骨水泥填充与髓芯减压植骨改善坏死股骨头力学性能的实验研究  

Comparative study on bone cement filling and core decompression improve mechanical properties of the necrotic femoral head

作　　者：李思维 陈林林[1] 张皎玥 孙莉娜 谭跃龙 LI Siwei;CHEN Linlin;ZHANG Jiaoyue;SUN Lina;TAN Yuelong(Department of Orthopeadic,Ansteel Group General Hospital,Eighth Clinical College of China Medical University,Anshan 114002,China)

机构地区：[1]中国医科大学第八临床学院,鞍钢集团公司总医院骨科,辽宁鞍山114002

出　　处：《中国医科大学学报》2024年第11期994-998,共5页Journal of China Medical University

基　　金：环球医疗重点课题扶持基金(2022001)。

摘　　要：目的探讨坏死股骨头内部空间结构及力学性能改变,对比研究髓芯减压植骨和骨水泥填充对改善坏死股骨头力学性能及预防股骨头塌陷的作用。方法收集2020年6月至2022年1月于我院行髋关节置换患者切除的股骨头标本32例,分为TFF组(来源于股骨颈骨折患者的股骨头标本)、ONFH组(坏死股骨头)、CPI组(坏死股骨头注射骨水泥)和CDBG组(坏死股骨头模拟行髓芯减压植骨),每组8例。CPI组和CDBG组的植骨和骨水泥填充在X射线引导下进行。收集患者的性别、年龄等资料,所有样本进行MicroCT扫描和三维重建。计算并分析股骨头的微观结构参数。采用力学加载实验评价股骨头刚度及最大载荷的变化。结果TFF组股骨头内部各区域骨小梁排列规则有序;ONFH组股骨头内侧及外侧区域明显疏松化,坏死区骨小梁出现断裂,排列杂乱无序,硬化区骨小梁排列无序、增粗。股骨头坏死区的生物力学性能明显减弱,坏死区的刚度及最大载荷均明显下降。CPI组和CDBG组刚度及最大载荷均有所改善,而CPI组的生物力学性能改善更为明显。结论坏死股骨头内部空间结构发生明显改变,力学性能显著下降。骨水泥填充和植骨均可改善股骨头的生物力学性能,提高负荷能力。骨水泥填充可能是一种治疗股骨头坏死的实用方法。Objective To investigate the changes in the structural parameters and mechanical properties of the necrotic femoral head and compare the effects of core decompression and bone grafting with those of bone cement filling on the mechanical properties and prevention of articular surface collapse of the necrotic femoral head.Methods Thirty-two fresh human femoral heads were collected from patients who underwent total hip arthroplasty at our hospital between June 2020 and January 2022.The femoral heads were divided into four groups:8 femoral neck fractures(TFF group),8 osteonecrosis of the femoral head(ONFH group),8 osteonecrosis of the femoral head treated with cement percutaneous injection(CPI group),and 8 osteonecrosis of the femoral head treated with core decompression and bone graft(CDBG group).Cement filling or core decompression was performed under radiographic guidance.All samples were scanned and three-dimensionally reconstructed using micro-CT.The spatial heterogeneity of the femoral head was observed,and the bone morphometric parameters of each region of interest were calculated.Mechanical analysis was performed to evaluate the femoral head parameters of displacement and stress in vitro.Results Bone microarchitecture and morphometry in necrotic femoral heads were markedly altered.The biomechanical properties of the necrotic zone in the femoral head were markedly weakened.After the necrotic area was filled with bone cement,the biomechanical properties of the necrotic zone of the femoral head increased significantly.In addition,after core decompression and bone grafting in the necrotic area,the biomechanical properties increased significantly in the necrotic zone of the femoral head.Conclusion Bone cement filling or bone grafting in the necrotic area can change the biomechanical mechanism of the femoral head,improve the load-supporting ability,and prevent femoral head collapse.Cement filling may be a practical approach for the treatment of osteonecrosis of the femoral head that can be useful for practicing ort

关 键 词：股骨头坏死 骨水泥填充 力学分析 骨微观结构参数 

分 类 号：R684.7[医药卫生—骨科学]