股骨头坏死骨吸收区对股骨头内应力分布及疾病进展的影响  

Effects of bone-resorptive lesion on stress distribution of the femoral head and on progression in patients with osteonecrosis of the femoral head

作　　者：刘光波 梅玉倩 马海洋[1] 卢强[1] 孟昊业[1] 全琦[1] 张宇轩 赵军[1] 李获 汪爱媛[1] 辛海莉[3] 陈端端 卢世璧[1] 彭江[1] Liu Guangbo;Mei Yuqian;Ma Haiyang;Lu Qiang;Meng Haoye;Quan Qi;Zhang Yuxuan;Zhao Jun;Li Huo;Wang Aiyuan;Xin Haili;Chen Duanduan;Lu Shibi;Peng Jiang(Department of Orthopaedics,the First Medical Center,Chinese PLA General Hospital,Beijing 100853,China;School of Life Science,Beijing Institute of Technology,Beijing 100081,China;Department of Pharmacy,Medical Security Center,Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院第一医学中心骨科,北京100853 [2]北京理工大学生命学院,100081 [3]解放军总医院医疗保障中心药剂科,北京100853

出　　处：《中华骨科杂志》2020年第7期408-416,共9页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金(81972047,81603008,81572148)。

摘　　要：目的探讨股骨头坏死骨吸收区对股骨头内应力分布及疾病进展的影响。方法回顾性分析2014年4月至2018年9月诊断为ARCOⅡ、Ⅲ期股骨头坏死的患者94例(155髋),男77例,女17例;年龄(39.90±10.45)岁(范围18~64岁)。依据是否含骨吸收区将患髋分为有骨吸收区组和无骨吸收区组,比较两组ARCO分期的差异。在无骨吸收区组选取1例ARCOⅡ期髋关节,模拟5、7、10、14、18、23 mm六个不同直径大小的球形骨吸收区,通过有限元方法模拟人在慢速行走时的髋关节负重,观察分析股骨头不含骨吸收区以及含不同直径大小骨吸收区时坏死区最大应力、平均应力和骨吸收区周围1 mm区域内的最大应力值。结果有骨吸收区组67髋,其中ARCOⅡ期17髋、ARCOⅢ期50髋;无骨吸收区组88髋,其中ARCOⅡ期58髋、ARCOⅢ期30髋。有骨吸收区组ARCOⅢ期比例(74.6%,50/67)明显高于无骨吸收区组(34.1%,30/88),差异有统计学意义(χ^2=25.03,P=0.000)。有限元应力云图显示在骨吸收区的上方存在应力集中区;有骨吸收区组的骨吸收区周围1 mm区域内最大von Mises应力为(6.94±1.78)MPa,高于无骨吸收区组的(5.01±0.35)MPa,差异有统计学意义(t=3.139,P=0.026)。线性回归分析显示股骨头内坏死区的最大应力、平均应力以及骨吸收区周围1 mm区域内最大应力值与骨吸收区直径呈线性正相关。结论骨吸收区可增加坏死区的最大应力和平均应力,骨吸收区越大应力增加越明显;骨吸收区周围可产生应力集中区,加速股骨头塌陷。Objective To investigate effects of bone-resorptive lesion on stress distribution of femoral head and on progression in patients with osteonecrosis of the femoral head(ONFH).Methods From April 2014 to September 2018,a total of 155 femoral heads from 94 patients diagnosed with ARCO stage II and III ONFH were retrospectively reviewed,including 77 males and 17 females with aged 39.90±10.45 years old(ranged from 18-64 years).The hips were divided into two groups according to whether there were bone-resorptive lesions.Further,we compared whether there was statistical difference between the two groups in staging.Then,a case of ARCO II hip joint without bone-resorptive lesion was selected from the included patients.Six femoral head with different diameters of spherical bone-resorptive lesion of 5 mm,7 mm,10 mm,14 mm,18 mm,and 23 mm were simulated.The influence of bone-resorptive lesion on the stress distribution of necrotic area and a spherical shell extending 1 mm radially around the bone-resorptive lesion was investigated by finite element method in slow walking conditions.Results Of the 155 ONFH hips,67 hips are complicated by bone-resorptive lesions,of which 17 were ARCO II,50 were ARCO III.A total of 88 hips did not contain bone-resorptive lesions,of which 58 were ARCO II,ARCO III 30 cases.The proportion of ARCO stage II in the group with bone-resorptive lesions was significantly higher than that in the group without bone-resorptive lesions(χ^2=25.03,P=0.000).The finite element stress distribution cloud diagram showed that there was a stress concentration area around the bone-resorptive lesions.The maximum von Mises stress around bone-resorptive lesions in the models that contained a synthetic bone-resorptive lesions were significantly higher than those reported in the matched,non-synthetic bone-resorptive lesions finite element models(t=3.139,P=0.026).The values for maximum von Mises stress around bone-resorptive lesions were 6.94±1.78 MPa and 5.01±0.35 MPa for the group with synthetic bone-resorptive lesions

关 键 词：股骨头坏死 骨质吸收 有限元分析 

分 类 号：R6[医药卫生—外科学]