Biomechanical properties of acetabular reconstruction in adult developmental dysplasia of the hip by a three-dimensional finite element analysis

doi:10.3969/j.issn.2095-4344.1010

Abstract

Abstract:

BACKGROUND: Many methods are used to treat adult developmental dysplasia of the hip, such as pericapsular osteotomy and rotational acetabular osteotomy. Due to the limitation of technical conditions, the curative effect is different. Although these methods have improved the relationship between the head and the acetabulum in varying degrees, there is still a certain gap from the ideal state, and some patients have poor results with continuous disease development.

OBJECTIVE: To analyze the feasibility and effectiveness of acetabular reconstruction in adult hip dysplasia by three-dimensional finite element method and provide theoretical basis for future clinical research.

METHODS: Thin-slice CT data of unilateral hip dysplasia patient were collected. Mimics 15.0 and Hypermesh were used to establish the model of healthy hip and dysplasia hip, and location and scope of bony defect were calculated, then model of reconstruction of the acetabulum was established by simulating tools. The Von Mises stress distribution in the subchondral bone of each hip joint was analyzed under the condition of single foot standing using Ansys 10.0.

RESULTS AND CONCLUSION: (1) The results of each model were consistent with the actual situation, and the maximum Von Mises stress value appeared in the acetabular dome and the posteromedial femoral neck. (2) The bone defect appeared in the anterolateral part of acetabulum, the size was 43 mm×14 mm×7 mm. (3) The Von Mises stress peak values of each group after stress loading in the healthy hip were femoral head (2.800±0.012) MPa, acetabulum (3.855±0.035) MPa; femoral head of affected hip (5.066±0.026) MPa; acetabulum (8.168±0.034) MPa; reconstructed hip femoral head (2.769±0.085) MPa, acetabulum (3.804±0.132) MPa. Statistical analysis showed that the peak Von Mises stress in each part of the affected hip was significantly higher than that in the other two groups (P < 0.001). The values between reconstructed hip and healthy hips were similar (P > 0.05), suggesting that the stress distribution of hip joint was normal after acetabular reconstruction. (4) The stress analysis of finite element model indicates that acetabular reconstruction can restore the mechanical structure of hip joint, and this method is feasible to treat adult early developmental dysplasia of the hip.

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

Key words: Hip Dislocation, Congenital, Acetabulum, Stress, Mechanical, Finite Element Analysis, Tissue Engineering

CLC Number:

R445

Tian Fengde, Zhao Dewei, Li Dongyi, Guo Lin, An Ning, Zhang Yao, Cheng Liangliang, Hao Ruihu, Yang Fan. Biomechanical properties of acetabular reconstruction in adult developmental dysplasia of the hip by a three-dimensional finite element analysis[J]. Chinese Journal of Tissue Engineering Research, 2018, 22(35): 5642-5647.

Figures/Tables 2

应力云图结果表明各组髋关节模型应力均由髋臼向股骨头传导，经股骨颈到近段股骨内上侧，这与正常髋关节应力传导方式相同。为了便于观察应力在髋臼与股骨的分布情况，此次研究将髋臼与股骨分离，单独显示。结果表明髋臼内应力主要集中于髋臼负重区(髋臼前外上部位)，最大应力位于髋臼外缘。图2A显示正常侧髋臼内应力呈均匀分布；图2C示患侧髋臼内应力值相对增高(颜色处于下方色谱的位置越偏右则表示应力越大)，而且分布不均匀，髋臼外侧存在应力集中现象(图2中髋臼外缘红色部分)；图2E见重建髋臼内应力分布恢复均匀，与正常侧结果相近。 3组模型股骨应力分布情况基本相同，最大应力均位于股骨颈后下方及股骨距处，而股骨头处相对处于低应力表达区，仅在关节负重面位置出现稍高应力表达。 2.2.2 各模型髋臼、股骨头及股骨近段Von Mises应力值测量各模型髋臼、股骨头及股骨近段兴趣区Von Mises应力值，将各组模型设定在同一负荷，对每个兴趣区(包括髋臼、股骨头及股骨近段)随机选取20个兴趣点，记录应力值，计算应力平均值及标准差，实验数据以x(_)±s表示，具体结果见表1。表1数据结果显示DDH、健康对照及重建髋各部位(髋臼、股骨头及股骨近段)Von Mises应力值，结果表明患髋各部位应力值均高于健髋及重建髋(P < 0.001)，证明DDH髋关节各部位在站立时承受更大的压力，DDH的髋臼及股骨头部位所受应力可达健康髋的2倍(髋臼8.168∶3.855；股骨头5.066∶2.8)，而股骨近段压力则高达3倍(40.376∶13.518)，该结果证明了DDH髋关节异常应力的存在，为DDH的异常应力理论提供了直接证据。统计结果显示，DDH各部位Von Mises应力值明显高于另外二者(P < 0.001)，差异有显著性意义；而重建髋与健髋各部位数值相近，差异无显著性意义(P > 0.05)，证明重建后髋关节应力分布恢复正常，因而髋臼重建治疗DDH的方法从力学角度看是有效的。 "

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