三维CT有限元评价Dega截骨术治疗小儿发育性髋脱位短期疗效  

Three-dimensional CT finite element evaluation of Dega pelvic osteotomy in the treatment of developmental dislocation of the hip in children

作　　者：高天阳 高月 李佳[2] 郑佳 潘诗农[1] GAO Tian-yang;GAO Yue;LI Jia;ZHENG Jia;PAN Shi-nong(Department of Radiology,Shengjing Hospital of China Medical University,Shenyang 110004,China;School of Mechanical Engineering and Automation,Northeastern University,Shenyang 110004,China;Department of Clinical Epidemiology,the Fourth Affiliated Hospital of China Medical University,Shenyang 110032,China)

机构地区：[1]中国医科大学附属盛京医院放射科,辽宁沈阳110004 [2]东北大学机械工程与自动化学院,辽宁沈阳110004 [3]中国医科大学附属第四医院临床流行病学教研室,辽宁沈阳110032

出　　处：《中国临床医学影像杂志》2021年第6期436-440,共5页Journal of China Clinic Medical Imaging

摘　　要：目的:建立不同载荷及站姿下Dega截骨手术前后CT有限元模型,以评估术前及术后髋臼及股骨头von Mises应力变化及分布情况,对手术疗效进行评价。方法:基于三维CT数据建立Dega截骨手术前后有限元模型,利用有限元模拟单腿站姿及双腿站姿,施加1-3倍体重载荷观察手术前后髋臼及股骨头von Mises应力变化及分布情况。分析手术前后患髋髋臼指数(AI)和中心边缘角(CEA)影像学参数变化情况,以及与髋臼及股骨头von Mises应力变化相关性。结果:Dega截骨术后患侧髋关节AI由术前36.53°±4.61°改善为28.76°±3.94°,CEA由术前21.67°±5.99°改善至35.93°±9.52°(P<0.01),AI减小及CEA增大,与髋臼和股骨头von Mises应力减小呈显著相关性。术后有限元结果表明术前髋臼顶部外侧缘及股骨头外侧柱高应力分布消失,髋臼内及股骨头von Mises应力较术前减低,且分布均匀。结论:Dega截骨术的术后疗效主要取决于患髋生物力学的改善,有限元分析极大程度上提供了手术前后髋臼和股骨头上的von Mises应力值和分布特征,为临床生物力学的诊断和治疗提供个性化指导及技术支持。Objective: To establish a CT finite element model before and after Dega osteotomy under different loads and standing positions to evaluate the changes and distribution of von Mises stress in the acetabulum and femoral head before and after the operation, and to evaluate the efficacy of the operation. Methods: Based on the three-dimensional CT data to establish the finite element model before and after the Dega osteotomy, the finite element was used to simulate the standing posture on one leg and the standing posture on two legs, and the load of 1 -3 times body weight was applied to observe the changes and distribution of von Mises stress in the acetabulum and femoral head before and after the operation. The changes in imaging parameters of the acetabular index(AI) and central marginal angle(CEA) before and after the operation were analyzed, as well as the correlation with changes in von Mises stress of the acetabulum and femoral head. Results: After Dega osteotomy, the AI of the affected hip joint improved from 36.53° ±4.61° to 28.76° ±3.94°, and the CEA was improved from21.67°±5.99° to 35.93°±9.52°(P<0.01), and AI decreased and CEA increased are significantly correlated with the decrease in von Mises stress of the acetabulum and femoral head. The finite element results showed that the high stress distribution on the lateral edge of the top of the acetabulum and the lateral column of the femoral head disappeared before the operation,and the von Mises stress in the acetabulum and the femoral head was lower than that before the operation, and the distribution was even. Conclusion: The postoperative curative effect of Dega osteotomy mainly depends on the improvement of the biomechanics of the affected hip. Finite element analysis greatly provides the von Mises stress value and distribution characteristics on the acetabulum and femoral head before and after the operation, which is the diagnosis of clinical biomechanics and treatment to provide personalized guidance and technical support.

关 键 词：髋脱位 截骨术 体层摄影术 X线计算机 

分 类 号：R681.6[医药卫生—骨科学] R814.42[医药卫生—外科学]