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姓名 陳俊名(Chun-Ming Chen) 查詢紙本館藏 畢業系所 生物醫學工程研究所 論文名稱 客製化局部表面置換型人工髖關節的設計與分析
(Design and Finite-element Analyses of a Custom-made hip Prosthesis with Partially Resurfacing Concept)相關論文 檔案 [Endnote RIS 格式]
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至系統瀏覽論文 ( 永不開放)
摘要(中) 髖關節置換的長期臨床療效，仍一直是臨床醫師與人工關節設計師所關注的問題。骨組織切除量的多寡與手術後的穩定度，都是影響手術後療效的重要考量因素。相對而言，關節表面置換術(Joint Resurfacing Surgery)切除的骨頭量較少，因此能儘量保留自然的關節解剖外型，所以不會大幅改變關節的受力情形。另一方面，也可縮減麻醉時間與降低輸血及器械感染的機會，使得第二次手術成功率大幅提高。同時具有不需要淘空骨髓腔的手術特性，也適合微創型手術的應用。因此，目前關節表面置換手術在國外已又成為治療僅關節表面組織壞死或退化的方式了。
可將此類具有微骨切除量特性的關節表面置換術，細分成整體(Total)與局部(Partial)兩種型式。整體關節表面置換術會將有問題的關節骨頭表面整個切除，然後將具規格尺寸的置換物固定於削型後的關節面上。因此曲面與病患關節曲面無法完全配合。本研究針對現今臨床上表面置換型髖關節設計的缺點，考慮股骨球頭關節退化部位的曲面差異，結合醫學影像重建的技術。依據不同病患，建構客製化關節的曲面設計，以及相對應之手術器械。規劃模擬評估其整體可行性，並建構髖關節站立時的有限元素分析平台，藉以改進表面置換型人工髖關節之設計。
依據規劃之手術流程，加上實際打樣成品的設計修改，目前成果是具可行性的。再經由有限元素分析的結果證實本論文之設計確實有比使用中之人工關節效果好。
摘要(英) The lone-term clinical curative effect of the hip joint replacement has still been clinician and the joint prosthesis designer matter of concern. The number of quantity of the bone tissue excision and the stability after the operation both are the important consideration factors to influence the curative effect after the operation. Relatively, the joint resurfacing surgery excises the bone quantities are few, can therefore retain the natural joint anatomy property as far as possible, and the surgery will not chanfe joint’s stress situation largely. On the other hand, it may also reduce the anaesthesia time with to reduce the opportunity which the blood transfusion and the instrument infect, causes the second surgery success ratio to enhance largely. Simultaneously the surgery has the surgery characteristic that does not need to bail the well dry the medullary cavity of bones, is also suitable for the applications of the minimally incision surgery. Therefore, the joint resurfacing surgery in abroad has became the treatment way for only joint surface tissue necrosis or the degenerated again at present.
We can subdivide the joint resurfacing surgery that has the kind of the minimally bone excision quantity characteristic into total and partial two patterns. The total joint resurfacing surgery will excise the necrotic tissues on the joint head surface entirely; will then put the implant with standard size to fix on articular surface in the paring type.Therefore the curved surface and patient’s joint surface are unable to fit completely. This research is directed against the design’s fedects on the clinical hip resurfacing today, and considers the surface’s differences between the femoral head joint degenerated position, then combines the technology of the medical image reconstruction technology. According to different patient, constructs the customization joint surface design, as well as corresponds the surgery instrument. Plan to estimate its whole feasivility in simulation, and constructs the finite element analysis platform when the hip joint stande, ues to improve the design of the resurfacing artificial hip joint.
According to the operation procedures of planning, in addition, prototypes and revises the designs of implants and instruments, the achievement has feasibility at present. And then verify that the design of this thesis is really more effectual than the artificial joint prosthesis while using via the result of the finite element analysis.
關鍵字(中) ★ 程式設計
★ 客製化
★ 人工髖關節
★ 表面置換
★ 局部置換
★ 有限元素分析關鍵字(英) ★ partial resiefacing
★ finite element analysis
★ program design
★ resurfacing
★ artificial hip joint
★ Custom-made論文目次 摘 要 ............................................... iv
Abstract ............................................ v
致謝文 .............................................. vii
目錄 ................................................ viii
圖目 錄 ............................................. xii
表目 錄 ............................................. xxi
第一章、緒論 ........................................ 1
1-1 研究動機與目的 .................................. 1
1-2 髖關節介紹 ...................................... 3
1-2-1 髖關節之解剖學與運動特性介紹 .................. 3
1-2-2 髖關節之病理學介紹 ............................ 9
1-3 人工髖關節植入物介紹 ............................ 12
1-3-1 全置換型人工髖關節植入物 ...................... 14
1-3-2 全表面置換型人工髖關節植入物 .................. 14
1-4 文獻回顧 ........................................ 15
1-4-1 表面置換型人工關節之股骨頭壞死臨床研究 ........ 15
1-4-2 全表面置換型植入物之相關文獻 .................. 16
1-4-3 局部表面置換型人工髖關節之臨床成效 ............ 18
1-4-4 局部表面置換型植入物之規格、外型及手術流程 .... 18
1-4-5 髖關節有限元素分析之相關文獻 .................. 23
1-5 本文架構 ........................................ 26
第二章、材料與方法 .................................. 27
2-1 三維髖關節電腦模型的建立 ........................ 27
2-1-1 醫學影像資料之拍攝 ............................ 27
2-1-2 三維髖關節模型之重建 .......................... 29
2-2 表面置換型植入物與手術器械設計 .................. 32
2-2-1 表面置換型植入物設計理念 ...................... 32
2-2-2 手術器械設計理念 .............................. 38
2-2-3 人工髖關節毛胚客製化程式平台建立............... 47
2-2-4 植入物與手術器械之打樣 ........................ 50
2-3 手術流程模擬規劃 ................................ 52
2-3-1 手術器械銑料及微調方式 ........................ 52
2-3-2 近端股骨模型製作 .............................. 54
2-3-3 完整手術模擬流程 .............................. 60
2-4 表面置換後之髖關節生物力學有限元素分析 .......... 63
2-4-1 股骨實體分析模型之建立 ........................ 63
2-4-2 植入物實體模型之建立 .......................... 64
2-4-3 模型材料性質 .................................. 67
2-4-4 模型負載、邊界及介面條件 ...................... 67
2-4-5 有限元素模型網格化 ............................ 70
2-4-6 有限元素分析後處理探討參數介紹 ................ 73
第三章、結果 ........................................ 76
3-1 人工髖關節毛胚客製化程式平台 .................... 76
3-2 植入物與手術器械之打樣結果 ...................... 81
3-3 髖關節生物力學有限元素分析結果 .................. 83
3-3-1 股骨及植入物的應力色階分佈情形 ................ 83
3-3-2 完整模型之硬質骨外表面應力分佈情形 ............ 92
3-3-3 股骨頸三區塊之應力分佈情形 .................... 97
3-3-4 植入有柄式表面置換型植體模型之中心軸應力情形 .. 99
第四章、討論 ........................................ 103
4-1 植入物與手術器械之打樣結果討論 .................. 103
4-2 髖關節生物力學有限元素分析結果討論 .............. 106
4-2-1 應力分佈情形討論 .............................. 106
4-2-2 完整模型之之硬質骨外表面應力分佈情形討論 ...... 108
4-2-3 股骨頸三區塊之應力分佈情形討論 ................ 111
4-2-4 植入有柄式表面置換型植體模型之中心軸應力討論 .. 117
4-2-5 置換手術後骨頭體積剩餘量 ...................... 118
4-2-6 植入物與股骨頭外型比對 ........................ 119
第五章、結論與未來展望 .............................. 122
5-1 結論 ............................................ 122
5-2 未來展望 ........................................ 123
5-2-1 客製化人工髖關節植入物與手術器械............... 123
5-2-2 人工髖關節毛胚客製化程式平台 .................. 123
5-2-3 手術流程模擬實驗與臨床實驗 .................... 124
5-2-4 髖關節生物力學有限元素分析平台 ................ 124
參考文獻 ............................................ 125
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