髋关节内侧间隙比值和臀中肌状态对股骨头坏死塌陷影响的有限元分析  

Effects of hip joint medial space ratio and gluteus medius status on collapse in osteonecrosis of the femoral head:a finite element analysis-based biomechanical study

作　　者：陆舜 林天烨 何敏聪 林锟 田佳庆 何宪顺 魏腾飞 杨帆 何晓铭 魏秋实 LU Shun;LIN Tianye;HE Mincong;LIN Kun;TIAN Jiaqing;HE Xianshun;WEI Tengfei;YANG Fan;HE Xiao-ming;WEI Qiushi(The Third Clinical Medical College of Guangzhou University of Chinese Medicine,Guangzhou 510006,Guangdong,China;The Third Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510378,Guangdong,China)

机构地区：[1]广州中医药大学第三临床医学院,广东广州510006 [2]广州中医药大学第三附属医院,广东广州510378

出　　处：《中医正骨》2024年第11期1-9,共9页The Journal of Traditional Chinese Orthopedics and Traumatology

基　　金：国家自然科学基金项目(82274544,82004392);广东省基础与应用基础研究基金项目(2023A1515010551);毕节市科学技术局2022年度“揭榜挂帅”项目(毕科合重大专项〔2022〕1号);2021年广东省中医骨伤研究院开放课题重点项目(GYH202101-01,GYH202101-04)。

摘　　要：目的:探讨髋关节内侧间隙比值(the medial space ratio,MSR)和臀中肌状态对股骨头坏死(osteonecrosis of the femoral head,ONFH)塌陷的影响。方法:基于3名健康志愿者的髋部CT数据,建立7种不同MSR(14.35、16.35、18.35、20.35、22.35、24.35、26.35)的左侧ONFH有限元模型。基于其中1名健康志愿者的正常MSR的ONFH有限元模型,构建7种不同臀中肌状态的ONFH有限元模型(75%、80%、85%、90%、95%、100%、105%),其中100%臀中肌状态对应臀中肌肌力为700 N。所有模型均基于日本骨坏死调查委员会分型C1型建模,并将股骨头前侧保留角和外侧保留角均设置为70°,同时将坏死区体积定义为股骨头体积的30%。模拟双下肢静立状态下模型的受力情况,测定不同MSR的ONFH有限元模型的股骨头最大应力、坏死区最大应力及坏死区最大位移,测定不同臀中肌状态的ONFH有限元模型的股骨头最大应力、坏死区最大应力及股骨头向外侧位移。结果:①模型验证结果。本研究建立的ONFH有限元模型的主要负重区为股骨头前、外侧区域,应力集中现象出现在坏死区上方与受力区重叠部位,股骨头最大应力为(5.050±0.377)MPa,与既往研究报道的坏死股骨头应力传导特征基本一致。②不同MSR的ONFH有限元模型应力和位移测定结果。当MSR≤20.35时(即MSR为14.35、16.35、18.35、20.35),模型的股骨头最大应力、坏死区最大应力、坏死区最大位移的组间差异均无统计学意义。当MSR>20.35时(即MSR为22.35、24.35、26.35),模型的股骨头最大应力、坏死区最大应力、坏死区最大位移均高于MSR≤20.35的模型。③不同臀中肌状态的ONFH有限元模型应力和股骨头向外侧位移测定结果。在正常MSR的ONFH有限元模型中,随着臀中肌状态好转,股骨头最大应力、坏死区最大应力、股骨头向外侧位移随之不断减小。结论:MSR>20.35时,股骨头和坏死区应力明显增大,塌陷风险增高;良�Objective:To explore the effects of hip joint medial space ratio(MSR)and gluteus medius(GM)status on collapse in osteonecrosis of the femoral head(ONFH).Methods:Three healthy volunteers were selected,and the CT data of their hips were extracted,based on which the finite element models of left ONFH with different MSRs(14.35,16.35,18.35,20.35,22.35,24.35 and 26.35)were established.Furthermore,based on the finite element model of ONFH with a normal MSR in one of the healthy volunteers,the finite element models of ONFH with different GM statuses(75%,80%,85%,90%,95%,100%,and 105%)were built,among which the 100%GM status corresponded to a GM force of 700 N.The models were constructed according to the Japanese Investigation Committee(JIC)classification for ONFH(type C1),with the anterior and lateral preserved angles of the femoral head set to 70 degrees,and the volume of the necrotic zone defined as 30%of the total volume of the femoral head.The load-bearing situation of the model in the static standing state of lower limbs was simulated to measure the maximum stress of the femoral head,the maximum stress of the necrotic zone,and the maximum displacement of the necrotic zone of the ONFH finite element models with different MSRs,as well as the maximum stress of the femoral head,the maximum stress of the necrotic zone,and the lateral displacement of the femoral head of the ONFH finite element models with different GM statuses.Results:①The model verification results.The main load-bearing zones of the ONFH finite element models established in this study presented in the anterior and lateral regions of the femoral head.The stress concentrated in the overlapping area of the necrotic zone with the load-bearing zone,with the maximum stress as 5.050±0.377 MPa in the femoral head,which was basically consistent with the stress conduction characteristics of the necrotic femoral heads reported in previous studies.②The stress and displacement of ONFH finite element models with different MSRs.In the case of MSR≤20.35(i.e.,MSR w

关 键 词：股骨头坏死 髋关节内侧间隙比值 臀中肌 限定因素分析 生物力学现象 

分 类 号：R681.8[医药卫生—骨科学]