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髋关节置换术中多孔金属补片重建严重髋臼骨缺损的有限元分析研究。

Reconstruction of severe acetabular bone defects with porous metal augment in total hip arthroplasty: A finite element analysis study.

机构信息

School of Mechanical Engineering, Southwest Jiaotong University, Sichuan, Chengdu, China.

Department of Bioengineering, Faculty of Engineering, Imperial College London, London, UK.

出版信息

Proc Inst Mech Eng H. 2022 Feb;236(2):179-187. doi: 10.1177/09544119211052377. Epub 2021 Oct 22.

Abstract

This study aims to evaluate the reconstructive stability for Paprosky III acetabular defects after total hip arthroplasty using three different reconstruction strategies with trabecular metal (TM) augments. The acetabular bone defects examined were located in the ilium, the sciatic ramus and the pubic ramus. Different scenarios of acetabular reconstructions were simulated, including the non-reconstruction model (NRM), the complete reconstruction model (CRM), the two-point reconstruction model (TRM) and the superior edge reconstruction model (SRM). A primary hip replacement model (HRM) was also investigated to compare the initial stability with different reconstruction models. The gait cycle was incorporated in the model to investigate the dynamic variation within the contact mechanics parameters. By comparing the SRM and the TRM, the acetabular cup translation was more pronounced when the superior defect on the acetabulum remained unfixed. Comparison of the acetabular cup displacement and the interface micromotion of both HRM and CRM demonstrated that the prosthetic implant provided good support for the reconstructed acetabulum. With the use of a press-fit cup, the cup displacement was reduced remarkably, while its Von-Mises stress increased significantly. The results show that the CRM was the best reconstruction option. In terms of acetabular defects, future improvements should focus on the reconstructive stability in stress concentration areas, to ensure no significant stress-shielding or other factors contributing to loosening of the prosthesis.

摘要

本研究旨在评估三种不同的使用小梁金属(TM)增强物的重建策略对全髋关节置换术后 Paprosky III 型髋臼缺损的重建稳定性。研究中检查的髋臼骨缺损位于髂骨、坐骨支和耻骨支。模拟了不同的髋臼重建场景,包括非重建模型(NRM)、完全重建模型(CRM)、两点重建模型(TRM)和上缘重建模型(SRM)。还研究了一个原发性髋关节置换模型(HRM),以比较不同重建模型的初始稳定性。该模型纳入了步态周期,以研究接触力学参数的动态变化。通过比较 SRM 和 TRM,当髋臼的上侧缺损未固定时,髋臼杯的平移更为明显。比较 HRM 和 CRM 的髋臼杯位移和界面微动,表明假体植入物为重建的髋臼提供了良好的支撑。使用压配合杯可显著减少杯位移,同时其 Von-Mises 应力显著增加。结果表明,CRM 是最佳的重建选择。就髋臼缺损而言,未来的改进应侧重于在应力集中区域提高重建稳定性,以确保没有明显的应力屏蔽或其他导致假体松动的因素。

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