本文選題：距骨缺血性壞死 + 骨隧道　； 參考：《遵義醫(yī)學(xué)院》2015年碩士論文

【摘要】：目的:應(yīng)用三維有限元建立正常距骨模型、距骨缺血性壞死模型及打入骨髓道后壞死距骨模型。分析正常距骨、壞死距骨、打入骨髓道后壞死距骨表面的應(yīng)力及位移數(shù)據(jù)變化,找出最合適的骨隧道位置,為臨床治療距骨缺血性壞死提供參考。方法:對正常人的踝關(guān)節(jié)行64排薄層螺旋CT掃描獲得人踝關(guān)節(jié)的三維數(shù)據(jù),通過圖像處理軟件建立幾何模型,導(dǎo)入到有限元軟件中生成距骨的三維有限元實(shí)驗?zāi)Ｐ?參照文獻(xiàn)模擬距骨壞死模型,另模擬在距骨體-頸交界部位打入骨隧道,挖出死骨,再植入人工骨,分析人自然站立位時距骨表面的應(yīng)力及位移數(shù)據(jù)變化,從中找出對距骨表面應(yīng)力及位移影響最小的骨隧道方向。結(jié)果:我們成功建立了距骨的三維有限元模型圖,共有節(jié)點(diǎn)159271個,單元122442個,其中松質(zhì)骨110898個,密質(zhì)骨11544個。建立的距骨形態(tài)還原性良好。當(dāng)距骨外側(cè)壞死時,在應(yīng)力方面,壞死距骨表面應(yīng)力明顯大于正常距骨表面應(yīng)力;打入骨隧道后壞死距骨表面應(yīng)力均小于壞死距骨表面應(yīng)力,但是均大于正常距骨表面應(yīng)力,內(nèi)側(cè)骨隧道距骨表面應(yīng)力最小;位移方面,壞死距骨位移小于正常距骨位移;外側(cè)、中部、內(nèi)側(cè)骨隧道距骨位移均大于正常及壞死距骨位移。距骨內(nèi)側(cè)壞死后,在應(yīng)力方面,結(jié)果同距骨外側(cè)壞死,外側(cè)、中部、內(nèi)側(cè)骨隧道距骨表面應(yīng)力比較,中部的應(yīng)力最小。在位移方面,距骨內(nèi)側(cè)壞死的位移同距骨外側(cè)壞死,外側(cè)、中部、內(nèi)側(cè)骨隧道距骨位移比較,變化不大,中部及內(nèi)側(cè)的位移相同,小于外側(cè)的位移。結(jié)論:通過本次實(shí)驗,我們成功建立了正常距骨、壞死距骨和打入骨髓道后壞死距骨的三維有限元模型,并觀察了當(dāng)人自然站立位時,正常距骨、壞死距骨、打入骨髓道后壞死距骨的應(yīng)力云圖及位移云圖,實(shí)驗結(jié)果發(fā)現(xiàn)當(dāng)距骨發(fā)生壞死時,距骨的力學(xué)環(huán)境發(fā)生明顯變化,表面應(yīng)力明顯大于正常距骨表面應(yīng)力,通過有限元軟件模擬對壞死距骨打入骨隧道后,距骨表面應(yīng)力均明顯小于壞死距骨表面應(yīng)力,但均大于正常距骨表面應(yīng)力,說明內(nèi)、中、外側(cè)3種骨隧道在恢復(fù)距骨力學(xué)壞境方面有所貢獻(xiàn),但均無法讓距骨的力學(xué)環(huán)境恢復(fù)正常;另外,我們通過對不同骨隧道進(jìn)行比較發(fā)現(xiàn):當(dāng)距骨外側(cè)發(fā)生壞死時,從距骨頸-體部交界部位內(nèi)側(cè)打入骨隧道后,距骨表面應(yīng)力最接近于正常距骨表面應(yīng)力,對距骨的表面應(yīng)力影響最小,應(yīng)屬最佳方案;當(dāng)距骨內(nèi)側(cè)發(fā)生壞死時,內(nèi)、中、外側(cè)3種骨隧道距骨表面應(yīng)力變化不大,但相比較而言,中間骨隧道距骨表面應(yīng)力最接近于正常距骨表面應(yīng)力,對距骨表面應(yīng)力影響最小,可作為最佳方案。
[Abstract]:Objective: to establish the normal talus model, the talus ischemic necrosis model and the talus model after penetrating the bone marrow canal by using three dimensional finite element method.The data of stress and displacement on the surface of the necrotic talus after penetrating into the bone marrow tract were analyzed to find out the most suitable location of the bone tunnel and to provide a reference for clinical treatment of avascular necrosis of the talus.Methods: the 3D data of human ankle were obtained by 64 row spiral CT scanning of ankle joint. The geometric model was established by image processing software, and the three-dimensional finite element model of talus was generated by introducing it into the finite element software.According to the model of talus osteonecrosis, the model of talus osteonecrosis was simulated, and the dead bone was dug out at the junction of talus and neck, and then the artificial bone was implanted. The data of stress and displacement on the surface of talus were analyzed when the human was standing naturally.The direction of bone tunnel which has the least influence on the surface stress and displacement of talus is found out.Results: we successfully established the three-dimensional finite element model of talus. There were 159271 nodes and 122442 units, of which the cancellous bone was 110898 and the dense bone was 11544.The shape of talus was reduced well.When the lateral talus is necrotic, the surface stress of the necrotic talus is obviously greater than that of the normal talus, the surface stress of the necrotic talus is smaller than that of the necrotic talus, but the surface stress of the necrotic talus is larger than that of the normal talus.The displacement of necrotic talus is smaller than that of normal talus, and that of lateral, middle and medial tunnel is greater than that of normal and necrotic talus.After the medial talus necrosis, the stress in the middle part of the talus was the smallest compared with the lateral necrosis, lateral necrosis, middle part and medial tunnel of talus.In terms of displacement, the displacement of medial necrosis of talus is similar to that of lateral necrosis, lateral, middle and medial bone tunnel of talus. The displacement of middle and medial talus is the same and smaller than that of lateral.Conclusion: through this experiment, we have successfully established the three-dimensional finite element model of normal talus, necrotic talus and necrotic talus after penetrating into bone marrow tract, and observed the normal talus and necrotic talus when people were standing naturally.The stress cloud image and displacement cloud image of the necrotic talus after penetrating into the bone marrow tract. The experimental results show that the mechanical environment of the talus changes obviously when the talus necrosis occurs, and the surface stress is obviously larger than that of the normal talus surface stress.After penetrating the necrotic talus into the tunnel by the finite element software, the surface stress of the talus is obviously smaller than that of the necrotic talus, but higher than that of the normal talus.Three kinds of lateral bone tunnels have contributed to the restoration of mechanical condition of talus, but none of them can make the mechanical environment of talus return to normal. In addition, we have compared different bone tunnels and found that: when the lateral talus necrosis occurs,After penetrating into the tunnel from the medial part of the talus neck-body junction, the surface stress of the talus is the closest to the normal one, which has the least influence on the surface stress of the talus.However, the surface stress of talus in the middle tunnel was the closest to the normal one, and had the least effect on the surface stress of talus.
【學(xué)位授予單位】：遵義醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R687.3

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