中国组织工程研究 ›› 2022, Vol. 26 ›› Issue (6): 843-847.doi: 10.12307/2022.163

• 数字化骨科 digital orthopedics • 上一篇    下一篇

髋臼假体在Lewinnek 安全区内应力分布的有限元分析

王海龙,李  龙,买合木提·亚库甫,陈洪涛,刘  旭,伊力哈木·托合提   

  1. 新疆医科大学第六附属医院运动损伤科,新疆维吾尔自治区乌鲁木齐市   830000
  • 收稿日期:2021-01-14 修回日期:2021-01-16 接受日期:2021-05-12 出版日期:2022-02-28 发布日期:2021-12-07
  • 通讯作者: 伊力哈木·托合提,博士,主任医师,副教授,新疆医科大学第六附属医院运动损伤科,新疆维吾尔自治区乌鲁木齐市 830000
  • 作者简介:王海龙,男,1988年生,甘肃省人,汉族,2014年新疆医科大学毕业,硕士,主治医师,主要从事骨科骨质疏松、骨折、关节及脊柱方面的研究。
  • 基金资助:
    新疆维吾尔自治区自然科学基金(2017D01C263),项目负责人:伊力哈木·托合提

Finite element analysis of stress distribution of acetabular prosthesis in the Lewinnek safety zone

Wang Hailong, Li Long, Maihemuti·Yakufu, Chen Hongtao, Liu Xu, Yilihamu·Tuoheti   

  1. Department of Sports Injury, Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi 830000, Xinjiang Uygur Autonomous Region, China
  • Received:2021-01-14 Revised:2021-01-16 Accepted:2021-05-12 Online:2022-02-28 Published:2021-12-07
  • Contact: Yilihamu·Tuoheti, MD, Chief physician, Associate professor, Department of Sports Injury, Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi 830000, Xinjiang Uygur Autonomous Region, China
  • About author:Wang Hailong, Master, Attending physician, Department of Sports Injury, Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi 830000, Xinjiang Uygur Autonomous Region, China
  • Supported by:
    the Natural Science Foundation of Xinjiang Uygur Autonomous Region, No. 2017D01C263 (to YT)

摘要:

文题释义:
Lewinnek 安全区:40 年前LEWINNEK等对300例初次和翻修全髋关节置换提出的髋臼假体放置的“安全区”概念,即将髋臼组件放置在 (15±10)°前倾角和(40±10)°外展角的“安全区”。术者可以借助局部解剖学标志、简单的设备或辅助技术手段来达到“安全区域”植入物放置,低脱位率与使用髋臼横韧带作为标志以及适当的髋臼杯定位相关。
应力:物体由于外因(受力、湿度、温度场变化等)而变形时,在物体内各部分之间产生相互作用的内力,以抵抗这种外因的作用,并试图使物体从变形后的位置恢复到变形前的位置。单位面积上的内力称为应力。同截面垂直的称为正应力或法向应力,同截面相切的称为剪应力或切应力。

背景:虽然Lewinnek等提出的髋臼假体放置的“安全区”概念 [外展角(40±10)°、前倾角(15±10)°]广泛应用于临床,但是髋臼假体在Lewinnek安全区内时对髋臼骨质和假体应力分布的影响缺乏生物力学研究。
目的:应用三维有限元法分析不同材料髋臼假体(陶瓷衬对陶瓷头,聚乙烯衬对金属头)在Lewinnek安全区内时对髋臼骨质和假体的应力分布特点。
方法:对1名健康成年男性志愿者进行CT扫描,建立骨盆有限元模型,采用不同材料组合的髋臼假体安放位置在Lewinnek安全区内(共18种不同安放位置)建立髋关节置换模型,施加390 N的力学加载观察髋臼周围骨质和假体应力分布情况。研究方案的实施符合《赫尔辛基宣言》和新疆医科大学第六附属医院对研究的相关伦理要求,参与者对试验过程完全知情同意。
结果与结论:利用有限元静态垂直施加用力情况下,髋臼假体安放位置在Lewinnek安全区内时,①不论陶瓷对陶瓷还是金属对聚乙烯材料情况下,在前倾角5°外展角50°时臼杯的应力峰值最小、应力区域最小,在相同前倾及外展角度下,臼杯的应力峰值变化不明显;②在股骨头和内衬应力变化中,金属对聚乙烯材料在股骨头和内衬的应力峰值、应力区域更小,且不受臼杯角度变化影响;③结果可见,在Lewinnek安全区内时,臼杯安装角度在前倾角5°外展角50°时联合金属对聚乙烯材料最理想,此方案臼杯、内衬、股骨头的应力峰值和应力区域最小,且股骨头及内衬的应力峰值和应力区域不受臼杯角度变化影响,并明显小于陶瓷对陶瓷的方案,可为临床提供参考。

https://orcid.org/0000-0002-7350-5566 (王海龙) 

中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程

关键词: Lewinnek安全区, 髋关节假体, 有限元分析, 股骨头, 内衬, 臼杯, 应力峰值, 应力区域, 陶瓷对陶瓷, 金属对聚乙烯

Abstract: BACKGROUND: Lewinnek et al. proposed a “safety zone” concept for acetabular cup position [Abduction angle (40±10)°, anteversion angle (15±10)°]. Although this concept has been widely accepted, it has been lack of further biomechanical study regarding influence of acetabular prosthesis on acetabular bone and prosthetic stress distribution in the safety zone.  
OBJECTIVE: To investigate the stress distribution of the acetabular bone and cup (ceramic on ceramic versus metal on polyethylene) with regard to the Lewinnek safety zone using the three-dimensional finite element analysis method.
METHODS:  One healthy volunteer received CT scan. The three-dimensional geometric model of the pelvis was established. Eighteen kinds of different cup position model of hip replacement were established with regard to the Lewinnek safety zone. The stress distribution along the acetabular bone and the different implant materials were studied by means of applying 390 N force. The protocol was performed in accordance with the Declaration of Helsinki and the relevant ethical requirements of Sixth Affiliated Hospital of Xinjiang Medical University.  
RESULTS AND CONCLUSION: By applying finite element static vertical force, within the Lewinnek zone: (1): if the cup was positioned in 5° anterversion, 50° abduction (whether it was ceramic on ceramic or metal on polyethylene), the peak stress and the stress zone of the cup were smallest. Under the same anterversion and abduction, the peak stress of the cup did not change significantly. (2) With regard to the stress distribution of the head and liner, the peak stress and the stress zone of the head and the liner were smallest in the metal on polyethylene group, in which the stress was not affected by the position of the cup. (3) The results indicated that within the Lewinnek safety zone, if the cup was positioned in 5° anterversion, 50° abduction, the metal on polyethylene group had the advantage of having the smallest peak stress and the stress zone of the cup, head and the liner. Moreover, the stress was not affected by the position of the cup, and was significantly smaller than the ceramic on ceramic scheme, which can provide clinical reference.

Key words: Lewinnek safety zone, acetabular implant, finite element analysis, femoral head, liner, acetabular cup, stress peak, stress region, ceramic on ceramic, metal on polyethylene

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