弧形髋臼截骨术对腰椎生物力学影响  

Biomechanical Effects of Curved Periacetabular Osteotomy on the lumbar Spine

作　　者：许世森 鲁宁[2] 许平[1] 李文金 XU Shisen;LU Ning;XU Ping;LI Wenjin(Faculty of Mechanical and Electrical Engineering,Kunming University of Science and Technology,Kunming 650504,China;Department of Orthopedics,the Second Affiliated Hospital of Kunming Medical University,Kunming 650101,China)

机构地区：[1]昆明理工大学机电工程学院,昆明650504 [2]昆明医科大学第二附属医院骨科,昆明650101

出　　处：《医用生物力学》2024年第5期916-922,共7页Journal of Medical Biomechanics

基　　金：昆明医科大学第二附属医院基金项目(2020yn1c008);云南省科技人才与平台计划项目(院士专家工作站)(202205AF150009)。

摘　　要：目的建立健康志愿者、髋关节发育不良(development dysplasia of the hip,DDH)患者手术前后股骨-骨盆-腰椎模型,研究弧形髋臼截骨术对腰椎生物力学影响。方法利用CT扫描获取4名DDH患者手术前后以及1名健康志愿者股骨-骨盆-腰椎DICOM数据,构建三维有限元模型。在Geomagic中采用偏移命令划分皮质骨与松质骨,在SolidWorks中添加腰椎软骨、骶髂关节、耻骨联合等软骨,在ANASYS中对模型进行有限元分析,步态为慢走中的单腿支撑中期相。分析对比DDH患者手术前后腰椎生物力学变化,将患者术后腰椎生物力学数据与健康志愿者进行对比。结果建立了4组患者和1组健康志愿者股骨-骨盆-腰椎模型,模型在各工况下结果均在所参考的文献范围内,证明模型有效。患者术后腰椎、股骨颈、纤维环与髓核所受应力远小于患者术前的状态,患者术后腰椎、股骨颈、纤维环与髓核所受应力与健康志愿者相近。结论弧形髋臼截骨术在治疗DDH后会显著降低腰椎、椎间盘所受应力,纤维环与髓核受力也更加均匀,说明弧形髋臼截骨术会将患者调整到健康状态。研究结果为临床治疗DDH提供了生物力学依据,有助于优化手术方案。Objective To establish preoperative and postoperative femoral-pelvic-lumbar spine models of patients with developmental dysplasia of the hip(DDH)and healthy volunteers and to study the biomechanical effects of curved periacetabular osteotomy on the lumbar spine.Methods Preoperative and postoperative femoral-pelviclumbar spine DICOM data from four patients with DDH and one healthy volunteer were acquired using CT scanning technology,and a three-dimensional finite element model was constructed.The offset method was used to divide the cortical and cancellous bones in Geomagic and the lumbar cartilage,sacroiliac joint,pubic symphysis,and other cartilages were added to SolidWorks.The model was analyzed using ANSYS for finite element analysis,and the gait was the mid-stage of single-leg support during slow walking.The biomechanical changes in the lumbar spine of patients with DDH before and after surgery were analyzed and compared,and the biomechanical data of the lumbar spine of patients after surgery were compared with those of healthy volunteers.Results The femoral-pelvic-lumbar spine models of four patients and a healthy volunteer were established.Theresults obtained by the established models under each working condition were within the range of the referencedliterature,and the validity of the models was proved.The postoperative stresses on the lumbar spine,femoralneck,annulus fibrosus,and nucleus pulposus were much smaller than those of the patients in the preoperativestate,and the postoperative stresses on the lumbar spine,femoral neck,annulus fibrosus,and nucleus pulposusof the patients were similar to those of healthy volunteers.Conclusions Curved periacetabular osteotomysignificantly reduced the stresses on the lumbar spine and intervertebral discs.Additionally,the stresses on theannulus fibrosus were more uniform after surgery,which indicated that curved periacetabular osteotomy will adjustpatients to a healthy state.This study provides a biomechanical basis for the clinical treatment of DDH and helpsoptimize

关 键 词：髋关节发育不良 弧形髋臼截骨术 股骨-骨盆-腰椎模型 有限元方法 

分 类 号：R318.01[医药卫生—生物医学工程]