摘要
背景:对于良性骨肿瘤患者而言,生存周期长,通过手术降低患者并发症发生概率并提高术后生活质量是目前广大医师共同追求的目标。通过探讨良性肿瘤患者的手术方式与预后,选择合理手术方式,预测并降低二次骨折风险,增加患者生活质量。目的:应用有限元技术分析股骨近端良性病变给予不同方案治疗后股骨颈处的受力情况,针对病灶范围较大的病例,评估不同治疗方式术后股骨颈处的稳定性与骨折风险。方法:根据10例股骨近端良性肿瘤患者(受试者)病变部位的术前CT数据,分别建立病灶刮除后填充骨水泥联合钢板内固定三维模型(A组)与病灶刮除后填充骨水泥三维模型(B组)。根据有限元方法模拟人行走股骨颈最大受力情况,对比2组模型术后股骨颈处应力峰值,并评估该处骨折风险。试验方案征得患者同意并经过承德医学院附属医院伦理委员会审查。结果与结论:①A组模型股骨颈处应力值小于B组,差异有显著性意义(P=0.007<0.05);②确认A组模型局部受力合理,采用A组方案对10例受试者进行手术治疗,另有17例符合条件但拒绝进入有限元实验的股骨近端良性病变患者接受A组手术方案;③术后随访14-42个月,随访期间复查影像学资料未发现术区新发骨折,内固定装置牢固无断裂。术后12个月,所有患者的国际骨与软组织肿瘤协会评分平均为(26.12±2.28)分;④提示通过有限元技术进行模拟受力评估与术后随访,验证了刮除病灶后填充骨水泥联合钢板内固定治疗股骨近端良性肿瘤更加合理有效,该方案可有效降低术后二次骨折发生风险,增强手术区域的稳定性。
BACKGROUND:For benign bone tumor patients,the life cycle is long.To reduce the incidence of complications and improve the quality of life after surgery through surgery is the common goal of physicians.The quality of life of patients can be increased through discussing the operation mode and prognosis of benign tumor patients,choosing the reasonable operation mode,predicting and reducing the risk of secondary fracture.OBJECTIVE:To analyze the femoral neck force after different surgical methods using finite element technique in the analysis of benign proximal femoral lesions,and to assess the stability of the femoral neck and the risk of fracture after different surgical procedures for cases with a wide range of lesions.METHODS:According to preoperative CT data of lesion sites in 10 subjects with benign tumor of proximal femur,three-dimensional model of internal fixation with bone cement and steel plate after focal curettage(group A)and three-dimensional model of treating with bone cement after focal curettage(group B)were set in this study.Finite element technique was used to simulate the maximum force of the femoral neck when walking.The stress peaks of the femoral neck were compared after surgery between the two groups.The risk of fracture at this location was assessed.Patients signed the informed consent.This study was approved by the Ethics Committee of Chengde Medical College.RESULTS AND CONCLUSION:(1)The stress was significantly lower in the group A than in the group B(P=0.007<0.05).(2)The local stress of the model was reasonable in the group A.Ten patients were operated with the protocol of the group A.An additional 17 patients with proximal femur benign lesions who met the requirements but refused to enter the finite element experiment were treated with the surgical program of the group A.(3)The patients were followed up for 14-42 months.During the follow-up,no new fracture was found in the operation area,and the internal fixation device was firm without fracture.At 12 months postoperatively,the mean Musculoskeletal Tumor Society score of all patients was(26.12±2.28).(4)The finite element technology for simulating the stress evaluation and postoperative follow-up verified that the treatment of proximal femur benign tumor with bone cement and steel plate internal fixation after curettage is more reasonable and effective.The scheme can effectively reduce the risk of secondary fracture and enhance the stability in the surgical area.
作者
杨朝昕
牛梦晔
刘月星
曹海营
孔令伟
赵景新
金宇
Yang Zhaoxin;Niu Mengye;Liu Yuexing;Cao Haiying;Kong Lingwei;Zhao Jingxin;Jin Yu(Department of Orthopedic Trauma,Affiliated Hospital of Chengde Medical College,Chengde 067000,Hebei Province,China)
出处
《中国组织工程研究》
CAS
北大核心
2020年第12期1841-1846,共6页
Chinese Journal of Tissue Engineering Research
关键词
股骨近端
良性病变
缺损
钢板
有限元
病灶刮除
力学分析
proximal femur
benign lesion
defect
steel plate
finite element
curettage
mechanical analysis
