中国组织工程研究

中国组织工程研究 ›› 2019, Vol. 23 ›› Issue (36): 5788-5793.doi: 10.3969/j.issn.2095-4344.1958

• 骨科植入物 orthopedic implant • 上一篇    下一篇

支撑股骨头防止塌陷的空芯钛棒设计及生物力学分析

胡长波，杨新明，张  瑛   

  1. 河北北方学院附属第一医院骨科，河北省张家口市   075000
  • 出版日期:2019-12-28 发布日期:2019-12-28
  • 通讯作者: 杨新明，硕士，主任医师，教授，河北北方学院附属第一医院骨科，河北省张家口市 075000
  • 作者简介:胡长波，男，1985年生，河北省张家口市人，回族，2011年河北联合大学(原华北煤炭医学院)毕业，硕士，主治医师，主要从事关节脊柱外科研究。 并列第一作者：杨新明，男，1963年生，河北省石家庄市人，汉族，1986年河北医科大学毕业，硕士，主任医师，教授，主要从事关节脊柱外科的研究。
  • 基金资助:
    河北省卫健委2019年度医学科研项目(20190882)，项目负责人：胡长波|张家口市2007年科学技术研究与发展指令计划(0711045D-5)，项目负责人：杨新明

Design and biomechanical analysis of hollow titanium rod supporting the femoral head to prevent collapse

Hu Changbo, Yang Xinming, Zhang Ying
  

  1. Department of Orthopedics, First Affiliated Hospital of Hebei North University, Zhangjiakou 075000, Hebei Province, China
  • Online:2019-12-28 Published:2019-12-28
  • Contact: Yang Xinming, Master, Chief physician, Professor, Department of Orthopedics, First Affiliated Hospital of Hebei North University, Zhangjiakou 075000, Hebei Province, China
  • About author:Hu Changbo, Master, Attending physician, Department of Orthopedics, First Affiliated Hospital of Hebei North University, Zhangjiakou 075000, Hebei Province, China Yang Xinming, Master, Chief physician, Professor, Department of Orthopedics, First Affiliated Hospital of Hebei North University, Zhangjiakou 075000, Hebei Province, China Both Hu Changbo and Yang Xinming contributed equally to this paper.
  • Supported by:

    the Hebei Province Health Commission 2019 Medical Research Project, No. 20190882 (to HCB)| the Zhangjiakou City Science and Technology Research and Development Planning Program in 2007, No. 0711045D-5 (to YXM)

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摘要：

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文题释义：
髓芯减压：单纯的髓芯减压对早期、受累范围较小的股骨头坏死具有一定疗效，但在股骨减压、清除坏死骨组织后，缺乏对股骨头负重区软骨下骨的力学支撑，尤其当减压面积较大时，会增加术后骨折及关节面进一步塌陷的风险，所以髓芯减压后在通道内增加股骨头的强度，改变负重的载荷，降低股骨头塌陷的可能性。
股骨头坏死：是一个病理演变过程，初始发生在股骨头的负重区，在应力作用下坏死骨的骨小梁结构发生损伤即显微骨折及随后针对损伤骨组织的修复过程，造成骨坏死的原因不消除，修复不完善，损伤-修复的过程继续，导致股骨头结构改变、股骨头塌陷、变形以及关节炎症、功能障碍。
 
摘要
背景：在治疗早期股骨头坏死的众多方法中，空芯钛棒的临床应用得到国内外诸多学者的认可，但关于空芯钛棒支撑股骨头病变区域预防其塌陷设计的体外生物力学分析未作报道。
目的：探讨支撑股骨头空芯钛棒设计及防止股骨头塌陷的生物力学可行性，为临床应用提供理论依据。
方法：取成人尸体股骨头颈标本15只，随机分为正常组、髓芯减压组、髓芯减压+空芯钛棒置入组，每组5个标本。将标本置于生物力学机中，股骨头顶部施加压力并逐渐增大至股骨头塌陷，记录股骨转子窝、股骨矩、股骨大转子下3点的应变，及股骨头塌陷时的最大载荷(破坏极限点载荷)，并进行统计学比较。
结果与结论：①3组标本载荷到300 N时，正常组股骨转子窝、股骨矩、股骨大转子下3处应变值比较差异无显著性意义(P > 0.05)；髓芯减压组股骨转子窝、股骨矩应变值比较差异无显著性意义(P > 0.05)，但股骨大转子下应变值明显大于股骨转子窝、股骨矩(P < 0.05)；并且正常组股骨转子窝、股骨矩处应变值大于髓芯减压组，而股骨大转子下应变值小于髓芯减压组(P < 0.05)；②髓芯减压+空芯钛棒置入组股骨转子窝、股骨矩、股骨大转子下3处应变值比较差异无显著性意义(P > 0.05)；但髓芯减压+空芯钛棒置入组股骨转子窝、股骨矩处应变值大于髓芯减压组，而股骨大转子下应变值小于髓芯减压组(P < 0.05)；而正常组、髓芯减压+空芯钛棒置入组之间比较，差异无显著性意义(P > 0.05)；③3组标本加压致股骨头发生塌陷时破坏极限点的载荷是不同的，髓芯减压组破坏极限点的载荷明显小于正常组、髓芯减压+空芯钛棒置入组(P < 0.05)，而正常组、髓芯减压+空芯钛棒置入组破坏极限点的载荷差异无显著性意义(P > 0.05)；④提示用于支撑股骨头的空芯钛棒具有诸多设计优点，符合临床患者人性化需求，空芯钛棒置入可以有效改变髓芯减压后股骨头负重时的应力分布，使得生物力学性能接近正常，具有良好的支撑作用，可有效防止股骨头塌陷，为临床应用空芯钛棒治疗早期股骨头坏死提供了生物力学依据。


ORCID: 0000-0002-3209-9100(杨新明)

关键词: 股骨头, 空芯钛棒, 设计, 股骨头塌陷, 应变, 破坏极限点载荷, 生物力学

Abstract:

BACKGROUND: Among many methods for the treatment of early femoral head necrosis, the clinical application of hollow titanium rod has been recognized by many scholars. However, the in vitro biomechanical analysis of hollow titanium rod supporting the lesion area of the femoral head to prevent its collapse has not been reported.
OBJECTIVE: To design the hollow titanium rod preventing the collapse of the femoral head and investigate its biomechanical feasibility, providing a theoretical basis for clinical application.  
METHODS: Fifteen normal adult femoral specimens were randomly divided into three groups (5 specimens in each group): normal group (group A), core decompression group (group B), core decompression + hollow titanium rod placement group (group C). When the specimen was placed in a biomechanical machine, pressure was applied to the top of the femoral head and gradually increased until the femoral head collapsed. The strain value of femoral trochanteric fossa (a), femoral moment (b), and femoral greater trochanter (c) was measured. The maximum load (failure limit point load) was recorded when the femoral head collapsed and statistical data were compared among a, b and c.
RESULTS AND CONCLUSION: (1) When the load of group A reached 300 N, there was no statistically significant difference in the strain values among a, b and c (P > 0.05). When the load of group B reached 300 N, there was no significant difference in strain values between a and b (P > 0.05). However, the strain value at c was significantly greater than that at a and b (P < 0.05). The strain value at a and b in Group A was significantly greater than that in group B, and the train value at c in group A was significantly lower than that in group B (P < 0.05). (2) There was no significant difference in strain value at a, b and c in group C (P > 0.05). The strain value at a and b in group C was significantly greater than that in group B, and the train value at c in group C was significantly lower than that in group B (P < 0.05). There were no significant differences in the strain values at a, b and c between group A and group C (P > 0.05). (3) The load at the failure limit point of the femoral head caused by compression was different among three groups. The load at the failure limit point of group B was significantly lower than that in group A and group C (P < 0.05). There was no significant difference in load at the failure limit point between group A and group C (P > 0.05). (4) These results suggest that hollow titanium rod used to support the femoral head has many design advantages and meets the humanized needs of clinical patients. Hollow titanium rod placement can effectively change the stress distribution of the femoral head under load after decompression of the core, so that the biomechanical properties are close to the normal distribution and have a good supporting effect, which can effectively prevent femoral head collapse and provide a biomechanical basis for the clinical application of hollow titanium rod in the treatment of early osteonecrosis of the femoral head.

Key words: femoral head, hollow titanium rob, design, femoral head collapse, strain, load at the failure limit point, biomechanics

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