发育性髋关节脱位患儿不同股骨颈前倾角对股骨生物力学的影响研究  

Effect of different femoral neck anteversion angles on femoral biomechanics in children with developmental dislocation of the hip

作　　者：李杰[1] 龙江涛[1] 王倩倩 席红卫[2] 程鑫葵 成毅 徐树明[3] Li Jie;Long Jiangtao;Wang Qianqian;Xi Hongwei;Cheng Xinkui;Cheng Yi;Xu ShuMing(Department of Orthopedics,Shanxi Children’s Hospital,Taiyuan 030013,China;Department of General Surgery,Shanxi Children’s Hospital,Taiyuan 030013,China;Department of Medical Imaging,Shanxi Children’s Hospital,Taiyuan 030013,China)

机构地区：[1]山西省儿童医院骨科,太原030013 [2]山西省儿童医院普外科,太原030013 [3]山西省儿童医院影像科,太原030013

出　　处：《临床小儿外科杂志》2023年第8期757-761,共5页Journal of Clinical Pediatric Surgery

基　　金：山西省卫生健康委科研基金(2021131);山西省教育厅科研基金(2022L198)

摘　　要：目的利用计算机仿真技术模拟发育性髋关节脱位(developmental dislocation of the hip,DDH)患儿不同股骨颈前倾角时股骨的应力分布,以明确DDH患儿股骨颈前倾角矫正的意义,并指导手术方案的制定。方法回顾性分析2021年6月在山西省儿童医院骨科住院治疗的1例右侧DDH患儿影像学资料。患儿女,6岁,提取正常侧(左侧)髋关节股骨扫描数据,通过三维CT扫描重建股骨三维模型,分别设计股骨颈前倾角35°、25°、15°时的力学仿真模型,通过有限元软件进行仿真计算,观察不同股骨颈前倾角度时股骨的生物力学分布。结果DDH患儿股骨三维模型上股骨颈前倾角为35°、25°、15°时股骨模型受到的最大应力分别为21.18 MPa、17.36 MPa、9.85 MPa。股骨颈前倾角为35°时,股骨干应力集中;股骨颈前倾角为25°时,股骨远端骨骺的应力降低25%;股骨颈前倾角为15°时,股骨应力主要集中在股骨头颈至股骨干上段。股骨颈前倾角为35°时,位移大于1 mm的区间是股骨头至股骨干中段;股骨颈前倾角为25°时,位移大于1 mm的区间是股骨头至股骨干中上端;股骨颈前倾角为15°时,位移大于1 mm的区间是股骨头至股骨颈。股骨颈前倾角为35°、25°、15°时其股骨远端骨骺的最大位移分别为0.0041 mm、0.0018 mm、0.0012 mm。结论股骨颈前倾角对DDH患儿的股骨力学有着重要影响。股骨的应力分布随着股骨颈前倾角改变而改变,股骨颈前倾角度增大,股骨干应力逐渐增加,在股骨干位置出现应力集中现象;股骨颈前倾角越大,应力传递在股骨干区域受到的遮挡效应越大,股骨远端骨骺在横断面的变形也增加。股骨颈前倾角为15°时股骨应力分布较为理想。Objective To apply computer simulation technology to simulate the stress distribution of femur in children with developmental dislocation of the hip(DDH)with different angles of femoral neck anteversion to find the significance of femoral neck anteversion correction in DDH children and guide the formulation of surgical plan.Methods A 6-year-old girl of right developmental hip dislocation was retrospectively analyzed in June 2021.The femoral scan data of left hip joint at normal side were extracted.A three-dimensional femoral model was reconstructed by 3D-CT scan.The mechanical simulation models of femoral neck anteversion at 35°,25°and 15°were designed respectively.The finite element software was utilized for simulation calculation to observe the biomechanical distribution of femur at different neck anteversion angles.Results At a femoral neck anteversion angle of 35°,25°and 15°,maximal stress of femoral model was 21.18 MPa,17.36 MPa and 9.847 MPa respectively.At a femoral neck anteversion angle of 35°,stress of femoral shaft was concentrated.At a femoral neck anteversion angle of 25°,stress of distal femoral epiphysis declined by 25%.At a femoral neck anteversion angle of 15°,femoral stress was concentrated in femoral head and neck to upper femoral shaft.At a femoral neck anteversion angle of 35°,a displacement>1 mm interval was from femoral head to middle of femoral shaft;at a femoral neck anteversion angle of 25°,the range of displacement>1 mm was from femoral head to middle/upper end of femoral shaft;at a femoral neck anteversion angle of 15°,the range of displacement>1 mm was from femoral head to femoral neck.At a femoral neck anteversion angle of 35°,25°and 15°,the maximal displacement of distal femoral epiphysis was 0.0041,0.0018 and 0.0012 mm respectively.Conclusion Femoral neck anteversion has an important impact on femoral mechanics in children with developmental hip dislocation.With the angles of femoral neck anteversion,stress distribution of femur changes.With a rising femoral neck ang

关 键 词：发育性髋关节发育不良 髋脱位 先天性 股骨颈 骨前倾 下肢 生物力学现象 儿童 

分 类 号：R726.8[医药卫生—儿科]