基于三维重建和有限元分析的股骨头坏死围塌陷期保髋新技术的临床应用  

Clinical application of a new technique based on three-dimensional reconstruction and finite element analysis for osteonecrosis of femoral head in peri-collapse stage

作　　者：庞智晖[1] 何伟[1] 

机构地区：[1]广州中医药大学第一附属医院全国中医髋关节病重点专科,510405

出　　处：《中华关节外科杂志（电子版）》2013年第3期15-18,共4页Chinese Journal of Joint Surgery(Electronic Edition)

基　　金：教育部高等学校博士学科点专项科研基金(20104425120012);广东省自然科学基金(S2011040005966);广东省科技计划(粤科规划字2011年106号);广东省科学技术厅-广东省中医药科学院联合科研专项(2012A032500005)

摘　　要：目的对围塌陷期股骨头坏死进行三维重建和有限元分析定量研究,为确定保髋手术指征和优化保髋方案提供依据。方法首先基于患者的CT和MRI资料,运用Mimics软件进行三维重建和坏死区的形态学定量研究;接着建立股骨头坏死个体化三维有限元模型,运用ABAQUS软件进行量化的有限元分析和保髋手术规划。结果实现了坏死区的形态、位置、体积、体积百分比、负重区投影面积和面积百分比的三维可视化,进而运用正蛙位和失稳分型定性判断疾病的预后和治疗方案;在此基础上,运用个体化三维有限元模型模拟改良髓芯减压、打压植骨、腓骨支撑、空心加压螺钉内稳定的手术操作,通过vonMisesStress冯米斯应力、SSR(stress/strengthratio)应力/强度比值和SED(strainenergydensity)应变能密度等指标确定保髋手术指征和优化保髋方案。结论三维重建和有限元分析进一步从坏死区形态和生物力学方面进行定量研究,完善了股骨头坏死围塌陷期"微观辨证论治体系"体系,有助于进一步明确保髋手术指征,优化保髋方案,提高保髋疗效。Objective To determine the hip joint preserving （HJP） surgical indications and provide the basis for optimization of HJP in peri-collapse-stage （PCS） osteonecrosis of the femoral head （ONFH） by conducting three-dimensional （3D） reconstruction and finite element analysis quantitative research. Methods The 3D reconstruction and quantitative study on the morphology of the necrotic area were carried out with MIMICS software based on CT and MRI information of the patient. An individualized 3D finite element model of ONFH was established to conduct quantitative finite element analysis and HJP surgery planning with ABAQUS software. Results 3D visualization of the necrotic region were achieved, including the shape, location, volume, volume percentage, projected area of weight-bearing and area percentage. The prognosis and therapentic plans for the disease were qualitatively evaluated according to the classification system of anterior-posterior/frog-leg-position radiography, and the classification system of unstable status within femoral head. Operations of modified core decompression, impacted bone grafting, supporting fibular implanting, and cannulated screws internal stability were simulated with the individualized 3D finite element model. Surgical indications and optimized programm of HJP were determined by means of the Von Mises stress, SSR （stress/strength ratio ） and SED （strain energy density） indicatrixes. Conclusions 3D reconstruction and finite element analysis can make further quantitative study on morphology and biomechanical of ONFH. The microcosmic syndrome differentiation and treatment system of 0NFH in PCS is consummated, which may facilitate further surgical indications clarifying, the operative plan optimizing and the success rate of HJP for 0NFH.

关 键 词：股骨头坏死 围塌陷期 成像 三维 有限元分析 保髋治疗 

分 类 号：R687.4[医药卫生—骨科学]