中国组织工程研究

中国组织工程研究 ›› 2024, Vol. 28 ›› Issue (33): 5265-5269.doi: 10.12307/2024.661

• 骨与关节生物力学 bone and joint biomechanics • 上一篇    下一篇

步行运动下缺血性坏死股骨头力学性能及塌陷风险预测

高永昌1，3，付彦涛1，赵  昕1，崔庆峰1，张志峰2，陈世斌1   

  1. 1长安大学工程机械学院，公路养护装备国家工程实验室，陕西省西安市   710064；2内蒙古医科大学第二附属医院关节外科，内蒙古自治区呼和浩特市   010030；3大博医疗科技有限公司，福建省厦门市   361000
  • 收稿日期:2023-08-28 接受日期:2023-10-28 出版日期:2024-11-28 发布日期:2024-01-30
  • 通讯作者: 张志峰，博士，主任医师，内蒙古医科大学第二附属医院关节外科，内蒙古自治区呼和浩特市 010030 陈世斌，博士，教授，博士生导师，长安大学工程机械学院，公路养护装备国家工程实验室，陕西省西安市 710064
  • 作者简介:高永昌，2016年西安交通大学毕业，博士，讲师，硕士生导师，主要从事生物力学和生物摩擦学方面的研究。

Mechanical performance and collapse risk prediction of avascular necrosis of femoral head under walking movement

Gao Yongchang1, 3, Fu Yantao1, Zhao Xin1, Cui Qingfeng1, Zhang Zhifeng2, Chen Shibin1   

  1. 1National Engineering Laboratory for Highway Maintenance Equipment, School of Engineering Machinery, Chang’an University, Xi’an 710064, Shaanxi Province, China; 2Department of Joint Surgery, The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010030, Inner Mongolia Autonomous Region, China; 3Dabo Medical Technology Co., Ltd., Xiamen 361000, Fujian Province, China
  • Received:2023-08-28 Accepted:2023-10-28 Online:2024-11-28 Published:2024-01-30
  • Contact: Zhang Zhifeng, MD, Chief physician, Department of Joint Surgery, The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010030, Inner Mongolia Autonomous Region, China Chen Shibin, MD, Professor, Doctoral supervisor, National Engineering Laboratory for Highway Maintenance Equipment, School of Engineering Machinery, Chang’an University, Xi’an 710064, Shaanxi Province, China
  • About author:Gao Yongchang, MD, Lecturer, Master’s supervisor, National Engineering Laboratory for Highway Maintenance Equipment, School of Engineering Machinery, Chang’an University, Xi’an 710064, Shaanxi Province, China; Dabo Medical Technology Co., Ltd., Xiamen 361000, Fujian Province, China

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摘要：


文题释义：

缺血性股骨头坏死：是由于输送血液到股骨头的血管遭受一些原因无法供血，导致股骨头的血液供应减少或中断进而骨头细胞死亡的疾病。继而可能会出现股骨头结构发生变化、坏死部位塌陷等问题，导致髋关节功能紊乱，活动范围受限，患者疼痛难忍。
步行运动：此文中步行运动指一个ISO标准步行完整周期，在行走时一侧足跟着地到该侧足跟再次着地的过程被称为一个步行周期，一个完整的步态周期通常包括站立阶段和摆动阶段两部分。


背景：股骨头缺血性坏死这一难治性骨科疾病严重影响患者的正常生活，受限于假体寿命与翻修的问题，临床建议年轻患者采取保髋治疗，在早期精准预测坏死区力学性能而后施加干预治疗是保髋的关键。

目的：建立基于人体髋关节CT数据的包含髋骨和髋臼软骨的坏死股骨头有限元接触动力学模型，预测步行运动过程中不同坏死体积和坏死位置对坏死区域力学性能的影响。
方法：采集志愿者髋关节CT影像学数据，重建了髋关节三维几何模型。基于Abaqus有限元软件建立股骨头坏死模型，构建了小、中、大体积坏死耦合坏死区域与力线重合、中度偏离和远离力线共9种不同坏死模型。预测在静态3 000 N载荷和一个ISO标准步行完整周期内不同坏死模型坏死区域的应力，对比评估坏死区域塌陷风险。

结果与结论：①坏死体积增大和坏死区域靠近力线时坏死区内的最大等效应力显著增加，坏死区塌陷风险也随之增加；②对不同载荷类型，运动时相同坏死体积和坏死位置条件下的股骨头坏死区最大应力较静载作用下的最大应力显著提高；③表明运动过程中，步行运动使股骨头坏死区的最大等效应力较静载时显著增大，故局部塌陷风险会因为更大的局部应力而增大，但整体塌陷风险因承载区域动态变化较静载有所降低，在临床评估时骨科医生需考虑运动对力学性能的影响。

https://orcid.org/0000-0002-7815-3790 (高永昌)

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: 股骨头缺血性坏死, 步行运动, 有限元分析, 塌陷风险, 应力

Abstract: BACKGROUND: Avascular necrosis of the femoral head is a refractory orthopedic disease that seriously affects the normal life of patients. Hip preservation is recommended for young patients due to the limited prosthesis longevity and revision. Accurate prediction of the mechanical properties of the necrotic area in the early stage and then intervention is the key to hip preservation.
OBJECTIVE: To establish a dynamic contact mechanics finite element model of necrotic femoral head based on human hip CT data and predict effects of both necrotic volume magnitude and its position on biomechanics of the necrotic region under walking movement. 
METHODS: CT data of a volunteer were collected and then geometry model of the hip was rebuilt. Finite element model of the necrotic femoral head was established using the Abaqus software. Nine different necrotic femoral models were constructed by combined both three different necrotic volume magnitudes (small, medium and big volume) and three different necrotic positions (coincided with, medium deviated with and kept away from the line of the force). The Von Mises of the necrotic region for all models were predicted under both 3 000 N static load and dynamical loads of one whole ISO walking gait cycle. The collapse risk for all models was evaluated based on collapse criterion. 
RESULTS AND CONCLUSION: (1) More approaching of the necrotic region to the line of force and bigger collapse volume made the maximum Von Mises increasing. This also enlarged the collapse risk of the necrotic region. (2) For different load types, walking movement increased the maximum Von Mises of the necrotic region than that of the value under static load under the same necrotic volume and location. (3) In conclusion, dynamic load would result in increasing of the maximum Von Mises of the necrotic region comparing to static load during exercise. Therefore, the risk of local collapse will increase due to greater Von Mises. However, the overall collapse risk is lower than that of static load due to the dynamic change of bearing area. This factor should be carefully considered by surgeons when they evaluate the mechanical performance of the necrotic femoral head. 

Key words: avascular necrosis of femoral head, walking movement, finite element analysis, collapse risk, stress

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