有限元壁厚分析法诊断股骨干骨折术后骨愈合程度的应用价值  

Application value of finite element wall thickness analysis in diagnosis of bone healing degree after operation of femoral shaft fractures

作　　者：李颖 童梁成 薛庆 杨智伟 闫浩 杨林 袁新平 LI Ying;TONG Liang-cheng;XUE Qing;YANG Zhi-wei;YAN Hao;YANG Lin;YUAN Xin-ping(Department of Orthopedics,the Air Force Hospital From Eastern of PLA,Nanjing,Jiangsu 210002,China;不详)

机构地区：[1]解放军东部战区空军医院骨科,江苏南京210002 [2]三的部落(上海)科技股份有限公司 [3]解放军东部战区空军医院医学影像科

出　　处：《中国骨与关节损伤杂志》2020年第6期569-572,共4页Chinese Journal of Bone and Joint Injury

基　　金：南京军区医学科技创新项目(15DX012);南京市科技计划项目(201503008)。

摘　　要：目的利用有限元壁厚分析法对股骨干骨折术后骨愈合不同阶段的CT数据进行三维模拟仿真计算,并通过不同时间段的抗压强度值变化趋势判断骨愈合情况,辅助诊断骨不愈合与骨延迟愈合。方法纳入自2014-01—2017-12行内固定手术治疗的54例股骨干骨折,术后9个月随访时影像学检查发现骨延迟愈合或骨不愈合征象。收集CT扫描数据,采用Mimics软件建立患侧股骨干、健侧股骨干及患侧去除内固定后的三维几何模型,进行有限元壁厚分析,以各模型最大壁厚峰值的比值进行拟合判断。结果54例均获得随访,随访时间2~5年。26例壁厚差值在10%以内,判定为骨愈合良好,可直接取出内固定物。20例壁厚差值在10%以上,继续随访观察,平均观察12个月后骨愈合良好,取出内固定物。4例壁厚差值在10%以上,进行植骨治疗,平均观察8个月后骨愈合良好。4例壁厚差值在10%以上,连续观察2次,累计8个月以上无明显骨增长趋势,判定为骨不愈合,结合其他临床指标确诊骨不愈合后行二次手术治疗,最终骨愈合良好。结论有限元壁厚分析法可以实现骨愈合程度的快速计算与准确判断,为股骨干骨折术后骨不愈合与骨延迟愈合提供一个相对客观的诊断依据。Objective To carry out the three-dimensional simulation calculation of the CT data from different stages of bone healing after operation of femoral shaft fractures through the finite element wall thickness analysis method,judge the bone healing situation by the changing trend of compressive strength value in different periods of time and assist the diagnosis of nonunion and delayed bone healing.Methods Fifty-four cases of femoral shaft fractures treated with internal fixation from January 2014 to December 2017,were included in the research,and signs of delayed bone union or nonunion were found by imaging examination at 9 months after operation.The CT scanning date were collected and the Mimics software was used to set up three dimensional geometric models of the affected side femoral diaphysis,the healthy side femoral diaphysis and the affected side after removal of internal fixation,and the finite element wall thickness analysis was performed and value comparison was carried out.Results All the 54 patients were followed up for 2-5 years.In 26 cases,the difference in wall thickness was within 10%,and it was determined that the bone was well healed,the internal fixator could be removed directly.In 20 cases,the difference in wall thickness was more than 10%.Follow-up observation was continued.After 12 months,the bones healed well and the internal fixation was removed.In 4 cases,the difference in wall thickness was more than 10%.Bone grafting was performed,and bone healing was observed after an average of 8 months.In 4 cases,the difference in wall thickness was more than 10%and was observed for 2 consecutive times.There was no obvious bone growth trend for more than 8 months,which was judged as bone nonunion.Combined with other clinical indicators,bone nonunion was diagnosed and received the second surgical treatment,and finally the union was recovered.Conclusion The finite element wall thickness analysis method can realize the rapid calculation and accurate judgment of the degree of bone healing,and provide a relat

关 键 词：股骨干骨折 内固定 骨不愈合 骨延迟愈合 有限元分析 壁厚分析 

分 类 号：R687.3[医药卫生—骨科学]