【作者】 李峰；

【导师】 吴华；

【作者基本信息】 华中科技大学 ， 外科学， 2009， 博士

【摘要】 第一部分：股骨颈保留型人工髋关节置换的临床应用第一节股骨颈保留型人工髋关节置换治疗髋部疾病目的：评价股骨颈保留型人工髋关节在髋关节置换中的临床效果。方法以2003年3月份至2008年4月同济医院收治的42例病人共52髋行股骨颈保留型人工髋关节置换，其中男性27例，女性15例，年龄17--65岁，平均41岁。双侧10例，单侧32例。观察手术时间，术中出血量，手术后住院天数，Harris评分及围手术期并发症。结果全部病例随访12-61个月，平均39个月。手术时间30-70min，平均45分钟。术中出血70-200ml，平均110 ml。术后第5天扶助行器下地活动。本组患者无一例发生伤口感染，术后脱位，下肢深静脉血栓及大腿痛，异位骨化等并发症。术后3个月Harris评分90—97分37例、81—89分5例，平均(93．2±4．1)分。结论股骨颈保留型人工髋关节置换具有创伤小，出血少，符合人体生物力学，假体稳定、假体磨损小的特点，可以成为传统股骨柄的替代方向。第二节保留股骨颈人工髋关节置换治疗头下型股骨颈骨折目的评价股骨颈保留型人工髋关节置换治疗头下型股骨颈骨折的临床效果。方法选择华中科技大学附属同济医院骨科头下型股骨颈骨折患者12例，男8例，女4例，年龄45～65岁，均为单侧。根据Garden分型标准：GardenⅢ型4例，Ⅳ型8例，置换前Harris评分为差11例、可1例。全部患者均在入院后1周内施行股骨颈保留型人工髋关节置换治疗，记录置换时间，置换过程中出血量，Harris评分及围手术期并发症，置换后摄标准髋关节正侧位X射线平片，并测量髋臼外展角和前倾角。结果12例患者均获得随访，平均37个月。置换时间30～65 min，平均46．5 min；置换过程中出血量80～200 mL，平均120 mL。置换后X射线平片测量髋臼外展角40°～55°，平均48．3°；前倾角16°～23°，平均19．4°。全部患者置换后关节功能恢复情况良好，未发生伤口感染，置换后脱位，下肢深静脉血栓及大腿痛，异位骨化等并发症。置换后3个月Harris评分为优(90～97分)11例，良(81～89分)1例，平均(93.3±3．2)分。结论股骨颈保留型人工髋关节置换符合人体生物力学，具有假体稳定、假体磨损小的特点，为头下型股骨颈骨折患者的治疗提供了一个新途径。第二部分基于DICOM数据构建股骨三维有限元物理模型及其生物力学意义目的：利用有限元方法研究人体股骨在载荷下的受力状态，探索一种快速建立股骨有限元模型并能进行较为精确的力学分析的方法。方法：选择标准成年男性志愿者行股骨CT扫描成像，得到股骨每层横截面图像，应用DICOM数据和MIMICS软件行三维重建，结合有限元分析软件ABQUS 6．8构建股骨三维有限元模型，并分析了股骨模型受载荷状态下的应力分布。结果：基于DICOM数据建立的股骨三维有限元模型，划分网格后形成38636个节点，201422个单元，其中包括股骨松质骨体网格模型和皮质骨体网格模型。有限元分析结果与以往的实验数据一致性较好，能够客观反映股骨真实解剖形态及生物力学行为，分析精度较高。结论：本研究运用Mimics软件提供了简单有效的建模方法，极大程度提高了建模效率，基于DICOM数据的三维有限元模型几何形状较准确，可以为股骨正常力学行为研究提供精确模型。利用ABQUS 6．8分析得到的应力分布情况跟临床观察一致。第三部分股骨颈保留型髋关节置换生物力学特点的有限元研究目的：探讨股骨颈保留型髋关节置换术后股骨侧应力分布情况，为临床改良人工髋关节置换术手术方案提供生物力学依据。方法：采用64排螺旋CT扫描得到患者股骨颈保留型髋关节置换术后股骨数据，重建股骨颈保留型髋关节置换术后有限元分析模型，对该模型进行载荷和仿真计算。分析股骨颈保留型髋关节置换术后股骨侧的应力分布。结果：股骨颈保留型髋关节置换术后股骨总体的应力模式无改变，股骨假体覆盖区无明显应力遮挡。保留股骨颈髋关节较正常股骨1区应力值增大，而4区，8区应力值减少。结论：股骨颈保留型髋关节置换术后股骨总体的应力模式无改变，假体近端无明显应力遮挡，说明这种短柄，近端固定型假体生物力学上的表现是优异的。同时假体颈部可以在材料及结构上做进一步的改进。更多还原

【Abstract】 PartⅠ: Clinical application of femoral neck preservation in total hip replacement.Paper 1 The treatment of hip disease with femoral neck preservation in total hipreplacementObjective:To evaluate the clinical results of CFP prosthesis in total hip replacement..Methods:From march 2003 to april 2008 52 hip of 42 patients underwent total hip arthroplastywith preservation of femoral neck. The study group included 27 males and 15 females with anaverage age of 41 years from 17 to 65 years.10 patients underwent bilateral THA and 32patients one side. Operation time ,blood loss, average postoperative hospitalization ,Harris hipscore and operation related complications were analyzed.Results:The patients were followed up from 12 to 61 months with an average of 39 months.Theoperation time was 30-70 mins with an average of 45 mins. The blood loss was 70-200mlwith an average of 110ml. All the patients were ambulatory 5 days after surgery with the helpof a walker.None of infection ,dislocation,deep venous thrombosis,thigh pain and heterotopicossification happened. Harris hip score are 88-97 points with an average age of 93.2 points 3months after surgery.Conclusion:Total hip arthroplasty with preservation of femoral neck has the advantages of minimalinvasion,less blood loss, good biodynamic harmony ,excellent stability of the prosthetic hip,and less prosthesis wear. It can replace traditional total hip arthroplasty as a new option. Paper 2 Total hip replacement with femoral neck preservation for the treatment ofsub-capitated femoral neck fractureObjective:To evaluate the clinical results of CFP prosthesis in the treatment of sub-capitatedfemoral neck fracture.Methods:From march 2003 to may 2008, 12 hip of 12 patients underwent total hip arthroplastywith preservation of femoral neck. The study group included 8 males and 4 females with anaverage age of 50.4 years from 45 to 65 years.All patients underwent one side THA.Operation time ,blood loss, average postoperative hospitalization ,Harris hip score andoperation related complications were analyzed.Results:The patients were followed up from 29 to 50months with an average of 37 months.Theoperation time was 35-65 mins with an average of 46.5 min mins. The blood loss was 80-200mL with an average of 120 mL. All the patients were ambulatory 5 days after surgery with thehelp of a walker.None of infection ,dislocation,deep venous thrombosis,thigh pain andheterotopic ossification happened. Harris hip score are 86-97 points with an average age of93.3 points 3 months after surgery.Conclusion:Total hip arthroplasty with preservation of femoral neck has the advantages of goodbiodynamic harmony, excellent stability of the prosthetic hip, and less prosthesis wear.Itprolong the waiting time and provide good bone condition for the hip revision. It will be anew option for the treatment of sub-capitated femoral neck fracture. PartⅡ: Construction of Three-dimensional Finite Element Model ofFemur Based on DICOM Data and its biomechanical significanceObjective:To introduce a way of quick and precise construction of the three-dimensional finiteelement femur model and provide a new method for the construction of femur model.Methods:Normal male human femur was used as specimen for CT scan to obtain configuration,three-dimensional finite element model of the femur was obtained using MIMICS andABQUS 6.8 software.Results:Based on DICOM data, the three-dimensional finite element model of femur wasconstructed more quickly and precisely. The models were divided into 38636 nodes, 201422units. The model include the parts of coetical and cancellous bone. The biomechanical testresults accords with the previous results,so the model objectively reflected the real femurarthroplasty shape and biomechanical behavior.Conclusion:The research provides a more simple and precise method forthe construction of femur model and improve the efficiency based on Dicom standard andMimics software. The model was accurate and can be used for the reaseach on biomechanicalbehavior of femur. PartⅢThe FEA research of CFP Prosthesis in total hip replacementObjective:To analyze the stress distribution on the femur after the hip arthroplasty with CFPprosthesis and provide biomechanical evidence for the improvement of femoral neckpreservation anhroplasty.Methods:The patients with the preservation of femoral neck in total hip replacement was used forCT scan to obtain configuration data to construct the three-dimensional finite elementmodel.The model was simulated under the load of body weight,and me stress distribution onthe femoral part was calculated.Results:The stress mode of the femoral part did not change in total hip replacement with collumfemoris reserved. There was no stress shielding around the femur prosthesis. The stress of 1zone increases and the stress of 4 and 8 zone decrease in total hip replacement with collumfemoris reserved.Conclusion:The stress mode of the femoral part did not change in total hip replacement with collumfemoris reserved. There was no stress shielding at the proximal part of the femurprosthesis. Illustrate this brachypus, proximal fixed prosthesis is excellent on thebiomechanical performance.更多还原