- 期刊
Comparison of Stress Shielding among Different Cement Fixation Modes of Femoral Stem in Total Hip Arthroplasty-A Three-Dimensional Finite Element Analysis
不同骨水泥固定方式對於全人工髖關節置換術後應力遮蔽之比較－有限元素分析
摘要
以骨水泥或無骨水泥方式施行人工髖關節置換手術後，股骨近端皮質骨發生區域性骨質流失現象始終是骨科界無法解決的問題。應力遮蔽被公認為是造成骨質流失現象的主因之一。本研究以有限元素分析方法，針對無骨水泥、股骨柄上端包覆及股骨柄外圍全部包覆骨水泥等三種固定情況下，施行人工髖關節置換手術後三者間應力遮蔽及術後骨質流失的差異性。研究的方法，是利用人造股骨及電腦斷層影像分別建立完整股骨及以上述三種不同骨水泥固定方式施行人工髖關節置換手術後之股骨三維有限元素模型。在1,000牛頓的垂直壓力作用下，分別比較四種股骨之應變分佈差異性。分析結果顯示，無論以何種方式植入股骨柄，術後股骨近端均將產生應力遮蔽現象，其中以股骨柄上端包覆固定者所產生之應力遮蔽現象最為輕微；無水骨泥固定者最為顯著。我們研判，骨水泥的介入將使術後股骨應力分佈更為均勻，有利於減輕應力遮蔽效應。
並列摘要
Local bone loss after cementless and cemented implantation of prostheses remains an unsolved problem during the long-term application of total hip replacement. Stress shielding is considered to be one of several important factors that result in local bone loss after prosthesis implantation. This study was designed to investigate the roles of bone cement different fixation configurations on initial stress shielding using a three-dimensional finite element analysis. Synthetic femora were used to create four finite element models including intact, and femora after implantation of C-fit stem with three different configurations of cement fixation: cementless, proximally-cemented and fully-cemented fixations. Under a 1,000-N vertical loading, the proximal strain distributions of the four models were analyzed and compared. The results revealed that, regardless of cement fixation configurations, stress shielding was found at the proximal femur following the insertion of stem. Less stress shielding was found for femur with fully-cemented fixation, whereas the most obvious stress shielding was found in the femur with cementless fixation. The introduction of bone cement was considered to produce more uniform transmission of external force, which led to the reduction of stress shielding.
延伸閱讀
- 黃歆景（2010）。不同材質人工髖關節對全人工髖關節置換術醫療利用之影響〔碩士論文，國立臺灣大學〕。華藝線上圖書館。https://doi.org/10.6342/NTU.2010.00530
- Chen, C. Y., Huang, K. Y., Chang, J. K., Lin, G. T., & Lin, S. Y. (2000). 人工全髖關節置換術後之髖臼金屬外殼與聚乙烯內襯間之固鎖裝置失效一病例報告. The Kaohsiung Journal of Medical Sciences, 16(7), 368-374. https://doi.org/10.6452/KJMS.200007.0368
- 方強如（2011）。人工關節用骨水泥調製機轉之影響研究〔碩士論文，國立臺北科技大學〕。華藝線上圖書館。https://www.airitilibrary.com/Article/Detail?DocID=U0006-1908201114510500
- Shih, S. L., Cheng, C. K., & Chen, C. S. (2015). 以不同長度側鋼板之動態髖骨釘治療骨粗隆骨折－有限元素分析. 北市醫學雜誌, 12(1), 28-41. https://doi.org/10.6200/TCMJ.2015.12.1.03
- Tai, C. L., Chen, W. P., Lee, M. S., Lee, P. C., & Shih, C. H. (2004). 無骨泥式對稱型及解剖型股骨柄人工髖關節置換術後應力遮蔽之比較研究－體外力學測試. Journal of Medical and Biological Engineering, 24(4), 177-181. https://www.airitilibrary.com/Article/Detail?DocID=16090985-200412-24-4-177-181-a