北京生物醫(yī)學工程

股骨頭壞死中松質(zhì)骨微觀力學特性的演變規(guī)律

Evolution of micromechanical properties of cancellous bone in osteonecrosis of the femoral head

作者：張長灝孟昊業(yè) 汪愛媛劉有軍馬海洋楊海勝

單位：北京工業(yè)大學環(huán)境與生命學部(北京100124) 中國人民解放軍總醫(yī)院骨科研究所(北京100853)

關(guān)鍵詞：顯微 CT; 有限元分析; 股骨頭壞死; 松質(zhì)骨; 微觀力學性能

分類號：R318

出版年·卷·期（頁碼）：2021·40·2（123-129）

摘要：

目的采用結(jié)合顯微 CT 和顯微有限元分析方法,即基于顯微 CT 圖像建立三維有限元模型并進行數(shù)值模擬仿真分析,無創(chuàng)研究不同分期的壞死股骨頭松質(zhì)骨的微結(jié)構(gòu)和微觀力學性能,以期了解在股骨頭壞死的發(fā)展過程中,松質(zhì)骨微結(jié)構(gòu)和微觀力學特性的變化規(guī)律,為臨床預測股骨頭壞死提供理論基礎(chǔ)? 方法采集 10 例股骨頭壞死患者的股骨頭標本的顯微 CT 圖像,按照國際骨循環(huán)研究學會分期標準分為Ⅱ 期樣本 3 例,Ⅲ 期 3 例,Ⅳ期 4 例? 將圖像中骨組織進行閾值分割,分區(qū)域建立壞死區(qū)?側(cè)向區(qū)?硬化區(qū)和遠端區(qū)的松質(zhì)骨塊三維有限元模型(邊長 8 mm),并根據(jù) CT 值賦予非均勻材料屬性? 利用 ImageJ 軟件中的 BoneJ 插件通過識別顯微 CT 組圖像,計算測量各區(qū)域松質(zhì)骨的微結(jié)構(gòu)參數(shù),包括骨體積分數(shù)?骨小梁厚度?骨小梁間隙?結(jié)構(gòu)模型指數(shù)? 對松質(zhì)骨塊施加表觀應(yīng)變?yōu)?1%的壓縮載荷,計算骨組織應(yīng)力和松質(zhì)骨表觀剛度等參數(shù),對比分析各分期?各分區(qū)結(jié)果? 結(jié)果在松質(zhì)骨微結(jié)構(gòu)方面,Ⅳ期較Ⅱ 期的股骨頭內(nèi)部硬化區(qū)和壞死區(qū)的變化最為明顯,硬化區(qū)的骨體積分數(shù)不斷上升,骨小梁間隙下降,結(jié)構(gòu)模型指數(shù)減小,而壞死區(qū)域與之相反;在骨組織微觀受力方面,Ⅱ 期到Ⅲ 期壞死區(qū)域的應(yīng)力并沒有明顯變化,而硬化區(qū)域隨著分期增加應(yīng)力不斷上升,側(cè)向區(qū)的應(yīng)力不斷下降? 表觀剛度變化與應(yīng)力變化一致? 結(jié)論隨著股骨頭壞死程度的加劇,硬化區(qū)的松質(zhì)骨微結(jié)構(gòu)和力學性能變化最大,應(yīng)作為臨床早期診斷中重點關(guān)注的區(qū)域? 此外,微結(jié)構(gòu)參數(shù)并不能準確體現(xiàn)松質(zhì)骨的力學行為,而股骨頭塌陷最終取決于其力學特性,因此結(jié)合有限元分析方法可更加全面了解股骨頭壞死的微觀力學演變規(guī)律?

Objective In this study, the microstructure parameters and mechanical properties of the trabecular bone in different areas of the femoral head in different periods were compared by combining the methods of micro CT and finite element analysis, which meant 3D finite element model based on micro CT image and numerical simulation analysis, to understand the changes of the internal trabecular bone in the pathogenesis of the osteonecrosis of the femoral head and provide a theoretical basis for clinical prediction of the necrosis of the femoral headMethods Ten cases of osteonecrosis of the femoral head were scanned by micro CT the third stage and 4 cases in the fourth stage according to the ARCO stage element models of trabecular bone cube of necrotic area, lateral area, sclerotic area and distal area (side length 8 mm) were established in different regions, and the heterogeneous material attribute was given according to the CT value the trabecular bones in each region were calculated, including bone volume fraction, bone trabecular thickness, bone trabecular space and structural model index of 1% of the apparent strain calculated, and the results of different stages and zones were comparedResults In the aspect of microstructure, the sclerotic area and necrotic area of the femoral head changed the most from stage Ⅱ to stage IV, the bone volume fraction of the sclerotic area increased continuously, the trabecular separation decreased, the structure model index decreased, and the necrotic area was the opposite the stress of necrotic area in stage Ⅱ to stage Ⅲ did not change obviously, while the stress in sclerotic area increased with the increase of stages is consistent with the change of stressConclusions With the aggravation of the necrosis of the femoral head, the microstructure and mechanical properties of the cancellous bone in the sclerotic area change the most, which should be the focus of early clinical diagnosis reflect the mechanical behavior of trabecular bone, and the collapse of the femoral head ultimately depends on its mechanical properties comprehensively understand the micromechanical evolution law of femoral head necrosis

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