髋臼发育不良引发骨关节病的力学机理研究及代偿范围初探
|
摘要
目的：通过对不同程度的成人髋臼发育不良关节进行有限元受力分析并与正常髋关节受力情况进行对照，进而分析其受力改变对髋关节局部受力情况的影响；阐明髋臼发育不良导致的力学异常是引发髋关节骨关节病的主要力学机制；进行模拟不同程度CE角缺损，探讨该缺损角度与人体代偿能力的相关性，为成人髋臼发育不良的治疗和对骨关节病的预防、治疗提供力学指导。
方法：临床选取典型的不同程度髋臼发育不良之髋关节作模板同时选取正常髋关节作模板，予以拍摄双足直立位全骨盆正位X线片，并摄单足站立位全骨盆正位片(双足直立平衡位要求：双足等肩宽，双门牙中缝处咬铅垂线通过耻骨联合；单足直立位要求：身体直立，双肩水平，对侧足抬起，膝间距10cm，骨瓮中立位，Tredelenberg征阴性，骨盆不出现向健侧或患侧倾斜。)，经图象处理后按有限元网格划分的原则，划分节点、单元。其中，CE角35°正常髋关节：双足直立位片：1029节点、899单元，单足站立位片：1028节点、896单元；CE角20°髋关节：双足直立位片：1024节点、894单元，单足站立位片：1026节点、893单元；CE角2°髋关节：双足直立位片：1014节点、882单元，单足站立位片：1020节点、886单元，运用Super—sap(93)有限元软件建立有限元模型，根据其双足平衡负重、单足直立负重之不同受力情况，按一定边界条件模拟加载于电脑模型上，计算出在人体正常典型关节行为中的负荷情况，得出所建立模型在该状态下各个节点、单元的应力情况，尤其髋臼及股骨头周围的剪切应力、压应力、M氏应力，探讨应力、应变、位移值的改变与其引发骨关节病的必然联系；进行模拟不同程度CE角缺损，初步探讨该缺损角度与人体代偿能力的相关性，初步提供一个以CE角为指标的人体髋关节的代偿能力的大概范围。
结果:在双足平衡负重状态下，在垂直轴上，随着CE角的减小，髓臼外上缘受
力显著增加，骸臼外上缘受压应力明显增加(p<0.01);单足站立位下，骸臼外上缘
受压应力明显增大同时剪切应力逐渐增大，随着CE角减小髓臼外上缘压力明显增
大，外上缘与内下缘关节囊处出现水平轴方向的拉应力;随着应力的增加、站立位
的变化、CE角的变化骸臼外缘软骨受力显著增加，内下缘关节囊由受轻微拉力力至
受较大拉应力;股骨头负重区由股骨头球心正上方移至内上方，髓臼负重区也发生
相应改变:随着CE角减小外展肌开始做功，导致髓臼与股骨头上缘M氏应力、剪
切应力和压应力均明显增加(p<0.01);进行模拟不同程度单足直立位CE角缺损，
当CE角为一10。时，对于体重60kg患者其外展肌肌力正好抵消局部产生的脱位应
力，由此得出对于该患者其代偿范围为单足直立位CE角在一10“一20”之间。
结论:
1、在双足直立平衡位下，随着CE角的减小，臼缘外上方骨质、软骨所受压应
力逐渐增加:关节囊受拉应力明显增加;股骨头负重区内移，剪切应力、M氏应力
值明显增加。
2、在单足直立位下，随着外展肌的介入和CE角减小，臼缘外上方骨质、软骨
受压应力明显增大;臼下缘关节囊受拉应力显著增大;股骨头受力区内移，剪切应
力、M氏应力明显增大。
3、髓臼发育程度与骨关节病的发生呈正相关，CE角减小导致骨关节病出现的
机率增大。
4、对于平均体重60kg患者，平均外展肌力为1 27.2 kg患者，单足直立位CE角
的代偿范围为一10。一20“。
Objective
To study and compare the stress distribution and changes of acetabular dysplasia which with different CE angle decrease by the method of finite element analasis (FEA). To analyse the relationship between stress chang of acetabular dysplasia and osteoarthritis(OA). To illuminate the mechanism of OA relating to acetabular dysplasia and the disorder's arising and development. To simulate CE angle of different degree acetabular dysplasia and to do the loading experiment on the FEA model. Then to discuss the compensative-ability scope of body according to CE angle. To analyze the pathogenesis mechanism of this type of OA,with which we can provide biomechanics guidance to the prevention and treatment of this kind of OA. Methods
Two abnormal hips and one normal hip of volunteers were obtained. Six total pelvic X-ray photographs were obtained by taking them in two different conditions which direct the volunteers stand strightly with double feet (DFS)or with single foot(SFS). After the images operated by the computer,we artificially divided these models into handreds of elements and nodes according to FEA principles. For example,in the condition of normal hip which with CE angle 35?, on DFS phrase, the model was divided into 899 elements(Es) including 1029 nodes(Ns). On SFS phrase , the model was divided into 896 Es including 1028 Ns. In the condition of abnormal hip which with CE angle 20 ?, on DFS phrase, the model was divided into 894 Es including 1024 Ns. On SFS phrase , the model was divided into 893 Es including 1026 Ns. In the condition of abnormal hip which with CE angle 2?, on DFS phrase, the model was divided into 882 Es including 1014 Ns. On SFS phrase , the model was divided into 886 Es including 1020 Ns. Then ,we used
the computer software(Super-sap93) to create six plain FEA models. The loading of body weight in normal condition was calculated. When loading on the models ,the condition of two kinds of postures was imitated such as on DFS phrase or on SFS phrase. The stress loading state and distrbution especially shear stress,compress stress and Von mises stress were calculated by the computer. Then,the relation between acetabular dysplasia and OA was gotten by analyzing. A probable compensative ability scope of CE angle was introductively provided by simulating CE angle decrease and giving the same loading on the models.
Results
On the DFS phrase,with the CE angle's decrease,the compress stress at Z axis significantly concentrated on the lateral-superior edge(p<0.01), at the same time, the draw stress on the inferior edge of capsule significantly increased compared with normal hip(p<0.01). On the SFS phrase,the compress stress and the shear stress on the lateral-superior edge of acetabular increased gradually. With CE angle's decreasing ,the draw stress of hip capsule increased gradually at Y axis. With the increase of stress, the change of phrase and the decrease of CE angle,the compress stress increasingly concentrated on the lateral-superior cartilage of the acetabulais Meanwhile ,the loading area on the head of femur moved inwardly and the stress concentrated on the interior-suprior part of the head. With valgus muscle's working,Von mises stress,shear stress and compress stress significantly increased(p<0.01). In simulating test ,when the CE angle was minorized to -10 ,the draw stress of valgus muscle of a 60kg-weight patient co
uld balance the dislocation stress at Y axis,moreover,a calculation was gotten that the compensative ability scope of this acetabular dysplasia patient was between CE angle-10 to CEangle20 according to the degree of acetabular dysplasia. Conclusion
1. On DFS phrase,with CE angle's decrease,vulgas muscle's begining to work,the compress stress increasingly concentrates on the lateral-suprior part of acetabular,the draw stress of capsule occurs and significantly increases.the loading area moves inwardty,the shear stress and Von mises stress increase significantly.
2. On SFS phrase ,with CE angle's decrease ,the bone and cartilage of acetabular get more
方法：临床选取典型的不同程度髋臼发育不良之髋关节作模板同时选取正常髋关节作模板，予以拍摄双足直立位全骨盆正位X线片，并摄单足站立位全骨盆正位片(双足直立平衡位要求：双足等肩宽，双门牙中缝处咬铅垂线通过耻骨联合；单足直立位要求：身体直立，双肩水平，对侧足抬起，膝间距10cm，骨瓮中立位，Tredelenberg征阴性，骨盆不出现向健侧或患侧倾斜。)，经图象处理后按有限元网格划分的原则，划分节点、单元。其中，CE角35°正常髋关节：双足直立位片：1029节点、899单元，单足站立位片：1028节点、896单元；CE角20°髋关节：双足直立位片：1024节点、894单元，单足站立位片：1026节点、893单元；CE角2°髋关节：双足直立位片：1014节点、882单元，单足站立位片：1020节点、886单元，运用Super—sap(93)有限元软件建立有限元模型，根据其双足平衡负重、单足直立负重之不同受力情况，按一定边界条件模拟加载于电脑模型上，计算出在人体正常典型关节行为中的负荷情况，得出所建立模型在该状态下各个节点、单元的应力情况，尤其髋臼及股骨头周围的剪切应力、压应力、M氏应力，探讨应力、应变、位移值的改变与其引发骨关节病的必然联系；进行模拟不同程度CE角缺损，初步探讨该缺损角度与人体代偿能力的相关性，初步提供一个以CE角为指标的人体髋关节的代偿能力的大概范围。
结果:在双足平衡负重状态下，在垂直轴上，随着CE角的减小，髓臼外上缘受
力显著增加，骸臼外上缘受压应力明显增加(p<0.01);单足站立位下，骸臼外上缘
受压应力明显增大同时剪切应力逐渐增大，随着CE角减小髓臼外上缘压力明显增
大，外上缘与内下缘关节囊处出现水平轴方向的拉应力;随着应力的增加、站立位
的变化、CE角的变化骸臼外缘软骨受力显著增加，内下缘关节囊由受轻微拉力力至
受较大拉应力;股骨头负重区由股骨头球心正上方移至内上方，髓臼负重区也发生
相应改变:随着CE角减小外展肌开始做功，导致髓臼与股骨头上缘M氏应力、剪
切应力和压应力均明显增加(p<0.01);进行模拟不同程度单足直立位CE角缺损，
当CE角为一10。时，对于体重60kg患者其外展肌肌力正好抵消局部产生的脱位应
力，由此得出对于该患者其代偿范围为单足直立位CE角在一10“一20”之间。
结论:
1、在双足直立平衡位下，随着CE角的减小，臼缘外上方骨质、软骨所受压应
力逐渐增加:关节囊受拉应力明显增加;股骨头负重区内移，剪切应力、M氏应力
值明显增加。
2、在单足直立位下，随着外展肌的介入和CE角减小，臼缘外上方骨质、软骨
受压应力明显增大;臼下缘关节囊受拉应力显著增大;股骨头受力区内移，剪切应
力、M氏应力明显增大。
3、髓臼发育程度与骨关节病的发生呈正相关，CE角减小导致骨关节病出现的
机率增大。
4、对于平均体重60kg患者，平均外展肌力为1 27.2 kg患者，单足直立位CE角
的代偿范围为一10。一20“。
Objective
To study and compare the stress distribution and changes of acetabular dysplasia which with different CE angle decrease by the method of finite element analasis (FEA). To analyse the relationship between stress chang of acetabular dysplasia and osteoarthritis(OA). To illuminate the mechanism of OA relating to acetabular dysplasia and the disorder's arising and development. To simulate CE angle of different degree acetabular dysplasia and to do the loading experiment on the FEA model. Then to discuss the compensative-ability scope of body according to CE angle. To analyze the pathogenesis mechanism of this type of OA,with which we can provide biomechanics guidance to the prevention and treatment of this kind of OA. Methods
Two abnormal hips and one normal hip of volunteers were obtained. Six total pelvic X-ray photographs were obtained by taking them in two different conditions which direct the volunteers stand strightly with double feet (DFS)or with single foot(SFS). After the images operated by the computer,we artificially divided these models into handreds of elements and nodes according to FEA principles. For example,in the condition of normal hip which with CE angle 35?, on DFS phrase, the model was divided into 899 elements(Es) including 1029 nodes(Ns). On SFS phrase , the model was divided into 896 Es including 1028 Ns. In the condition of abnormal hip which with CE angle 20 ?, on DFS phrase, the model was divided into 894 Es including 1024 Ns. On SFS phrase , the model was divided into 893 Es including 1026 Ns. In the condition of abnormal hip which with CE angle 2?, on DFS phrase, the model was divided into 882 Es including 1014 Ns. On SFS phrase , the model was divided into 886 Es including 1020 Ns. Then ,we used
the computer software(Super-sap93) to create six plain FEA models. The loading of body weight in normal condition was calculated. When loading on the models ,the condition of two kinds of postures was imitated such as on DFS phrase or on SFS phrase. The stress loading state and distrbution especially shear stress,compress stress and Von mises stress were calculated by the computer. Then,the relation between acetabular dysplasia and OA was gotten by analyzing. A probable compensative ability scope of CE angle was introductively provided by simulating CE angle decrease and giving the same loading on the models.
Results
On the DFS phrase,with the CE angle's decrease,the compress stress at Z axis significantly concentrated on the lateral-superior edge(p<0.01), at the same time, the draw stress on the inferior edge of capsule significantly increased compared with normal hip(p<0.01). On the SFS phrase,the compress stress and the shear stress on the lateral-superior edge of acetabular increased gradually. With CE angle's decreasing ,the draw stress of hip capsule increased gradually at Y axis. With the increase of stress, the change of phrase and the decrease of CE angle,the compress stress increasingly concentrated on the lateral-superior cartilage of the acetabulais Meanwhile ,the loading area on the head of femur moved inwardly and the stress concentrated on the interior-suprior part of the head. With valgus muscle's working,Von mises stress,shear stress and compress stress significantly increased(p<0.01). In simulating test ,when the CE angle was minorized to -10 ,the draw stress of valgus muscle of a 60kg-weight patient co
uld balance the dislocation stress at Y axis,moreover,a calculation was gotten that the compensative ability scope of this acetabular dysplasia patient was between CE angle-10 to CEangle20 according to the degree of acetabular dysplasia. Conclusion
1. On DFS phrase,with CE angle's decrease,vulgas muscle's begining to work,the compress stress increasingly concentrates on the lateral-suprior part of acetabular,the draw stress of capsule occurs and significantly increases.the loading area moves inwardty,the shear stress and Von mises stress increase significantly.
2. On SFS phrase ,with CE angle's decrease ,the bone and cartilage of acetabular get more
引文
1 赵钟岳，李世民，娄思权，等．关节外科学[M]．天津：天津科学技术出版社，2002，752-757．
2 毛宾尧．髋关节外科学[M]．北京：人民卫生出版社，1998，354-458．
3 刘红．有限元基本概念和原理[J]．北京：计算机世界日报．2001．
4 Manaster BF. Adult chronic hip pain [J], Radiographic, 2000,20(Special Issue):24-25.
5 M．南丁，V．H．傅兰谷著，过邦辅编译．临床骨科生物力学[M]．上海：上海远东出版社，1992．7-65．
6 王以进，王介鳞．骨科生物力学[M]．北京：人民军医出版社，1989．6-275．
7 孟和，顾志华．骨伤科生物力学[M]．北京：人民卫生出版社，1996，54-275．
8 裴可．成人髋臼发育不良Bernese经髋臼骨盆截骨术的两维有限元分析[J]．中国矫形外科杂志，2003，11(12)，844-846．
9 北京体院．人体肌肉生理横断面的研究[M]．北京：世界图书出版社，1960：97．
10 马和中．生物力学导论[M]．北京：北京航空学院出版．1986，167．
11 Murphy SB, Kijewski PK, Millis MB, Harkss A. Acetabular dysplasia in the adolescent and young adult[J]. Clin Orthop 1990;261:214-23.
12 伊藤铁夫．股关节外科学[M]．京都：金方堂，1976．303-304．
13 Bombell R.Osteoarthritis of the hip: classification and pathogenesis [M]. NewYorK: Springer-Verlog, 1983.36-39.
14 Wiberg G. A measuring method for distinguishing between a normal and a maldevelopmental acetabulum [J]. Acta Chir Scand 1939;83:28-38.
15 田军，毕万利，孟繁禄．成人髋臼发育不良性骨关节病的影像学表现[J]．中华放射学杂志，2003，37(2)：135—139．
16 陈统一．田川式旋转髋臼截骨术的临床治疗与疗效观察[J]．上海医学，2001，18(3)．5-11．
17 吕厚山主编．人工关节外科学[M]．北京：科学出版社，1998．125-127．
18 Lane NE,Lin P, Christiansen L, etal.Assosiation of mild acetabular dysplasia with an increased risk of incident hip osteoarthritis in elder white women:the study of osteoporotic fracture [J]. Arthritis Rheum,2000,43:400-404.
19 范广宇，朱悦．髋臼发育不良的光弹性生物力学研究[J]．中华实验外科杂志，2001，18(1)：35—36．
20 阿良，吉士俊，范慈方．有限元分析先天性髓臼发育不良半脱位及髋臼发育不良的应力变化[J]．中华小儿外科杂志，2000，21(6)：327—330．
21 吉士俊，马瑞雪，范慈方．髋臼发育不良的临床病理演变规律[J]．中华骨科杂志，2001，20(10)：609—611．
22 Murphy SB, Ganz R, Muller ME. The prognosis in untreated dysplasia of the hip. A study of radiographic factors that predict the outcome[J]. J Bone Joint Surg Am. 1995; 77:985-989.
23 郭磊，赵玉岩范广宇，等．髋臼发育不良的生物力学实验研究[J]．中国医科大学学报，2001，30(4)：277—278．
24 Tsumura H,Miura H,Wamoto YI.Three-dimensional distribution of the human hip finite element comparasion between normal hips and dysplastic hips [J].Fuduoka Acta Med, 1998,89(4): 109-118.
25 Genda E,Knishi N,Hasegwa Y, et al.A computer simulation study of normal and abnormal hip joint contact pressure [J]. Arch Orthop Trauma Surge, 1995,114(4):202-206.
26 George Hartofilakidis, Theofilos Karachalios, Konastantinos G Stamos. Epidemiology, demographics, and natural history of congenital hip disease in adults [J] Orthopedics. Thorofare: Aug 2000, 8(23): 823-828.
27 Masahiko Nozawa, Hisasi Kurosawa, Katsuo Shitoto,et al. Radiographic study of osteoarthritis of the hip joints treated conservatively for more than ten years [J] Journal of Orthopaedic Surgery. Hong Kong: Dec 1997, 2 (5): 1-9.
28 Perry GH. Spontaneous recovery of the joint space in degenerative hip disease [J]. Ann Rheum Dis 1972, 31:440-8.
29 Uno A, Hasegawa Y, Miura T. Natural history of advanced osteoarthritis of the hip [J]. Jpn Orthop Assoc 1993, 67:816-25.
30 Wada G, Kato T, Hasegawa A, et al. A study on developmental prospects in osteoarthritis of the hip [J]. Hip Joint 1976, 2:113-121.
31 Cooperman D, Wallenstein R, Stulberg S. Acetabular dysplasia in the adult [J]. Clin Orthop 1983,175:79.
32 Hotta Y, Matui K, Nakata D, Azuma H. A spontaneous healing in the course of osteoarthritis of the hip with special reference to osteophyte formation at the superolateral
acetabular rim [J]. Orthopaedic Surgery and Traumatology 1984, 17:483-492.
33 王居勇，范广宇，井上明生，等．髋关节骨关节病负重部位关节囊的组织病理学观察[J]．中华骨科杂志，2001，21(3)：167—171．
2 毛宾尧．髋关节外科学[M]．北京：人民卫生出版社，1998，354-458．
3 刘红．有限元基本概念和原理[J]．北京：计算机世界日报．2001．
4 Manaster BF. Adult chronic hip pain [J], Radiographic, 2000,20(Special Issue):24-25.
5 M．南丁，V．H．傅兰谷著，过邦辅编译．临床骨科生物力学[M]．上海：上海远东出版社，1992．7-65．
6 王以进，王介鳞．骨科生物力学[M]．北京：人民军医出版社，1989．6-275．
7 孟和，顾志华．骨伤科生物力学[M]．北京：人民卫生出版社，1996，54-275．
8 裴可．成人髋臼发育不良Bernese经髋臼骨盆截骨术的两维有限元分析[J]．中国矫形外科杂志，2003，11(12)，844-846．
9 北京体院．人体肌肉生理横断面的研究[M]．北京：世界图书出版社，1960：97．
10 马和中．生物力学导论[M]．北京：北京航空学院出版．1986，167．
11 Murphy SB, Kijewski PK, Millis MB, Harkss A. Acetabular dysplasia in the adolescent and young adult[J]. Clin Orthop 1990;261:214-23.
12 伊藤铁夫．股关节外科学[M]．京都：金方堂，1976．303-304．
13 Bombell R.Osteoarthritis of the hip: classification and pathogenesis [M]. NewYorK: Springer-Verlog, 1983.36-39.
14 Wiberg G. A measuring method for distinguishing between a normal and a maldevelopmental acetabulum [J]. Acta Chir Scand 1939;83:28-38.
15 田军，毕万利，孟繁禄．成人髋臼发育不良性骨关节病的影像学表现[J]．中华放射学杂志，2003，37(2)：135—139．
16 陈统一．田川式旋转髋臼截骨术的临床治疗与疗效观察[J]．上海医学，2001，18(3)．5-11．
17 吕厚山主编．人工关节外科学[M]．北京：科学出版社，1998．125-127．
18 Lane NE,Lin P, Christiansen L, etal.Assosiation of mild acetabular dysplasia with an increased risk of incident hip osteoarthritis in elder white women:the study of osteoporotic fracture [J]. Arthritis Rheum,2000,43:400-404.
19 范广宇，朱悦．髋臼发育不良的光弹性生物力学研究[J]．中华实验外科杂志，2001，18(1)：35—36．
20 阿良，吉士俊，范慈方．有限元分析先天性髓臼发育不良半脱位及髋臼发育不良的应力变化[J]．中华小儿外科杂志，2000，21(6)：327—330．
21 吉士俊，马瑞雪，范慈方．髋臼发育不良的临床病理演变规律[J]．中华骨科杂志，2001，20(10)：609—611．
22 Murphy SB, Ganz R, Muller ME. The prognosis in untreated dysplasia of the hip. A study of radiographic factors that predict the outcome[J]. J Bone Joint Surg Am. 1995; 77:985-989.
23 郭磊，赵玉岩范广宇，等．髋臼发育不良的生物力学实验研究[J]．中国医科大学学报，2001，30(4)：277—278．
24 Tsumura H,Miura H,Wamoto YI.Three-dimensional distribution of the human hip finite element comparasion between normal hips and dysplastic hips [J].Fuduoka Acta Med, 1998,89(4): 109-118.
25 Genda E,Knishi N,Hasegwa Y, et al.A computer simulation study of normal and abnormal hip joint contact pressure [J]. Arch Orthop Trauma Surge, 1995,114(4):202-206.
26 George Hartofilakidis, Theofilos Karachalios, Konastantinos G Stamos. Epidemiology, demographics, and natural history of congenital hip disease in adults [J] Orthopedics. Thorofare: Aug 2000, 8(23): 823-828.
27 Masahiko Nozawa, Hisasi Kurosawa, Katsuo Shitoto,et al. Radiographic study of osteoarthritis of the hip joints treated conservatively for more than ten years [J] Journal of Orthopaedic Surgery. Hong Kong: Dec 1997, 2 (5): 1-9.
28 Perry GH. Spontaneous recovery of the joint space in degenerative hip disease [J]. Ann Rheum Dis 1972, 31:440-8.
29 Uno A, Hasegawa Y, Miura T. Natural history of advanced osteoarthritis of the hip [J]. Jpn Orthop Assoc 1993, 67:816-25.
30 Wada G, Kato T, Hasegawa A, et al. A study on developmental prospects in osteoarthritis of the hip [J]. Hip Joint 1976, 2:113-121.
31 Cooperman D, Wallenstein R, Stulberg S. Acetabular dysplasia in the adult [J]. Clin Orthop 1983,175:79.
32 Hotta Y, Matui K, Nakata D, Azuma H. A spontaneous healing in the course of osteoarthritis of the hip with special reference to osteophyte formation at the superolateral
acetabular rim [J]. Orthopaedic Surgery and Traumatology 1984, 17:483-492.
33 王居勇，范广宇，井上明生，等．髋关节骨关节病负重部位关节囊的组织病理学观察[J]．中华骨科杂志，2001，21(3)：167—171．