of supporting stress will lead to the re-distribution of trabecular bone, which is an important influence factor on collapse of femoral head necrosis.
Objective To investigate the influence of trabecular bone reconstruction on femoral head necrosis with mechanical tests and histological observation on canine femoral neck fracture nailing internal fixation models. Methods Eighteen adult pastoral dogs were selected, and the femoral neck fracture were made. Healing of all the femoral neck fractures were confirmed after 12 weeks of surgery, and were divided into three groups by randomized control table. The femoral neck was examined mechanically and was observed histologically after 20 weeks of modeling. Results There was significant difference in the break point and maximum load along the taking nail group, the taking nail and making bone graft group and the group without taking nailing(P <0.05). There was no significant difference between the group without taking nailing and the taking nail and making bone graft group in the load of breaking point(P >0.05). The break point of the group without taking nailing and the taking nail and making bone graft group were larger than taking nail group. The maximum load of the group without taking nailing was larger than the taking nail, and the taking nail and making bone graft group was larger than taking nail group. There was significant difference at bone tissue maturation and new bone formation along the groups(P <0.05). The bone tissue maturation and new bone formation of the group without taking nailing were larger than taking nail and making bone graft group, which also larger than the taking nail group. Conclusion The change of supporting stress will lead to the re-distribution of trabecular bone, which is an important influence factor on collapse of femoral head necrosis.
引文
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[10]周恩昌,朱传英,唐萍.经股骨颈开槽死骨刮除、按压力骨小梁方向植骨治疗股骨头坏死35例疗效观察[J].山东医药,2011,51(11):92-93.
[11]Ohashi T,Matsunaga S,Nakahara K,et al.Biomechanical role of peri-implant trabecular structures during vertical loading[J].Clin Oral Investig,2010,14(5):507-513.
[12]王上增,孙永强.骨小梁金属重建棒植入治疗早期股骨头坏死效果观察[J].实用医学杂志,2012,28(23):3945-3947.
[13]Goda I,Assidi M,Ganghoffer JF.Cosserat 3D anisotropic models of trabecular bone from the homogenisation of the trabecular structure[J].Comput Methods Biomech Biomed Engin,2012,15(1):288-290.
[14]Jang IG,Kim IY.Computational simulation of simultaneous cortical and trabecular bone change in human proximal femur during bone remodeling[J].J Biomech,2010,43(2):294-301.
[2]Li M,Cole PA.Anatomical considerations in adult femoral neck fractures:how anatomy influences the treatment issues?[J].Injury,2015,46(3):453-458.
[3]Song HK,Choi HJ,Yang KH,et al.Risk factors of avascular necrosis of the femoral head and fixation failure in patients with valgus angulated femoral neck fractures over the age of 50 years[J].Injury,2016,47(12):2743-2748.
[4]Ai ZS,Gao YS,Sun Y,et al.Logistic regression analysis of factors associated with avascular necrosis of the femoral head following femoral neck fractures in middle-aged and elderly patients[J].J Orthop Sci,2013,18(2):271-276.
[5]Yu X,Zhao D,Huang S,et al.Biodegradable magnesium screws and vascularized iliac grafting for displaced femoral neck fracture in young adults[J].BMC Musculoskelet Disord,2015,16:329-331.
[6]Lambers FM,Koch K,Kuhn G,et al.Trabecular bone adapts to long-term cyclic loading by increasing stiffness and normalization of dynamic morphometric rates[J].Bone,2013,55(2):325-334.
[7]Zwahlen A,Christen D,Ruffoni D,et al.Image-guided failure assessment of human trabecular bone-inverse finite element modelling for characterization of elastic properties[J].Biomed Tech(Berl),2013,doi:10.1515/bmt-2013-4114.
[8]Wang H,Ji B,Liu XS,et al.Analysis of microstructural and mechanical alterations of trabecular bone in a simulated three-dimensional remodeling process[J].J Biomech,2012,45(14):2417-2425.
[9]Ting BL,Heng M,Vrahas MS,et al.Is disuse osteopenia a favorable prognostic sign after femoral neck fracture?[J].J Orthop Trauma,2016,30(9):496-502.
[10]周恩昌,朱传英,唐萍.经股骨颈开槽死骨刮除、按压力骨小梁方向植骨治疗股骨头坏死35例疗效观察[J].山东医药,2011,51(11):92-93.
[11]Ohashi T,Matsunaga S,Nakahara K,et al.Biomechanical role of peri-implant trabecular structures during vertical loading[J].Clin Oral Investig,2010,14(5):507-513.
[12]王上增,孙永强.骨小梁金属重建棒植入治疗早期股骨头坏死效果观察[J].实用医学杂志,2012,28(23):3945-3947.
[13]Goda I,Assidi M,Ganghoffer JF.Cosserat 3D anisotropic models of trabecular bone from the homogenisation of the trabecular structure[J].Comput Methods Biomech Biomed Engin,2012,15(1):288-290.
[14]Jang IG,Kim IY.Computational simulation of simultaneous cortical and trabecular bone change in human proximal femur during bone remodeling[J].J Biomech,2010,43(2):294-301.