Penix A R, Cook S D, Skinner H B, Weinstein A M, Haddad R J
Clin Orthop Relat Res. 1983 Mar(173):159-65.
A two-dimensional finite element model was used to compare the femoral head stress distribution of an intact femur with that of a femur following core biopsy and biopsy with cortical grafting. There was a decrease in superior and lateral femoral head stresses of up to 50% by an incorporated and properly placed cortical graft. Core biopsy and cortical grafting short of the subchondral plate produced stress-concentrating effects. A medially placed cortical graft did not stress-relieve the superolateral femoral head. Thus, if cortical grafting is to be undertaken, the graft should extend from the lateral cortex to the subchondral plate, transfixing the length of the necrotic segment. Because of deleterious effects on femoral head stress distribution, core biopsy without cortical grafting should be discouraged or only very cautiously used.
使用二维有限元模型比较完整股骨与经髓芯活检及带皮质骨移植活检后的股骨的股骨头应力分布。通过植入并正确放置的皮质骨移植，股骨头上部和外侧的应力可降低多达50%。髓芯活检及软骨下板以下的皮质骨移植会产生应力集中效应。内侧放置的皮质骨移植不能缓解股骨头外上侧的应力。因此，如果要进行皮质骨移植，移植应从外侧皮质延伸至软骨下板，贯穿坏死段的长度。由于对股骨头应力分布有有害影响，应避免或非常谨慎地使用无皮质骨移植的髓芯活检。
