Can hip abduction reduce the risk of femoral head necrosis deteriorated into osteoarthritis?A 3D finite element analysis  

作　　者：Guang-Quan Zhou Hong-Lai Zhang 

机构地区：[1]The First Affiliated Hospital,Guangzhou University of Chinese Medicine,Guangzhou,China [2]School of Medical Information Engineering,Guangzhou University of Chinese Medicine,Guangzhou,China

出　　处：《Traditional Medicine Research》2018年第5期230-236,共7页TMR传统医学研究

基　　金：The authors received grants from Natural Science Foundation of Guangdong Province(2014A030310214),Science and Technology Project of Guangdong Province(2014A020221041),and the Medical Science and Technology Foundation of Guangdong Province(A2015039).

摘　　要：The purpose of this study was to investigate biomechanical behavior changes of femoral head necrosis(FHN)by increasing lower extremity abduction(LEA)angle,offering scientific basis on choosing the LEA procedure for the exact classifications.Methods:Thirty computational models were constructed and used to simulate six different abducent angles with five different progresses of FHN.The initial model was validated by the bony density distribution in X-rays images and the photograph of the cadaver bone in cross-section.The stress transfer path(STP)of each model was analyzed and the contact stresses were assessed.Results:During the midstance phase,STP of type A showed strong similarities with the healthy level;STP distribution was from the top of the femoral head to the calcar;the damage area of STP of type B was approximately 25%of the healthy.While STPs in both type C1 and C2 were broken off.As the increase of the abduction angle,STP of type B transformed into type A,STP of type C1 transformed into type B.STP of type C2 transformed into type C1.There was no significant difference in contact stress between the four settings of FHN and normal femoral head.Conclusions:We found computational biomechanical technique to be a sensitive and useful method for distinguishing the biomechanical difference of FHN during abduction gait.These results showed that LEA motion could effectively reduce collapse risk and interrupt the disease pathway of FHN deteriorated into osteoarthritis.Furthermore,our findings indicated that the LEA procedure was suitable for type A,B and C1,while type C2 of FHN involved surgical intervention might get a better clinical outcome.目的:本研究的目的是调查外展角增大时坏死股骨头的生物力学响应,为下肢外展治疗股骨头坏死适应症的选择提供科学依据。方法:本研究根据日本调查委员会分型标准建立30个计算生物力学模型用于模拟5种坏死股骨头在六种外展角下的生物力学响应。收集应力传导路径和接触应力并以此来分析和评估不同外展角下坏死股骨头的生物力学差异。结果:在步态中期,A型坏死的应力传导路径的分布与正常股骨头的非常相似,应力传导路径从股骨头顶部伸向股骨矩。与正常的相比,B型坏死的应力传导路径分布面积损失约25%,而C1型坏死和C2型坏死的应力传导路径完全中断。随着外展角的增加,B型坏死转化成A型坏死,C1型坏死转化为B型坏死,C2型坏死转化为C1型坏死。接触应力在所有场景下都无明显的差异。结论:本研究发现计算生物力学分析工具是一种分辨外展步态周期下坏死股骨头生物力学差异的灵敏而有效的方法。下肢外展可有效降低坏死股骨头塌陷的风险和中断坏死股骨头恶化为骨性关节炎的疾病路径。而且,下肢外展治疗方法尤其适合A、B和C1型坏死股骨头,而C2型坏死股骨头手术治疗可能会获得更好的临床结果。

关 键 词：Lower extremity abduction Contact stress Femoral head necrosis Stress transfer path OSTEOARTHRITIS Computational biomechanics 

分 类 号：R[医药卫生]