儿童先天性髋关节脱位Steel三相截骨模板的设计与应用
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摘要
第一部分三维重建与逆向工程技术设计儿童先天性髋关节脱位Steel三相截骨术截骨模板
研究背景
先天性髋关节脱位又称为发育性髋关节脱位,是一种对儿童健康影响大的病变,估计我国的发生率大概为1%。髋是下肢重要的活动关节,如能做到早诊断、早治疗,临床效果是满意的。但是如果得不到及时有效的治疗,髋关节将早期退行性骨关节炎,最终威胁髋关节的远期功能,严重影响人类的健康和生活质量。因此在早期通过合理的手术不仅可使髋关节复位稳定,还可以避免许多手术并发症。然而在过去其治疗原则或手术方案的制定通常以患儿年龄和X线为依据。由于X线检查的局限性,难以使临床医师对髋关节发育不良有全面准确的认识。近年来随着计算机技术在影像学中的应用,三维重建技术及三维可视化分析技术获得了长足的进步,尤其在小儿先天性髋关节脱位的手术治疗中显示了它的优越性。本文主要探讨三维重建与逆向工程技术重建患儿髋关节可能性及模拟截骨的临床应用价值。
目的
先天性髋关节脱位在早期通过合理的手术不仅可使髋关节复位稳定,还可以避免许多手术并发症。然而在过去其治疗原则或手术方案的制定通常以患儿年龄和X线为依据。由于X线检查的局限性,难以使临床医师对髋关节发育不良有一个全面准确的认识。近年来随着计算机技术在影像学中的应用,三维重建技术及三维可视化分析技术获得了长足的进步,尤其在小儿先天性髋关节脱位的手术治疗中显示了它的优越性。本文主要探讨三维重建与逆向工程技术重建患儿髋关节可能性及模拟截骨的临床应用价值。本研究旨在利用三维重建与逆向工程技术为儿童先天性髋关节脱位Steel三相截骨矫正术提供一种相对精确的截骨方案。
方法
采用连续螺旋CT对一例儿童先天性髋关节脱位患者行骨盆连续断层扫描,扫描条件：电压120kv,层厚0.625mm,矩阵512x512。
髋关节的三维重建：将扫描Dicom格式图像导入Materialise Mimics14.1软件,采用表面遮盖显示法(shaded surface display,SSD)进行三维表面重建,然后将重建的髋关节以.stl格式保存,导入Imageware12.0软件进行进一步分析及设计。
先天性髋关节脱位的模拟截骨与复位：通过Imageware12.0软件,利用软件中的镜像功能,在患侧生成健侧的髋关节的三维模型,根据steel三相截骨方案在髋关节模型上进行截骨,以健侧髋关节的模型为指导将截断的骨块进行旋转,重建正常的髋关节解剖,使患臼覆盖达到预设的髋臼位置。
截骨模板的生成：通过截骨旋转重建后的髋关节与镜像生成的髋关节模型进行对比,以截骨两端区域为基准进行反求,设计模板(包括开口角度和旋转角度)。
结果
通过三维重建得到了较好的显示结果,重建的髋关节三维模型,可以直观显示患髋解剖形态。
通过三维可视化髋臼模型,模拟Steel三相截骨术可精确设计小儿髋关节。
通过三维重建与逆向工程技术构建的截骨模板,为Steel三相截骨矫正术提供一种相对精确的截骨方案。
结论
基于CT影像下先天性髋关节脱位的患儿髋关节三维重建效果直观：本课题通过目前较成熟的三维软件成像技术,利用先天性髋关节脱位的患儿薄层扫描后的CT影像,不仅可以清晰、直观地观察患儿髋关节的三维形态,而且可以将我们关心的部位分离或透视,并能以任一角度旋转,排除临近结构的遮挡。
第二部分Steel三相截骨模板在儿童先天性髋关节脱位治疗中的应用
目的
本研究主要探讨三维重建与逆向工程技术重建患儿髋关节可能性及模拟截骨的临床应用价值。利用三维重建与逆向工程技术为儿童先天性髋关节脱位Steel三相截骨矫正术提供一种相对精确的截骨方案,并观察13例使用此类方法设计的模板的临床疗效。
方法
临床资料：本组13例,男8例,女5例,平均年龄7.2±1.1(6-9)岁。右侧8例,左侧5例。髋臼指数44.0°±1.9°(40°-46°)。13例患者术前诊断无股骨头坏死。根据患者的X线及临床表现,拟按照Steel截骨术进行截骨矫形。
截骨模板在Steel截骨术中应用：按照Steel截骨的手术进行髋臼截骨后,将计算机辅助生成的截骨模板植入,克氏针固定。
结果
13例Steel截骨术的患儿通过三维重建与逆向工程技术构建的截骨模板重建的髋关节初期临床疗效满意。
结论
基于CT扫描后的三维重建影像可以应用于临床解剖研究：利用CT扫描数据三维重建的患儿髋关节可视化图像,不仅立体直观,而且由计算机软件对其解剖参数的测量也减小了人为因素的误差,能够在三维空间中准确的定位并获得各种三维数据,为临床解剖的研究提供一种新的研究途径。通过三维重建与逆向工程分析构建的Steel三相截骨模板可以提供良好的匹配性,同时减少了手术的时间,提高了手术的安全性。
三维重建和逆向工程技术的出现以及不断的发展为现代骨科手术提供了新的辅助手段,根据CT数据重建的三维模型可以直接、深入观察手术部位结构特点,可以对手术区的结构进行三维可视化分析,维持充分的髋臼覆盖,而且可提高手术的安全性。因此,针对先天性髋关节脱位患者采用Steel截骨的问题,我们按照临床手术要求进行设计,根据截骨位置以及截骨后骨块的三维可视化分析还原正常的髋关节,生成植入骨块模型,随着逆向工程技术及激光快速成型技术在医学的应用,我们可以将截骨模板通过快速成型技术生成实体,这样就保证了植入骨块的准确匹配,保证了充分的髋臼覆盖以及重建后髋臼的稳定性。螺旋CT以及三维可视化分析可精确重建小儿髋关节,为临床医师的手术方案、手术入路、植入骨块模型提供可靠的依据,达到针对不同病人手术个体化的最终目标,不但使手术实施的可行性、安全性增加,而且能够降低手术的风险性,减少手术的并发症。
Section I Three-dimensional Reconstruction and Reverse Engineering Technique in Designing Template of Steel Three-point Osteotomy for Congenital Dislocations of Hip
Background
Congenital dislocation of the hip, also called developmental dysplasia of the hip (DDH), damages the health of children, the incidence of which is about1%in China. The outcome of the treatment would be satisfied if treated in the early stage, while serious consequences, such as osteoarthritis, if the treatment is not prompt. Proper operation would make the hip embolia and avoid many complications. The operation plan was usually designed according to X-ray and age of the children. However, the surgeons can't evaluate the disease comprehensive because of the limitations of X-ray. Nowadays, the three-dimensional (3D) reconstruction technique has showed its advantages in designing the operation plan. This study aimed to detective the application of three-dimensional reconstruction and reverse engineering technique in designing template of steel three-point osteotomy for congenital dislocations of hip.
Objective
This study aimed to detective the application of three-dimensional reconstruction and reverse engineering technique in designing template of steel three-point osteotomy for congenital dislocations of hip.
Methods
Clinical materials:CT scan of the patient of pelvis conducted under the conditions of120kv voltage, slice thickness of0.625mm and matrix of512x512.
Three-dimensional reconstruction of the hip:The images from CT scan were saved as Dicom and imported into Materialise Mimics14.1. SSD was applied to perform3D reconstruction. The reconstructed data was saved as.stl and imported into Imageware12.0for further designation and analysis.
Simulation of osteotomy and embolia:3D-model of the hip at the health side was reconstructed to the affected side by means of "mirror image" in Imageware12.0. The osteotomy was performed. In order to reconstruct the hip, the bony block was placed according to the healty model.
Template generation:The osteotomized hip was compared with the mirror of the healthy hip, to demonstrate the template for osteotomy, including the opening-angle and the rotation angle.
Results
Distinct macroscopic anatomy structure view was achieved by means of three-dimensional reconstruction.
The operation for the hip of the children with DDH can be designed based on the3D reconstruction.
The application of three-dimensional reconstruction and reverse engineering technique provides a more accurate plan for Steel three-point osteotomy.
Conclusions
The3D reconstruction based on CT scan of the hip of children with DDH is accurate for operation:In this study, CT scan is performed for the hip of children with DDH, followed by reconstruction in Imageware12.0, which is a mature software for3D reconstruction. The reconstructed model demonstratses the3D structure of the affected hip, the particular section of which can be separated and rotated for meticulous observation.
The technique of3D reconstruction based on CT scan can be applied for anatomical research:The technique has the advantage of stereoscopic and intuitive, with small measuring error because of the application of computer measurement.
Section Ⅱ The clinical evaluation of Template of Steel Three-point Osteotomy for Congenital Dislocations of Hip
Background
Congenital dislocation of the hip, also called developmental dysplasia of the hip (DDH), damages the health of children, the incidence of which is about1%in China. The outcome of the treatment would be satisfied if treated in the early stage, while serious consequences, such as osteoarthritis, if the treatment is not prompt. Proper operation would make the hip embolia and avoid many complications. The operation plan was usually designed according to X-ray and age of the children. However, the surgeons can't evaluate the disease comprehensive because of the limitations of X-ray. Nowadays, the three-dimensional (3D) reconstruction technique has showed its advantages in designing the operation plan. This study aimed to detective the application of three-dimensional reconstruction and reverse engineering technique in designing template of steel three-point osteotomy for congenital dislocations of hip.
Objective
To evaluate the clinical application of the template of steel three-point Osteotomy for congenital dislocations of hip.
Methods
Clinical materials:A total of13cases,8male cases and5female cases, were recruited in this study. The average age was7.2±1.1(6-9) years. According to the X-ray and clinical manifestations, Steel osteotomy was chosen to be performed.
The application of the template:The template was implanted after the procedure of Steel osteotomy which was fixed by kirschner wires.
Results
The application of three-dimensional reconstruction and reverse engineering technique provides a more accurate plan for Steel three-point osteotomy.
The primary clinical outcome of template was satisfied in all of the13cases.
Conclusions
The template for Steel three-point osteotomy based on3D reconstruction and reverse engineering technique shows its satisfied match quality, helping the surgeons to reduce surgery time and complications.
SectionⅢ The establishing and verification of finite element model for femoral neck fracture
Background
The joint of hip plays an important role in movement and load-bearing, which has always been a research hotspot of sports medicine and bone science. Because of the multiple and diversity of femoral neck fracture as well as more complications, the golden treatment has not defined yet.
Femoral neck fracture takes account for about50%to60%of all hip fracture, with a high incidence in elderly patients, usually accompanied by severe osteoporosis. The choice of treatment can be affected by a variety of factors, including age, type of fracture, mental factors etc. The main treatment includes internal fixation, hemiarthroplasty and total hip arthroplasty (THA). THA was the terminal choice for treatment for most patients, however, it is advised to take the internal fixation as the first choice, to give a chance of a recovery to the femoral head. It is well convinced that, patients less than60years old, without a clear avascular signs, preferred internal fixation; hip arthroplasty for displaced fractures in patients over the age of80; Treatment of patients between the ages of60to80, according to the patient's injury, fracture classification, psychological factors, and whether combined with other systemic diseases to be comprehensive selection. The optional includes two cannulated screw, three cannulated screw, DHS, proximal femur locking plates, etc.
Finite element model (FEM) has a powerful modeling and simulation with complex geometry, material parameters and objects under different loading conditions in the static and dynamic state, it has to be applied to a growing number of human biomechanics.
Objectives
To establish three-dimensional digital model of femoral neck fractures and finite element model, and to verify the validity of the finite element model by cadaver.
Methods
Construction and verification of digital three-dimensional finite element model of femur:The including criteria is the hip without fracture, deformity, tumor, bone destruction confirmed by X-ray examination. The CT scan of femur was taken under Philips/Brilliance64-slice spiral CT. Scanning parameters:Tube voltage120kV, tube current of100mA over the greater trochanter, thickness0.625mm. About489slices has been obtained of a two-dimensional CT images. Data was saved with the. DICOM format to save, then input into the Mimics,10.01software, after automatic or manual threshold segmentation, three-dimensional reconstruction of a complete femur was established, and then export the STL format data import Geomagic Studio10.0software, based on the polygon stage extraction feature set and edit patches are automatically fitted NURBS surfaces, save as the iges format and then output. At the same time, the establishment of the femoral neck Pauwels-Ⅱ type fracture model, fracture line of50°and fixed with3low-angle lag screws (typically135°) in an inverted triangle position. According to the material properties of the bones and internal fixation, without taking into account the friction between the joints and cartilage, simplify the processing the muscle and tendon. Set the situation as that the fracture surface completely broken and is in the contact state, the friction coefficient of0.2. The DOF constraints and external condyle of the femur three-dimensional finite element model of the lower edge of all the nodes to0as the boundary conditions, i.e. the distal end of each node x, y, and z-axis displacement of0. Using simplified models, that the force on the femoral head from the pelvic acetabular fossa was only taken into consideration, take only the greater trochanter near abductor (gluteus medius muscle and piriformis) and vastus lateralis muscle force, external load force abductor as finite element analysis, be axial600N stress, average acting on the femoral head and acetabular contact surface axially down, then set mesh density generated grid and set an example attribute operator.
Finite element model validation:Take the body of an adult cadaver of the femoral neck, remove the soft tissue around, save the complete bone structure, X-ray examination to exclude tumors, fractures and other lesions, bone mineral density test value of1.17g/cm2.-80℃freezer spare sealed in double plastic bags. remove the natural thawing at room temperature24h before the test, fracture simulation osteotomy of the femoral neck Pauwels-Ⅱ type fracture with the fracture line of50 0, and fixed with cannulated screw. Femoral neck cannulated screw:cannulated screws total length of90mm, and diameter of6.5mm, the threaded portion of was20mm in length, hollow part of the diameter of2.5mm. The lag screws in an inverted triangle position and separated from each other. Specimen model was fixed in the the electronic universal dynamic static material testing machine, the distal femur bicondylar connection with the horizontal parallel proceeds the femur axis with the sagittal line showed a23°angle, piriform fossa and greater trochanter fixed by nylon thread (tensile elastic modulus of9.7N/mm2and0.15N/mm2), respectively to be fixed, the fixing strength of10MPa. Subsequently,600N force perpendicular to the direction of femoral head, record the stress on eight points around the femoral neck and three times each, and compared with finite element analysis results.
Results
Based on CT scan data to establish a femoral neck fracture model, is feasible and effective. The three-dimensional finite element method can simulate a variety of structures, given the biological material properties of the various organizations, reflecting the overall trend of the biomechanical properties, which can be used as a specimen experiment. The established the finite element model of normal human femoral neck fractures and has good geometric similarity.
Conclusion
It is effective and accurate to perform finite element analysis for femoral neck fracture.
研究背景
先天性髋关节脱位又称为发育性髋关节脱位,是一种对儿童健康影响大的病变,估计我国的发生率大概为1%。髋是下肢重要的活动关节,如能做到早诊断、早治疗,临床效果是满意的。但是如果得不到及时有效的治疗,髋关节将早期退行性骨关节炎,最终威胁髋关节的远期功能,严重影响人类的健康和生活质量。因此在早期通过合理的手术不仅可使髋关节复位稳定,还可以避免许多手术并发症。然而在过去其治疗原则或手术方案的制定通常以患儿年龄和X线为依据。由于X线检查的局限性,难以使临床医师对髋关节发育不良有全面准确的认识。近年来随着计算机技术在影像学中的应用,三维重建技术及三维可视化分析技术获得了长足的进步,尤其在小儿先天性髋关节脱位的手术治疗中显示了它的优越性。本文主要探讨三维重建与逆向工程技术重建患儿髋关节可能性及模拟截骨的临床应用价值。
目的
先天性髋关节脱位在早期通过合理的手术不仅可使髋关节复位稳定,还可以避免许多手术并发症。然而在过去其治疗原则或手术方案的制定通常以患儿年龄和X线为依据。由于X线检查的局限性,难以使临床医师对髋关节发育不良有一个全面准确的认识。近年来随着计算机技术在影像学中的应用,三维重建技术及三维可视化分析技术获得了长足的进步,尤其在小儿先天性髋关节脱位的手术治疗中显示了它的优越性。本文主要探讨三维重建与逆向工程技术重建患儿髋关节可能性及模拟截骨的临床应用价值。本研究旨在利用三维重建与逆向工程技术为儿童先天性髋关节脱位Steel三相截骨矫正术提供一种相对精确的截骨方案。
方法
采用连续螺旋CT对一例儿童先天性髋关节脱位患者行骨盆连续断层扫描,扫描条件：电压120kv,层厚0.625mm,矩阵512x512。
髋关节的三维重建：将扫描Dicom格式图像导入Materialise Mimics14.1软件,采用表面遮盖显示法(shaded surface display,SSD)进行三维表面重建,然后将重建的髋关节以.stl格式保存,导入Imageware12.0软件进行进一步分析及设计。
先天性髋关节脱位的模拟截骨与复位：通过Imageware12.0软件,利用软件中的镜像功能,在患侧生成健侧的髋关节的三维模型,根据steel三相截骨方案在髋关节模型上进行截骨,以健侧髋关节的模型为指导将截断的骨块进行旋转,重建正常的髋关节解剖,使患臼覆盖达到预设的髋臼位置。
截骨模板的生成：通过截骨旋转重建后的髋关节与镜像生成的髋关节模型进行对比,以截骨两端区域为基准进行反求,设计模板(包括开口角度和旋转角度)。
结果
通过三维重建得到了较好的显示结果,重建的髋关节三维模型,可以直观显示患髋解剖形态。
通过三维可视化髋臼模型,模拟Steel三相截骨术可精确设计小儿髋关节。
通过三维重建与逆向工程技术构建的截骨模板,为Steel三相截骨矫正术提供一种相对精确的截骨方案。
结论
基于CT影像下先天性髋关节脱位的患儿髋关节三维重建效果直观：本课题通过目前较成熟的三维软件成像技术,利用先天性髋关节脱位的患儿薄层扫描后的CT影像,不仅可以清晰、直观地观察患儿髋关节的三维形态,而且可以将我们关心的部位分离或透视,并能以任一角度旋转,排除临近结构的遮挡。
第二部分Steel三相截骨模板在儿童先天性髋关节脱位治疗中的应用
目的
本研究主要探讨三维重建与逆向工程技术重建患儿髋关节可能性及模拟截骨的临床应用价值。利用三维重建与逆向工程技术为儿童先天性髋关节脱位Steel三相截骨矫正术提供一种相对精确的截骨方案,并观察13例使用此类方法设计的模板的临床疗效。
方法
临床资料：本组13例,男8例,女5例,平均年龄7.2±1.1(6-9)岁。右侧8例,左侧5例。髋臼指数44.0°±1.9°(40°-46°)。13例患者术前诊断无股骨头坏死。根据患者的X线及临床表现,拟按照Steel截骨术进行截骨矫形。
截骨模板在Steel截骨术中应用：按照Steel截骨的手术进行髋臼截骨后,将计算机辅助生成的截骨模板植入,克氏针固定。
结果
13例Steel截骨术的患儿通过三维重建与逆向工程技术构建的截骨模板重建的髋关节初期临床疗效满意。
结论
基于CT扫描后的三维重建影像可以应用于临床解剖研究：利用CT扫描数据三维重建的患儿髋关节可视化图像,不仅立体直观,而且由计算机软件对其解剖参数的测量也减小了人为因素的误差,能够在三维空间中准确的定位并获得各种三维数据,为临床解剖的研究提供一种新的研究途径。通过三维重建与逆向工程分析构建的Steel三相截骨模板可以提供良好的匹配性,同时减少了手术的时间,提高了手术的安全性。
三维重建和逆向工程技术的出现以及不断的发展为现代骨科手术提供了新的辅助手段,根据CT数据重建的三维模型可以直接、深入观察手术部位结构特点,可以对手术区的结构进行三维可视化分析,维持充分的髋臼覆盖,而且可提高手术的安全性。因此,针对先天性髋关节脱位患者采用Steel截骨的问题,我们按照临床手术要求进行设计,根据截骨位置以及截骨后骨块的三维可视化分析还原正常的髋关节,生成植入骨块模型,随着逆向工程技术及激光快速成型技术在医学的应用,我们可以将截骨模板通过快速成型技术生成实体,这样就保证了植入骨块的准确匹配,保证了充分的髋臼覆盖以及重建后髋臼的稳定性。螺旋CT以及三维可视化分析可精确重建小儿髋关节,为临床医师的手术方案、手术入路、植入骨块模型提供可靠的依据,达到针对不同病人手术个体化的最终目标,不但使手术实施的可行性、安全性增加,而且能够降低手术的风险性,减少手术的并发症。
Section I Three-dimensional Reconstruction and Reverse Engineering Technique in Designing Template of Steel Three-point Osteotomy for Congenital Dislocations of Hip
Background
Congenital dislocation of the hip, also called developmental dysplasia of the hip (DDH), damages the health of children, the incidence of which is about1%in China. The outcome of the treatment would be satisfied if treated in the early stage, while serious consequences, such as osteoarthritis, if the treatment is not prompt. Proper operation would make the hip embolia and avoid many complications. The operation plan was usually designed according to X-ray and age of the children. However, the surgeons can't evaluate the disease comprehensive because of the limitations of X-ray. Nowadays, the three-dimensional (3D) reconstruction technique has showed its advantages in designing the operation plan. This study aimed to detective the application of three-dimensional reconstruction and reverse engineering technique in designing template of steel three-point osteotomy for congenital dislocations of hip.
Objective
This study aimed to detective the application of three-dimensional reconstruction and reverse engineering technique in designing template of steel three-point osteotomy for congenital dislocations of hip.
Methods
Clinical materials:CT scan of the patient of pelvis conducted under the conditions of120kv voltage, slice thickness of0.625mm and matrix of512x512.
Three-dimensional reconstruction of the hip:The images from CT scan were saved as Dicom and imported into Materialise Mimics14.1. SSD was applied to perform3D reconstruction. The reconstructed data was saved as.stl and imported into Imageware12.0for further designation and analysis.
Simulation of osteotomy and embolia:3D-model of the hip at the health side was reconstructed to the affected side by means of "mirror image" in Imageware12.0. The osteotomy was performed. In order to reconstruct the hip, the bony block was placed according to the healty model.
Template generation:The osteotomized hip was compared with the mirror of the healthy hip, to demonstrate the template for osteotomy, including the opening-angle and the rotation angle.
Results
Distinct macroscopic anatomy structure view was achieved by means of three-dimensional reconstruction.
The operation for the hip of the children with DDH can be designed based on the3D reconstruction.
The application of three-dimensional reconstruction and reverse engineering technique provides a more accurate plan for Steel three-point osteotomy.
Conclusions
The3D reconstruction based on CT scan of the hip of children with DDH is accurate for operation:In this study, CT scan is performed for the hip of children with DDH, followed by reconstruction in Imageware12.0, which is a mature software for3D reconstruction. The reconstructed model demonstratses the3D structure of the affected hip, the particular section of which can be separated and rotated for meticulous observation.
The technique of3D reconstruction based on CT scan can be applied for anatomical research:The technique has the advantage of stereoscopic and intuitive, with small measuring error because of the application of computer measurement.
Section Ⅱ The clinical evaluation of Template of Steel Three-point Osteotomy for Congenital Dislocations of Hip
Background
Congenital dislocation of the hip, also called developmental dysplasia of the hip (DDH), damages the health of children, the incidence of which is about1%in China. The outcome of the treatment would be satisfied if treated in the early stage, while serious consequences, such as osteoarthritis, if the treatment is not prompt. Proper operation would make the hip embolia and avoid many complications. The operation plan was usually designed according to X-ray and age of the children. However, the surgeons can't evaluate the disease comprehensive because of the limitations of X-ray. Nowadays, the three-dimensional (3D) reconstruction technique has showed its advantages in designing the operation plan. This study aimed to detective the application of three-dimensional reconstruction and reverse engineering technique in designing template of steel three-point osteotomy for congenital dislocations of hip.
Objective
To evaluate the clinical application of the template of steel three-point Osteotomy for congenital dislocations of hip.
Methods
Clinical materials:A total of13cases,8male cases and5female cases, were recruited in this study. The average age was7.2±1.1(6-9) years. According to the X-ray and clinical manifestations, Steel osteotomy was chosen to be performed.
The application of the template:The template was implanted after the procedure of Steel osteotomy which was fixed by kirschner wires.
Results
The application of three-dimensional reconstruction and reverse engineering technique provides a more accurate plan for Steel three-point osteotomy.
The primary clinical outcome of template was satisfied in all of the13cases.
Conclusions
The template for Steel three-point osteotomy based on3D reconstruction and reverse engineering technique shows its satisfied match quality, helping the surgeons to reduce surgery time and complications.
SectionⅢ The establishing and verification of finite element model for femoral neck fracture
Background
The joint of hip plays an important role in movement and load-bearing, which has always been a research hotspot of sports medicine and bone science. Because of the multiple and diversity of femoral neck fracture as well as more complications, the golden treatment has not defined yet.
Femoral neck fracture takes account for about50%to60%of all hip fracture, with a high incidence in elderly patients, usually accompanied by severe osteoporosis. The choice of treatment can be affected by a variety of factors, including age, type of fracture, mental factors etc. The main treatment includes internal fixation, hemiarthroplasty and total hip arthroplasty (THA). THA was the terminal choice for treatment for most patients, however, it is advised to take the internal fixation as the first choice, to give a chance of a recovery to the femoral head. It is well convinced that, patients less than60years old, without a clear avascular signs, preferred internal fixation; hip arthroplasty for displaced fractures in patients over the age of80; Treatment of patients between the ages of60to80, according to the patient's injury, fracture classification, psychological factors, and whether combined with other systemic diseases to be comprehensive selection. The optional includes two cannulated screw, three cannulated screw, DHS, proximal femur locking plates, etc.
Finite element model (FEM) has a powerful modeling and simulation with complex geometry, material parameters and objects under different loading conditions in the static and dynamic state, it has to be applied to a growing number of human biomechanics.
Objectives
To establish three-dimensional digital model of femoral neck fractures and finite element model, and to verify the validity of the finite element model by cadaver.
Methods
Construction and verification of digital three-dimensional finite element model of femur:The including criteria is the hip without fracture, deformity, tumor, bone destruction confirmed by X-ray examination. The CT scan of femur was taken under Philips/Brilliance64-slice spiral CT. Scanning parameters:Tube voltage120kV, tube current of100mA over the greater trochanter, thickness0.625mm. About489slices has been obtained of a two-dimensional CT images. Data was saved with the. DICOM format to save, then input into the Mimics,10.01software, after automatic or manual threshold segmentation, three-dimensional reconstruction of a complete femur was established, and then export the STL format data import Geomagic Studio10.0software, based on the polygon stage extraction feature set and edit patches are automatically fitted NURBS surfaces, save as the iges format and then output. At the same time, the establishment of the femoral neck Pauwels-Ⅱ type fracture model, fracture line of50°and fixed with3low-angle lag screws (typically135°) in an inverted triangle position. According to the material properties of the bones and internal fixation, without taking into account the friction between the joints and cartilage, simplify the processing the muscle and tendon. Set the situation as that the fracture surface completely broken and is in the contact state, the friction coefficient of0.2. The DOF constraints and external condyle of the femur three-dimensional finite element model of the lower edge of all the nodes to0as the boundary conditions, i.e. the distal end of each node x, y, and z-axis displacement of0. Using simplified models, that the force on the femoral head from the pelvic acetabular fossa was only taken into consideration, take only the greater trochanter near abductor (gluteus medius muscle and piriformis) and vastus lateralis muscle force, external load force abductor as finite element analysis, be axial600N stress, average acting on the femoral head and acetabular contact surface axially down, then set mesh density generated grid and set an example attribute operator.
Finite element model validation:Take the body of an adult cadaver of the femoral neck, remove the soft tissue around, save the complete bone structure, X-ray examination to exclude tumors, fractures and other lesions, bone mineral density test value of1.17g/cm2.-80℃freezer spare sealed in double plastic bags. remove the natural thawing at room temperature24h before the test, fracture simulation osteotomy of the femoral neck Pauwels-Ⅱ type fracture with the fracture line of50 0, and fixed with cannulated screw. Femoral neck cannulated screw:cannulated screws total length of90mm, and diameter of6.5mm, the threaded portion of was20mm in length, hollow part of the diameter of2.5mm. The lag screws in an inverted triangle position and separated from each other. Specimen model was fixed in the the electronic universal dynamic static material testing machine, the distal femur bicondylar connection with the horizontal parallel proceeds the femur axis with the sagittal line showed a23°angle, piriform fossa and greater trochanter fixed by nylon thread (tensile elastic modulus of9.7N/mm2and0.15N/mm2), respectively to be fixed, the fixing strength of10MPa. Subsequently,600N force perpendicular to the direction of femoral head, record the stress on eight points around the femoral neck and three times each, and compared with finite element analysis results.
Results
Based on CT scan data to establish a femoral neck fracture model, is feasible and effective. The three-dimensional finite element method can simulate a variety of structures, given the biological material properties of the various organizations, reflecting the overall trend of the biomechanical properties, which can be used as a specimen experiment. The established the finite element model of normal human femoral neck fractures and has good geometric similarity.
Conclusion
It is effective and accurate to perform finite element analysis for femoral neck fracture.
引文
[1]李卫平,王华明.发育性髋关节发育不良.中国组织工程研究与临床康复,2011；15(52)：9851-9854.
[2]王舒宜,陈汉勇,李刚,等.三维可视化技术在医学领域中的应用.现代电子技术,2009；(10)：91-93.
[3]汤敏,陈峰,陶玲.医学图像可视化及加速技术的研究进展和趋势.中国组织工程研究与临床康复,2011；15(4)：741-744.
[4]Choplin RH, Buckwalter KA, Rydberg J, et al. CT with 3D rendering of the tendons of the foot and ankle:technique, normal anatomy, and disease. Radiographics,2004; 24(2):343-356.
[5]Mckay DW. A comparison of the innominate and the pericapsular osteotomy in the treatment of congenital dislocation of the hip. Clin Orthop Relat Res,1974; (98):124-132.
[6]Carroll K L, Murray K A, Macleod L M, et al. Measurement of the center edge angle and determination of the Severin classification using digital radiography, computer-assisted measurement tools, and a Severin algorithm:intraobserver and interobserver reliability revisited. J Pediatr Orthop,2011; 31(4):e30-e35.
[7]Nemeth B A, Narotam V. Developmental dysplasia of the hip. Pediatr Rev,2012; 33(12):553-561.
[8]Lipton GE, Bowen JR. A new modified technique of triple osteotomy of the innominate bone for acetabular dysplasia. Clin Orthop Relat Res,2005; (434): 78-85.
[9]Steel HH. Triple osteotomy of the innominate bone. A procedure to accomplish coverage of the dislocated or subluxated femoral head in the older patient. Clin Orthop Relat Res,1977; (122):116-127.
[10]Lipton GE, Bowen JR. A new modified technique of triple osteotomy of the innominate bone for acetabular dysplasia. Clin Orthop Relat Res,2005; (434): 78-85.
[1]Rejholec M. Combined pelvic osteotomy for the bipartite acetabulum in late developmental dysplasia of the hip:a ten-year prospective study. J Bone Joint Surg Br.2011,93(2):257-61.
[2]Pauwels F:Biomechanics of the Normal and Diseased Hip:Theoretical Foundation,Technique and Results of Treatment. An Atlas. Berlin, Springer-Verlag 1-36,1976.
[3]Steel HH:Triple osteotomy of the innominate bone. J Bone Joint Surg 1973,55B:343-350.
[4]Lipton GE, Bowen JR.A new modified technique of triple osteotomy of the innominate bone for acetabular dysplasia.Clin Orthop Relat Res.2005,434:78-85
[5]Roach JW, Hobatho MC, Baker KJ, et al.Three-dimensional computer analysis of complex acetabular insufficiency.J Pediatr Orthop.1997,17(2):158-164.
[6]Mckay DW. A comparison of the innominate and the pericapsular osteotomy in the treatment of congenital dislocation of the hip. Clin Orthop Relat Res,1974; (98):124-132.
[7]Carroll K L, Murray K A, Macleod L M, et al. Measurement of the center edge angle and determination of the Severin classification using digital radiography, computer-assisted measurement tools, and a Severin algorithm:intraobserver and interobserver reliability revisited. J Pediatr Orthop,2011; 31(4):e30-e35.
[8]Graf R. New possibilities of the diagnosis of congenital hip joint dislocation by ultrasonography. J Pediatr Orthop.1983,3:354-359.
[9]Graf R. Hip Sonography:diagnosis and management of infant hip dysplasia. 2006.2nd Edtion.
[10]Ortiz-Neira CL, Paolucci EO, Donnon T. A meta-analysis of common risk factors associated with the diagnosis of developmental dysplasia of the hip in newborns. Eur J Radiol.2012,81(3):e344-51
[11]Bracken J, Ditchfield M. Ultrasonography in developmental dysplasia of the hip: what have we learned? Pediatr Radiol.2012,42(12):1418-1431.
[12]Harcke HT, Kumar SJ. The role of ultrasound in the diagnosis and management of congenital dislocation and dysplasia of the hip. J Bone Joint Surg Am.1991, 73(4):622-628.
[13]Dias JJ, Thomas IH,Lamont AC. The reliability of ultrasonographic assessment of neonatal hips. J Bone Joint Surg Br.1993,75(3):479-482.
[14]Rosendahl K, Aslaksen A, Lie RT, Markestad T. Reliability of ultrasound in the early diagnosis of developmental dysplasia of the hip. Pediatr Radiol.1995, 25(3):219-224.
[15]Noviek G, Ghelman B, Schneider M. Sonography of the neonatal and infant hip. Am J Roentgenol.1983,141(4):639-645.
[16]Morin C, Harcke HT, MacEwen GD. The infant hip:real-lime US assessment of acetabular development. Radiology.1985,157(3):673-677.
[17]Treguier C, Chapuis M, Branger B, Bruneau B, Grellier A, Chouklati K, Proisy M, Darnault P, Violas P, Pladys P, Gandon Y. Pubo-femoral distance:an easy sonographic screening test to avoid late diagnosis of developmental dysplasia of the hip. Eur Radiol.2012, Oct 20. [Epub ahead of print]
[18]Terjesen T, Bredland T, Berg V. Ultrasound for hip assessment in the newborn. J Bone Joint Surg Br.1989,71 (5):767-773.
[19]Engesaeter LB, Wilson DJ, Nag D, Benson MK. Ultrasound and congenital dislocation of the hip:the importance of dynamic assessment. J Bone Joint Surg Br.1990,72(2):197-201.
[20]Harcke HT. Screening newborns for developmental dysplasia of the hip:the role of sonography. Am J Roentgenol.1994,162(2):395-397.
[21]Suzuki S, Kasahara Y, Yamamoto A, Seto Y, Furukawa K, Nishino Y. Measurement of acetabular angle using ultrasound. Arch Orthop Trauma Surg. 1993,112(3):131-133.
[22]Rejholec M. Combined pelvic osteotomy for the bipartite acetabulum in late developmental dysplasia of the hip:a ten-year prospective study. J Bone Joint Surg Br.2011,93(2):257-61.
[23]Pauwels F:Biomechanics of the Normal and Diseased Hip:Theoretical Foundation,Technique and Results of Treatment. An Atlas. Berlin, Springer-Verlag 1-36,1976.
[24]Perlick L, Tingart M, Lerch K, et al. Navigation-assisted, minimally invasive implant removal following a triple pelvic osteotomy. Arch Orthop Trauma Surg. 2004,124(1):64-66.
[25]Lipton GE, Bowen JR.A new modified technique of triple osteotomy of the innominate bone for acetabular dysplasia.Clin Orthop Relat Res.2005, 434:78-85.
[26]Vedantam R, Capelli AM, Schoenecker PL. Pemberton osteotomy for the treatment of developmental dysplasia of the hip in older children. J Pediatr Orthop.1998,18(2):254-258.
[27]Wada A, Fujii T, Takamura K, Nakamura T, Yanagida H, Taketa M, Nakamura T. Pemberton osteotomy for developmental dysplasia of the hip in older children. J Pediatr Orthop.2003,23(4):508-513.
[28]Lipton GE, Bowen JR. A new modified technique of triple osteotomy of the innominate bone for acetabular dysplasia. Clin Orthop Relat Res,2005; (434): 78-85.
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[2]王舒宜,陈汉勇,李刚,等.三维可视化技术在医学领域中的应用.现代电子技术,2009；(10)：91-93.
[3]汤敏,陈峰,陶玲.医学图像可视化及加速技术的研究进展和趋势.中国组织工程研究与临床康复,2011；15(4)：741-744.
[4]Choplin RH, Buckwalter KA, Rydberg J, et al. CT with 3D rendering of the tendons of the foot and ankle:technique, normal anatomy, and disease. Radiographics,2004; 24(2):343-356.
[5]Mckay DW. A comparison of the innominate and the pericapsular osteotomy in the treatment of congenital dislocation of the hip. Clin Orthop Relat Res,1974; (98):124-132.
[6]Carroll K L, Murray K A, Macleod L M, et al. Measurement of the center edge angle and determination of the Severin classification using digital radiography, computer-assisted measurement tools, and a Severin algorithm:intraobserver and interobserver reliability revisited. J Pediatr Orthop,2011; 31(4):e30-e35.
[7]Nemeth B A, Narotam V. Developmental dysplasia of the hip. Pediatr Rev,2012; 33(12):553-561.
[8]Lipton GE, Bowen JR. A new modified technique of triple osteotomy of the innominate bone for acetabular dysplasia. Clin Orthop Relat Res,2005; (434): 78-85.
[9]Steel HH. Triple osteotomy of the innominate bone. A procedure to accomplish coverage of the dislocated or subluxated femoral head in the older patient. Clin Orthop Relat Res,1977; (122):116-127.
[10]Lipton GE, Bowen JR. A new modified technique of triple osteotomy of the innominate bone for acetabular dysplasia. Clin Orthop Relat Res,2005; (434): 78-85.
[1]Rejholec M. Combined pelvic osteotomy for the bipartite acetabulum in late developmental dysplasia of the hip:a ten-year prospective study. J Bone Joint Surg Br.2011,93(2):257-61.
[2]Pauwels F:Biomechanics of the Normal and Diseased Hip:Theoretical Foundation,Technique and Results of Treatment. An Atlas. Berlin, Springer-Verlag 1-36,1976.
[3]Steel HH:Triple osteotomy of the innominate bone. J Bone Joint Surg 1973,55B:343-350.
[4]Lipton GE, Bowen JR.A new modified technique of triple osteotomy of the innominate bone for acetabular dysplasia.Clin Orthop Relat Res.2005,434:78-85
[5]Roach JW, Hobatho MC, Baker KJ, et al.Three-dimensional computer analysis of complex acetabular insufficiency.J Pediatr Orthop.1997,17(2):158-164.
[6]Mckay DW. A comparison of the innominate and the pericapsular osteotomy in the treatment of congenital dislocation of the hip. Clin Orthop Relat Res,1974; (98):124-132.
[7]Carroll K L, Murray K A, Macleod L M, et al. Measurement of the center edge angle and determination of the Severin classification using digital radiography, computer-assisted measurement tools, and a Severin algorithm:intraobserver and interobserver reliability revisited. J Pediatr Orthop,2011; 31(4):e30-e35.
[8]Graf R. New possibilities of the diagnosis of congenital hip joint dislocation by ultrasonography. J Pediatr Orthop.1983,3:354-359.
[9]Graf R. Hip Sonography:diagnosis and management of infant hip dysplasia. 2006.2nd Edtion.
[10]Ortiz-Neira CL, Paolucci EO, Donnon T. A meta-analysis of common risk factors associated with the diagnosis of developmental dysplasia of the hip in newborns. Eur J Radiol.2012,81(3):e344-51
[11]Bracken J, Ditchfield M. Ultrasonography in developmental dysplasia of the hip: what have we learned? Pediatr Radiol.2012,42(12):1418-1431.
[12]Harcke HT, Kumar SJ. The role of ultrasound in the diagnosis and management of congenital dislocation and dysplasia of the hip. J Bone Joint Surg Am.1991, 73(4):622-628.
[13]Dias JJ, Thomas IH,Lamont AC. The reliability of ultrasonographic assessment of neonatal hips. J Bone Joint Surg Br.1993,75(3):479-482.
[14]Rosendahl K, Aslaksen A, Lie RT, Markestad T. Reliability of ultrasound in the early diagnosis of developmental dysplasia of the hip. Pediatr Radiol.1995, 25(3):219-224.
[15]Noviek G, Ghelman B, Schneider M. Sonography of the neonatal and infant hip. Am J Roentgenol.1983,141(4):639-645.
[16]Morin C, Harcke HT, MacEwen GD. The infant hip:real-lime US assessment of acetabular development. Radiology.1985,157(3):673-677.
[17]Treguier C, Chapuis M, Branger B, Bruneau B, Grellier A, Chouklati K, Proisy M, Darnault P, Violas P, Pladys P, Gandon Y. Pubo-femoral distance:an easy sonographic screening test to avoid late diagnosis of developmental dysplasia of the hip. Eur Radiol.2012, Oct 20. [Epub ahead of print]
[18]Terjesen T, Bredland T, Berg V. Ultrasound for hip assessment in the newborn. J Bone Joint Surg Br.1989,71 (5):767-773.
[19]Engesaeter LB, Wilson DJ, Nag D, Benson MK. Ultrasound and congenital dislocation of the hip:the importance of dynamic assessment. J Bone Joint Surg Br.1990,72(2):197-201.
[20]Harcke HT. Screening newborns for developmental dysplasia of the hip:the role of sonography. Am J Roentgenol.1994,162(2):395-397.
[21]Suzuki S, Kasahara Y, Yamamoto A, Seto Y, Furukawa K, Nishino Y. Measurement of acetabular angle using ultrasound. Arch Orthop Trauma Surg. 1993,112(3):131-133.
[22]Rejholec M. Combined pelvic osteotomy for the bipartite acetabulum in late developmental dysplasia of the hip:a ten-year prospective study. J Bone Joint Surg Br.2011,93(2):257-61.
[23]Pauwels F:Biomechanics of the Normal and Diseased Hip:Theoretical Foundation,Technique and Results of Treatment. An Atlas. Berlin, Springer-Verlag 1-36,1976.
[24]Perlick L, Tingart M, Lerch K, et al. Navigation-assisted, minimally invasive implant removal following a triple pelvic osteotomy. Arch Orthop Trauma Surg. 2004,124(1):64-66.
[25]Lipton GE, Bowen JR.A new modified technique of triple osteotomy of the innominate bone for acetabular dysplasia.Clin Orthop Relat Res.2005, 434:78-85.
[26]Vedantam R, Capelli AM, Schoenecker PL. Pemberton osteotomy for the treatment of developmental dysplasia of the hip in older children. J Pediatr Orthop.1998,18(2):254-258.
[27]Wada A, Fujii T, Takamura K, Nakamura T, Yanagida H, Taketa M, Nakamura T. Pemberton osteotomy for developmental dysplasia of the hip in older children. J Pediatr Orthop.2003,23(4):508-513.
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