全髖關節表面置換用植入物之植入角度探討

以作者查詢圖書館館藏

、以作者查詢臺灣博碩士

、以作者查詢全國書目

、勘誤回報

、線上人數：13

、訪客IP：18.222.163.31

姓名

沈永如(Yung-ru Shen) 查詢紙本館藏

畢業系所

機械工程學系

論文名稱

全髖關節表面置換用植入物之植入角度探討

相關論文

★ 以擠製冷卻成型法結合相分離法製作神經再生用多孔性導管	★ 整合可調式阻力之手足復健機研究
★ 應用於肝腫瘤治療之超音波影像輔助機械臂HIFU燒灼實驗系統	★ 顱顏整型手術用植入物之設計與製作
★ 電腦輔助骨科手術用規劃及導引系統	★ 遠端遙控機械手臂腹腔鏡手術系統
★ 頭部CT與MR影像之融合	★ 手術用影像導引機械人定位及鑽孔系統
★ 機器人校正與醫學影像導引定位應用	★ 顱顏手術用規劃及導引系統
★ 醫學用超音波影像導引系統	★ 應用3D區域成長法於腦部磁共振影像之分割
★ 腦部手術用導引系統之方位校準及腦瘤影像分割	★ 超音波影像即時震波導引
★ 腫瘤偵測與顱顏骨骼重建	★ 骨科手術用C-arm影像輔助規劃及導引系統

檔案

[Endnote RIS 格式]

[Bibtex 格式]

[相關文章]

[文章引用]

[完整記錄]

[館藏目錄]

[檢視]

[下載]

本電子論文使用權限為同意立即開放。
已達開放權限電子全文僅授權使用者為學術研究之目的，進行個人非營利性質之檢索、閱讀、列印。
請遵守中華民國著作權法之相關規定，切勿任意重製、散佈、改作、轉貼、播送，以免觸法。

摘要(中)

近年來應用手術導引系統在髖關節表面置換手術(Hip Resurfacing Arthroplasty)已是成熟的技術，此一手術需將植入物的中心柱沿股骨頸的軸線方向植入，但是在解剖上對於此一軸線卻無嚴格的定義，故本研究的目的即在探討植入物的中心柱依各種軸線植入後對於股骨頸應力分佈之影響，以作為植入物中心柱植入準則的參考依據。
本研究針對所蒐集到的五種股骨頸軸線的定義，再將髖關節表面置換用的植入物依各種股骨頸軸線定義植入後，利用有限元素法進行應力分析，以比較各軸線模型的應力分布。並以完整股骨(Intact Femur)的應力分布作為比較的標準。分析的結果顯示最大安全通道為最佳的植入方向，但是各軸線模型的整體von Mises應力分布彼此的差異不到5%。為進一步找尋較佳的植入方向，便由最大安全通道方向設定偏斜10°的八個軸線模型，並進一步分析各軸線之間的應力分布差異。研究結果發現當植入物的軸線偏向最大安全通道上方、前方及後方都會令股骨頸的應力遮蔽效應變大而偏向下方時應力分布和完整股骨最為接近。因此進一步改變偏向下方的角度值進行應力分析，發現當下偏的角度在8°~17°時整體von Mises應力和完整股骨僅相差10%。故建議髖關節表面置用植入物的植入方向應選在最大安全通道下方8°~17°範圍內。

摘要(英)

Recently hip resurfacing arthroplasty is a well developed technology. A key procedure of HRA is to implant the shaft of the femoral component along so called the axis of femoral neck. Unfortunately, in anatomy, there is no commonly established definition of the axis of femoral neck. Therefore, this study aims for investigating into the effect of the orientation of femoral component on stress distribution in the femoral neck and we expect that the result could be referred for the implantation of femoral component.
Five definitions of the axis of femoral neck from different literatures were collected. The shaft of the femoral component was implanted along each of these axes. The distribution of von Mises stress of femoral neck was analyzed by using finite element method. From the results of analysis, we found that the stress distribution of the model of max tunnel is closest to that of the intact femur model. In order to find better orientation of femoral axis, eight biased axis models regularly spread up 10° around the axis of max tunnel were analyzed, too. The results have shown that the models of biased axes superior, posterior, or anterior to max tunnel would make significant stress shielding to the femur. The model of biased axis inferior to the max tunnel had closest stress distribution to that of intact femur model. Again, to find better orientation of femoral axis, the biased axes with different spreading angle inferior to the max tunnel were investigated and analyzed. The results have shown that the difference of stress distribution between the intact femur model and the axes models with spreading angle between 8°~17° was within 10%. It is the best spreading angle to inferior for place implant. It is recommended to implant the femoral component along the axis 8°~17° inferior to the max tunnel.

關鍵字(中)

★ 股骨頸軸線
★ 植入方向
★ 有限元素分析
★ 髋關節表面重建

關鍵字(英)

★ Femoral Neck Axis
★ FEM
★ Hip Resurfacing Arthroplasty

論文目次

中文摘要 i
Abstract ii
誌謝 iii
目錄 iv
圖目錄 vii
表目錄 x
第1章緒論 1
1-1 前言 1
1-2 研究動機 2
1-3 文獻回顧 3
1-4 各章內容介紹 6
第2章研究方法 7
2-1 研究方法概說 7
2-2 有限元素分析的環境建立 7
2-2-1 有限元素介紹 7
2-2-2 模型的建置 8
2-2-3 有限元素分析的參數設定 10
2-3 破壞理論 12
2-4 完整股骨分析 14
2-4-1 完整股骨應力分析結果 14
2-4-2 完整股骨結果驗證 21
第3章植入方向之應力分析與比較 26
3-1 股骨頸軸線定義 26
3-2 各組模型分析結果 31
3-2-1 以Karlsson軸線植入的模型結果 32
3-2-2 以Ziylan軸線植入的模型結果 38
3-2-3 以Mahaisavariya軸線植入的模型結果 44
3-2-4 以范紀偉軸線植入的模型結果 50
3-2-5 以最大安全通道軸線植入的模型結果 56
3-3 各組模型結果比較 62
3-3-1 整體結果比較 62
3-3-2 各環上不同軸線模型的應力分布比較 64
3-3-3 各方向上不同軸線模型的應力分布 67
3-4 各軸線模型分析討論 71
3-4-1 各軸線應用在手術導引上的論述 71
3-4-2 全髖表面置換植入物對股骨應力分布的影響 72
3-4-3 各個軸線比較結果： 73
第4章搜尋更佳植入軸線 77
4-1 設定植入方向偏向 77
4-2 植入方向偏向的結果 78
4-3 植入方向偏向討論 88
4-3-1 垂直偏向分析 88
4-3-2 水平偏向分析 90
4-3-3 下偏向軸線的範圍搜尋 94
4-3-4 軸線偏向結果整理 96
第5章結論與未來展望 98
5-1 結論 98
5-2 未來展望 99
參考文獻 101

參考文獻

[1]. Adams, D., and Quigley, S., “Hip resurfacing: Past, present and future.” Journal of Orthopaedic Nursing, Vol. 9, Issue 2, pp.87-94, 2005.
[2]. Amstutz, H.C., Beaulé, P.E. , Dorey, F.J., et.al, "Metal-on-Metal Hybrid Surface Arthroplasty: Two to Six-Year Follow-up Study.", The Journal of Bone & Joint Surgery, Vol. 86-A, pp. 28-39, January 2004.
[3]. Amstutz, H.C., Campbell, P.A. AND Le Duff, M.J., "Fracture of the Neck of the Femur After Surface Arthroplasty of the Hip", Journal of Bone & Joint Surgery - American Volumn, Vol.86-A, pp.1874-1877, 2004
[4]. Amstutz, H.C., Beaulé, P.E. , Dorey, F.J., et.al, "Metal-on-Metal Hybrid Surface Arthroplasty", The Journal of Bone & Joint Surgery, Vol. 88-A, pp.234-249, September 2006
[5]. Beaulé, P.E., Dorey, F.J., Le Duff, M., et.al, "Risk Factors Affecting Outcome of Metal-on-Metal Surface Arthroplasty of the Hip", Clinical orthopaedics and related research, Vol.418, pp.87-93, January 2004
[6]. Beaulé, P.E., Lee, J.L., Le Duff, M.J., "Orientation of the Femoral Component in Surface Arthroplasty of the Hip.- A Biomechanical and Clinical Analysis." The Journal of Bone & Joint Surgery, Vol. 86-A, Number 9, pp.2015-2021, September 2004
[7]. Becker, E.B., Carey, G.F., & Oden, J.T., "FINITE ELEMENTS An Introduction", Prentice-Hall, USA, 1981
[8]. Brand, R.A., Pedersen, D.R. and Friederich, J.A., "The sensitivity of muscle force predictions to changes in physiologic cross-sectional area." Journal of Biomechanics, Vol.19, pp.589–596, 1986.
[9]. Davis, E.T., Gallie, P., Macgroarty, K., Waddell, J. P., Schemitsch, E., "The accuracy of image-free computer navigation in the placement of the femoral component of the Birmingham Hip Resurfacing- A Cadaver Study" Journal of Bone and Joint Surgery - British Volume, Vol 89-B, Issue 4, pp.557-560, 2007
[10]. Duda, G.N., Brand, D., and Freitag, S., et.al, "Variability of femoral muscle attachments." Journal of Biomechanics. 29, pp.1185–1190, 1996.
[11]. Ebied, A., and Journeaux, S., “Metal-on-metal hip resurfacing.” Current Orthopaedics, Vol. 16, Issue 6, pp.420-425, 2002.
[12]. Ganapathi, M., Evans, S. and Roberts, P., "Strain pattern following surface replacement of the hip", Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine, Vol.222, pp.13-18, 2008
[13]. Karlsson, K.M., Sernbo, I., Obrant, K.J., et.al, "Femoral Neck Geometry and Radiographic Signs of Osteoporosis As Predictors of Hip Fracture", Bone, Vol. 18, No. 4, pp. 327-330, April 1996.
[14]. Little, J.P., Taddei, F., Viceconti, M., et al, "Changes in femur stress after hip resurfacing arthroplasty: Response to physiological loads." Clinical Biomechanics, Vol. 22, pp.440–448, 2007.
[15]. Mahaisavariya, B., Sitthiseripratip, K., Tongdee, T., et.al., “Morphological study of the proximal femur: a new method of geometrical assessment using 3-dimensional reverse engineering,”Medical Engineering and Physics, Vol. 24, pp. 617-622, 2002.
[16]. Marker, D.R., Seyler, T.M., Jinnah, R.H., "Femoral Neck Fractures After Metal-on-Metal Total Hip Resurfacing A Prospective Cohort Study", The Journal of Arthroplasty, Vol. 22, No. 7,pp.66-71, 2007.
[17]. Nishii, Takashi., et al, "Five-Year Results of Metal-on-Metal Resurfacing Arthroplasty in Asian Patients." The Journal of Arthroplasty Vol. 22 No. 2 2007.
[18]. Olsen, M., Davis, E.T., Gallie, P.A.M., et.al, "The Reliability of Radiographic Assessment of Femoral Neck-Shaft and Implant Angulation in Hip Resurfacing Arthroplasty", The Journal of Arthroplasty, Vol. 24, No. 3, pp.333-340, 2009
[19]. Olsen, M., Davis, E.T., Waddell, J.P., Schemitsch, E.H., "Imageless computer navigation for placement of the femoral component in resurfacing arthroplasty of the hip." Journal of Bone and Joint Surgery - British Volume, Vol. 91-B, Issue 3, pp.310-315, 2009.
[20]. Radcliffe, I.A.J., Taylor, M., "Investigation into the effect of varus–valgus orientation on load transfer in the resurfaced femoral head: A multi-femur finite element analysis." Clinical Biomechanics, Vol. 22, pp.780–786, 2007.
[21]. Rafferty, K.L., "Structural design of the femoral neck in primates", Journal of Human Evolution, Vol. 34, pp.361–383, 1998
[22]. Schmalzierd, T.P., “Why Total Hip Resurfacing,” The Journal of Arthroplasty Vol. 22 No. 7 Suppl. 3 2007.
[23]. Shih, K.S., Tseng, C.S., Lee, C.C., "Influence of muscular contractions on the stress analysis of distal femoral interlocking nailing", Clinical Biomechanics, Vol. 23, pp.38–44, 2008
[24]. Shimmin, A.J., Anat, D., Bare, J., et.al, "Complications Associated with Hip Resurfacing Arthroplasty", Orthopedic Clinics of North America, Vol.36, pp.187–193, 2005
[25]. Shimmin, A.J. and Back, D., "Femoral neck fractures following Birmingham hip resurfacing", Journal of Bone and Joint Surgery - British Volume, Issue 4, Vol 87-B, pp.463-464, 2005
[26]. Simoes, J.A., Vaz, M.A., Blatcher, S., et.al, "Influence of head constraint and muscle forces on the strain distribution within the intact femur", Medical Engineering & Physics, Vol.22, pp.453–459, 2000.
[27]. Spencer, S., Carter, R., Murray, H., et.al, "Femoral Neck Narrowing After Metal-on-Metal Hip Resurfacing", The Journal of Arthroplasty, Vol.23, Issue.8, pp.1105-1109, 2008
[28]. Tai, C.L., Shih, C.H., Chen, W.P., et.al, "Finite element analysis of the cervico-trochanteric stemless femoral prosthesis", Clinical Biomechanics, Vol.18, pp.S53–S58, 2003
[29]. Taylor, M.E., Tanner, K.E., Freeman, M.A., et.al, "Stress and strain distribution within the intact femur: compression or bending?" Medical Engineering & Physics, Vol.18, pp.122–131., 1996.
[30]. Taylor, M., "Finite element analysis of the resurfaced femoral head", Proceedings of the Institution of Mechanical Engineers. Part H, Journal of engineering in medicine, Vol.220(2), pp.289-297, February 2006
[31]. Zheng, G., Marx, A., Langlotz, U., et. al., “A hybrid CT-free navigation system for total hip arthroplasty,” Computer Aided Surgery, Vol. 7, Issue 3, pp. 129-145, 2002
[32]. Ziylan, T., and Murshid, K.A., “An analysis of anatolian human femur anthropometry,” Turkish Journal of Medical Sciences, Vol. 32, Issue 3, pp. 231-235, March 2002.
[33]. 范紀偉, "應用於髖關節表面重建手術之C-arm 影像輔助手術導引系統", 碩士論文, 中央大學機械工程研究所, 2007

指導教授

曾清秀(Ching-Shiow Tseng)

審核日期

2009-8-3

推文