Zhang Heng, Zhou Yu-Fan, Li Bo-Wen, Li Kuan-Xin, Liu Yang, Zhou Jian-Sheng, Zhao Jian-Ning
Department of Orthopaedics, the First Affiliated Hospital of Bengbu Medical University, Laboratory of Tissue and Transplant in Anhui Province, Bengbu Medical University, Bengbu 233004, Anhui, China; Department of Orthopaedics, General Hospital of Eastern Theater Command, Nanjing 210000, Jiangsu, China.
Clinical Medical School, Bengbu Medical University, Bengbu 233030, Anhui, China.
Zhongguo Gu Shang. 2024 May 25;37(5):505-15. doi: 10.12200/j.issn.1003-0034.20221143.
To analyze the hip joint biomechanics of the acetabular anatomical reconstruction and nonanatomical reconstruction in total hip arthroplasty (THA) for Crowe type Ⅲ developmental dysplasia of the hip (DDH) by finite element method, which provided theoretical foundation and experimental basis for the anatomical acetabular reconstruction during THA in clinical practice.
One patient with left end-stage hip arthritis secondary to Crowe type Ⅲ DDH was selected in this study, who underwent total hip arthroplasty in the orthopedic department of the First Affiliated Hospital of Bengbu Medical College in April 2020. This patient was female, 57 years old. The preoperative and postoperative three dimentional CT scan of the patient's pelvis were performed. Fourteen acetabular cup models with different anteversion, inclination and rotation center height were established in Mimics and 3-Matic software. The boundary and load conditions were set in Abaqus software. The Von Mises and stress distribution of the hip joint were calculated and observed.
In the Crowe type Ⅲ DDH THA, if the hip rotation center was restored anatomically and the acetabular cup's inclination was set as 40°, the cup's anteversion varied from 5° to 25°, the lowest Von Mises value of acetabular cup and polyethylene liner occured in 20°anteversioin;if the hip rotation center was restored anatomically and the acetabular cup's anteversion was set as 15°, the cup's inclination varied from 35° to 55°, the lowest Von Mises value of acetabular cup and polyethylene liner occured in 35° inclination;if the acetabular cup's anteversion and inclination were set as 15°and 40°respectively, the up migration of hip rotaion center varied from 0 mm to 20 mm, the lowest Von Mises value of acetabular cup and polyethylene liner occured in 10 mm up migration. In all fourteen models, the Von Mises value of the acetabulum, acetabulum cup and polyethylene liner were lowest when the acetabular cup's anteversion and inlcination were 15°, 35° respectively, as well as the rotation center was restored anatomically.
In total hip arthroplasty for Crowe type Ⅲ DDH, the anatomical restoration of hip rotation center with 15° anteversion and 35° inclination of the acetabular cup are suggested, bone graft above the acetabular cup and additional screws are recommended simultaneously to further reduce the Von Mises of hip joint.
采用有限元方法分析全髋关节置换术（THA）治疗CroweⅢ型发育性髋关节发育不良（DDH）时髋臼解剖重建与非解剖重建的髋关节生物力学，为临床THA术中髋臼解剖重建提供理论依据和实验基础。
选取1例2020年4月在蚌埠医学院第一附属医院骨科行全髋关节置换术的CroweⅢ型DDH继发左髋关节终末期关节炎患者。该患者为女性，57岁。对患者骨盆进行术前及术后三维CT扫描。在Mimics和3-Matic软件中建立14个不同前倾、倾斜和旋转中心高度的髋臼杯模型。在Abaqus软件中设置边界和载荷条件。计算并观察髋关节的Von Mises应力及应力分布。
在CroweⅢ型DDH的THA中，若髋关节旋转中心解剖复位，髋臼杯倾斜角设为40°，髋臼杯前倾角度在5°至25°之间变化时，髋臼杯及聚乙烯内衬的最低Von Mises值出现在前倾20°时；若髋关节旋转中心解剖复位，髋臼杯前倾角度设为15°，髋臼杯倾斜角在35°至55°之间变化时，髋臼杯及聚乙烯内衬的最低Von Mises值出现在倾斜35°时；若髋臼杯前倾和倾斜角分别设为15°和40°，髋关节旋转中心上移距离在0 mm至20 mm之间变化时，髋臼杯及聚乙烯内衬的最低Von Mises值出现在上移10 mm时。在所有14个模型中，当髋臼杯前倾和倾斜角分别为15°、35°且髋关节旋转中心解剖复位时，髋臼、髋臼杯及聚乙烯内衬的Von Mises值最低。
在CroweⅢ型DDH的全髋关节置换术中，建议髋关节旋转中心解剖复位，髋臼杯前倾15°、倾斜35°，同时建议在髋臼杯上方植骨并增加螺钉以进一步降低髋关节的Von Mises应力。
