DDH患者全髋关节置换中股骨偏心距对骨肌多体动力学和接触力学的影响
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摘要
目的探讨先天性髋关节发育不良(developmental dysplasia of the hip,DDH)患者全髋关节置换(total hip arthroplasty,THA)中股骨偏心距的生物力学影响。方法以1例CroweⅣ型DDH女性患者的相关数据为材料,基于骨肌多体动力学软件AnyBody,建立与患者对应的个体化THA下肢骨肌多体动力学模型,分析股骨偏心距在±20 mm内变化时髋关节力、外展肌力的改变。同时建立不同偏心距下股骨-S-ROM假体动态有限元模型,由骨肌模型计算的不同偏心距下水平匀速行走步态内的动态载荷被加载至相应的有限元模型,对S-ROM假体柄与袖套之间的应力、接触应力和微动进行分析。结果股骨偏心距±20 mm内的变化对髋关节力峰值影响较小,股骨偏心距减小会导致外展肌力峰值显著增加,股骨偏心距增大会导致柄的最大应力、接触应力和微动显著增加。结论 DDH患者THA中股骨偏心距改变对外展肌力和假体最大应力、接触应力与微动影响显著,医生应予以考虑。
Objective To investigate the biomechanical effects of femoral offset(FO) on total hip arthroplasty(THA) patients with developmental dysplasia of the hip(DDH). Methods Based on the musculoskeletal dynamic software AnyBody and the related data from a female patient with Crowe Ⅳ DDH, the corresponding patient-specific lower extremity musculoskeletal multi-body dynamic model was constructed to analyze both hip joint forces and abductor forces within ±20 mm variation of FOs. The dynamic finite element(FE) model of S-ROM stem with varying offsets was also established. The dynamic load during a whole walking gait cycle calculated by the multi-body musculoskeletal model was applied to this FE models, and the Von Mises stress, contact stress, and stem-sleeve micromotion were then analyzed. Results A variation of ±20 mm offset had small influences on peak forces of hip joints. However, the decrease in FO could lead to an obvious increase in peak abductor force, while the increase in FO could lead to an obvious increase in the maximum Von Mises stress, contact stress, and micromotion of S-ROM prosthesis stem. Conclusions The change in FO had an obvious influence on the abductor forces, the maximum Von Mises stress, the contact pressure and the consequent fretting wear of THA patients with DDH, which should be carefully considered by surgeons.
Objective To investigate the biomechanical effects of femoral offset(FO) on total hip arthroplasty(THA) patients with developmental dysplasia of the hip(DDH). Methods Based on the musculoskeletal dynamic software AnyBody and the related data from a female patient with Crowe Ⅳ DDH, the corresponding patient-specific lower extremity musculoskeletal multi-body dynamic model was constructed to analyze both hip joint forces and abductor forces within ±20 mm variation of FOs. The dynamic finite element(FE) model of S-ROM stem with varying offsets was also established. The dynamic load during a whole walking gait cycle calculated by the multi-body musculoskeletal model was applied to this FE models, and the Von Mises stress, contact stress, and stem-sleeve micromotion were then analyzed. Results A variation of ±20 mm offset had small influences on peak forces of hip joints. However, the decrease in FO could lead to an obvious increase in peak abductor force, while the increase in FO could lead to an obvious increase in the maximum Von Mises stress, contact stress, and micromotion of S-ROM prosthesis stem. Conclusions The change in FO had an obvious influence on the abductor forces, the maximum Von Mises stress, the contact pressure and the consequent fretting wear of THA patients with DDH, which should be carefully considered by surgeons.
引文
[1] TONG SH,EID MA,CHOW W,et al.Screening for developmental dysplasia of the hip in Hong Kong [J].J Orthop Surg,2011,19(2):200-203.
[2] 毛宾尧.人工髋关节外科学[M].北京:人民卫生出版社,2001.
[3] MCGRORY BJ,MORREY BF,CAHALAN TD,et al.Effect of femoral offset on range of motion and abductor muscle strength after total hip arthroplasty [J].J Bone Joint Surgery Br,1995,77(6):865-869.
[4] CASSIDY KA,NOTICEWALA MS,MACAULAY W,et al.Effect of femoral offset on pain and function after total hip arthroplasty [J].J Arthroplasty,2012,27(10):1863-1869.
[5] LECERF G,FESSY MH,PHILIPPOT R,et al.Femoral offset:anatomical concept,definition,assessment,implications for preoperative templating and hip arthroplasty [J].Orthop Traumatol Surg Res,2009,95(3):210-219.
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[7] BACHOUR F,MARCHETTI E,BOCQUET D,et al.Radiographic preoperative templating of extra-offset cemented THA implants:How reliable is it and how does it affect survival?[J].Orthop Traumatol Surg Res,2010,96(7):760-768.
[8] AMIROUCHE F,SOLITRO G,WALIA A.No effect of femoral offset on bone implant micromotion in an experimental model [J].Orthop Traumatol Surg Res,2016,102(3):379-385.
[9] 陈瑱贤,王玲,靳忠民,等.全膝关节置换个体化患者右转步态的骨肌多体动力学仿真[J].医用生物力学,2015,30(5):397-403.CHEN ZX,WANG L,JIN ZM,et al.Musculoskeletal multi-body dynamic simulation on patient-specific total knee replacement during right-turn gait [J].J Med Biomech,2015,30(5):397-403.
[10] DAMSGAARD M,RASMUSSEN J,CHRISTENSEN ST,et al.Analysis of musculoskeletal systems in the AnyBody modeling system [J].Simul Model Pract Th,2006,14(8):1100-1111.
[11] ANDERSEN MS,RASMUSSEN J.Total knee replacement musculoskeletal model using a novel simulation method for non-conforming joints[C]//Proceedings of ISB 2011.Brussels:[s.n.],2011.
[12] 刘冬旭,严新谊,华子恺.单腿站立姿态下Ⅰ+Ⅱ+Ⅲ型标准半骨盆假体生物力学研究[J].医用生物力学,2015,30(6):495-500.LIU DX,YAN XY,HUA ZK.Biomechanical study on type Ⅰ+Ⅱ+Ⅲ standard hemipelvic prosthesis under single-leg stance [J].J Med Biomech,2015,30(6):495-500.
[13] AnyBody."Anyscript reference manual/AnyForceSurfaceContact"[R].Aalborg:AnyBody Technology,2004.
[14] HOBATHO MC,ASHMAN RB.Relations of mechanical properties to density and CT numbers in human bone [J].Med Eng Phys,1995(5):347-355.
[15] PALIWAL M,ALLAN DG,FILIP P.Retrieval analysis of a cementless modular total hip arthroplasty prosthesis [C]//Proceedings of 7th IEEE International Conference on Bioinformatics and Bioengineering.Boston:IEEE,2007.
[16] MEENA VK,KUMAR M,PUNDIR A,et al.Musculoskeletal-based finite element analysis of femur after total hip replacement [J].Proc Inst Mech Eng H,2016,230(6):553-560.
[17] BERGMANN G,DEURETZBACHER G,HELLER M,et al.Hip contact forces and gait patterns from routine activities[J].J Biomech,2001,34(7):859-871.
[18] SARIALI E,KLOUCHE S,MOUTTET A,et al.The effect of femoral offset modification on gait after total hip arthroplasty [J].Acta Orthop,2014,85:123-127.
[19] 吕作刚,孔荣.股骨偏心距变化可影响髋关节置换后相关并发症的发生[J].中国组织工程研究,2012,16(13):2309-2312.
[20] ISAO A,SAMATCHAI C,SIMPSON KJ,et al.Reconstructed hip joint position and abductor muscle strength after total hip arthroplasty [J].J Arthroplasty,2005,20(4):414-420.
[21] SARIN VK,PRATT WR,BRADLEY GW.Accurate femur repositioning is critical during intraoperative total hip arthroplasty length and offset assessment [J].J Arthroplasty,2005,20(7):887-891.
[2] 毛宾尧.人工髋关节外科学[M].北京:人民卫生出版社,2001.
[3] MCGRORY BJ,MORREY BF,CAHALAN TD,et al.Effect of femoral offset on range of motion and abductor muscle strength after total hip arthroplasty [J].J Bone Joint Surgery Br,1995,77(6):865-869.
[4] CASSIDY KA,NOTICEWALA MS,MACAULAY W,et al.Effect of femoral offset on pain and function after total hip arthroplasty [J].J Arthroplasty,2012,27(10):1863-1869.
[5] LECERF G,FESSY MH,PHILIPPOT R,et al.Femoral offset:anatomical concept,definition,assessment,implications for preoperative templating and hip arthroplasty [J].Orthop Traumatol Surg Res,2009,95(3):210-219.
[6] CHARLES MN,BOURNE RB,DAVEY JR,et al.Softtissue balancing of the hip:The role of femoral offset restoration [J].J Bone Joint Surg Am,2004,86(5):1078-1088.
[7] BACHOUR F,MARCHETTI E,BOCQUET D,et al.Radiographic preoperative templating of extra-offset cemented THA implants:How reliable is it and how does it affect survival?[J].Orthop Traumatol Surg Res,2010,96(7):760-768.
[8] AMIROUCHE F,SOLITRO G,WALIA A.No effect of femoral offset on bone implant micromotion in an experimental model [J].Orthop Traumatol Surg Res,2016,102(3):379-385.
[9] 陈瑱贤,王玲,靳忠民,等.全膝关节置换个体化患者右转步态的骨肌多体动力学仿真[J].医用生物力学,2015,30(5):397-403.CHEN ZX,WANG L,JIN ZM,et al.Musculoskeletal multi-body dynamic simulation on patient-specific total knee replacement during right-turn gait [J].J Med Biomech,2015,30(5):397-403.
[10] DAMSGAARD M,RASMUSSEN J,CHRISTENSEN ST,et al.Analysis of musculoskeletal systems in the AnyBody modeling system [J].Simul Model Pract Th,2006,14(8):1100-1111.
[11] ANDERSEN MS,RASMUSSEN J.Total knee replacement musculoskeletal model using a novel simulation method for non-conforming joints[C]//Proceedings of ISB 2011.Brussels:[s.n.],2011.
[12] 刘冬旭,严新谊,华子恺.单腿站立姿态下Ⅰ+Ⅱ+Ⅲ型标准半骨盆假体生物力学研究[J].医用生物力学,2015,30(6):495-500.LIU DX,YAN XY,HUA ZK.Biomechanical study on type Ⅰ+Ⅱ+Ⅲ standard hemipelvic prosthesis under single-leg stance [J].J Med Biomech,2015,30(6):495-500.
[13] AnyBody."Anyscript reference manual/AnyForceSurfaceContact"[R].Aalborg:AnyBody Technology,2004.
[14] HOBATHO MC,ASHMAN RB.Relations of mechanical properties to density and CT numbers in human bone [J].Med Eng Phys,1995(5):347-355.
[15] PALIWAL M,ALLAN DG,FILIP P.Retrieval analysis of a cementless modular total hip arthroplasty prosthesis [C]//Proceedings of 7th IEEE International Conference on Bioinformatics and Bioengineering.Boston:IEEE,2007.
[16] MEENA VK,KUMAR M,PUNDIR A,et al.Musculoskeletal-based finite element analysis of femur after total hip replacement [J].Proc Inst Mech Eng H,2016,230(6):553-560.
[17] BERGMANN G,DEURETZBACHER G,HELLER M,et al.Hip contact forces and gait patterns from routine activities[J].J Biomech,2001,34(7):859-871.
[18] SARIALI E,KLOUCHE S,MOUTTET A,et al.The effect of femoral offset modification on gait after total hip arthroplasty [J].Acta Orthop,2014,85:123-127.
[19] 吕作刚,孔荣.股骨偏心距变化可影响髋关节置换后相关并发症的发生[J].中国组织工程研究,2012,16(13):2309-2312.
[20] ISAO A,SAMATCHAI C,SIMPSON KJ,et al.Reconstructed hip joint position and abductor muscle strength after total hip arthroplasty [J].J Arthroplasty,2005,20(4):414-420.
[21] SARIN VK,PRATT WR,BRADLEY GW.Accurate femur repositioning is critical during intraoperative total hip arthroplasty length and offset assessment [J].J Arthroplasty,2005,20(7):887-891.