四维有限元骨承载力分析技术在判断长管骨愈合程度中的应用  

Application of four-dimensional finite element bone bearing capacity analysis in estimating the degree of long tube bone healing

作　　者：李颖 童梁成[1] 杨智伟 蒋继亮 汪剑龄 杨俊生 邢建新 Li Ying;Tong Liangcheng;Yang Zhiwei;Jiang Jiliang;Wang Jianling;Yang Junsheng;Xing Jianxin(Department of Orthopedics,Eastern Air Force Hospital of PLA,Nanjing 21002,China;AnhuiMedicalUniversity,Hefei230032,China;Departmentof Orthopedics,YuhuaHospital,Nanjing21002,China)

机构地区：[1]解放军东部战区空军医院骨科,南京210002 [2]安徽医科大学,合肥230032 [3]南京市雨花医院,南京210002

出　　处：《中华老年骨科与康复电子杂志》2020年第6期312-320,共9页Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition)

基　　金：南京军区医学科技创新项目(NO.15DX012);南京市医学科技发展项目(NO.201503008)。

摘　　要：目的利用四维有限元骨承载力分析的方法,对于长管骨骨折术后患者采用双腿平行CT扫描、双腿几何建模、有限元分析的方法,通过与健侧肢体相同部位的对比分析,根据时间轴上的变化趋势,判断目标骨段骨愈合的程度,辅助诊断长管骨的骨愈合、骨延迟愈合和骨不连。方法选择2014年到2017年间,临床诊断骨延迟愈合的26例病例进行了系统随访。在骨愈合不同阶段的CT数据进行三维建模,材料赋值,建立下肢长管骨的三维有限元模型,模拟仿真计算目标骨段承载受力状况,通过有限元分析软件,进行单轴压缩实验的仿真,分析双腿目标骨段的受载荷情况。结合米塞斯应力最大值及载力-位移曲线下总面积进行比值分析,作为观察骨愈合程度的指标,对于临床诊断进行二次修正,并观察最终临床愈合结果。结果所有病例均获得2~4年的随访,平均随访时间3.4年。临床诊断骨延迟愈合完整病例26例,对26例病例采用有限元骨承载力分析法共分析54次,修正诊断为:6例(23.1%)病例判定骨愈合;16例(61.5%)病例判定骨愈合不良;4例(15.4%)病例判定骨不连。利用米塞斯应力最大值及载力-位移曲线下总面积进行比值分析,并进行卡方检验,差异无统计学意义。通过Fisher精确概率检验法得到P=0.170,具有统计学意义,两种方法存在非随机相关性。结论采用有限元骨承载力分析的技术,可以三维定量分析骨折端的骨愈合程度,结合时间轴上变化规律的描述,可以给骨不连和骨延迟愈合的临床诊断提供一个相对客观的诊断依据。该方法也较好的观察到,高能量损伤的骨愈合过程难以按照经典骨愈合理论的进程演变,通常其骨愈合所需的时间更长,但能显示出其缓慢的愈合趋势,应用前景广阔。Objective Using the method of four-dimensional finite element analysis of bone bearing capacity,using the methods of parallel CT scanning of both legs,geometric modeling of both legs and finite element analysis for postoperative patients with long bone fracture,through the comparative analysis of the same part of the healthy limb,and according to the changing trend on the time axis,to judge the degree of bone healing of the target bone segment,and to assist in the diagnosis of bone healing,delayed union and nonunion of long bone.Methods From 2014 to 2017,26 cases of clinically diagnosed femoral bone healing were systematically followed up.The CT data were used for three-dimensional modeling and material assignment,and the three-dimensional finite element model of the long bone of the lower limb was established,and the bearing force of the target bone segment was simulated and calculated.Through the finite element analysis software,the uniaxial compression experiment was carried out to analyze the load of the target bone segment of both legs.Combined with the maximum value of Mises stress and the total area under the stress-strain curve,the ratio analysis was used as an index to observe the degree of bone healing,the clinical diagnosis was modified twice,and the final clinical healing results were observed.Results All patients were followed for 2 to 4 years,with an average follow-up time of 3.4 years.There were 26 cases clinically diagnosed with delayed bone union and complete bone union.The finite element bone bearing capacity analysis was used to analyze the 26 cases for a total of 54 times.The revised diagnosis was:6 cases(23.1%)were bone union.Poor bone union was determined in 16 cases(61.5%).Bone nonunion was determined in 4 cases(15.4%).The ratio analysis was performed using the mises maximum stress and the total area under the stress-strain curve,and the chi-square test was performed(P>0.05),showing no statistical difference.Fisher’s exact probability test(P=0.170)showed statistical significance,and there

关 键 词：骨生物力学 有限元分析 骨愈合 骨承载力分析 

分 类 号：R687.3[医药卫生—骨科学]