arXiv 1901.074612019-01-14q-bio.TO

弧形钻孔技术治疗股骨头坏死的生物力学研究

A Biomechanical Study on the Use of Curved Drilling Technique for Treatment of Osteonecrosis of Femoral Head

Mahsan Bakhtiarinejad, Farshid Alambeigi, Alireza Chamani, Mathias Unberath, Harpal Khanuja, Mehran Armand

备注：: Accepted for 2018 MICCAI Workshop on Computational Biomechanics for Medicine XIII

摘要：

骨坏死是由于骨的血液供应丧失而发生的，导致骨小梁的自发死亡。延迟治疗所涉及的患者导致股骨头塌陷，这导致需要进行全髋关节置换术。髓芯减压术是治疗骨坏死最常用的技术，包括通过钻直隧道到病变处去除病变区域，清除死骨并用骨替代物替代。然而，这种治疗方法有两个缺点。首先，由于目前在髓芯减压期间使用的器械的刚性，病变不能被完全去除和/或过多的健康骨也可能与病变一起被去除。其次，尽管骨替代物具有生物相容性和骨传导性，但其使用可能无法为骨提供足够的机械强度和支撑。为了解决这些缺点，引入了一种新型机器人辅助弯曲髓芯减压（CCD）技术，为外科医生提供直接进入病变的途径，对健康骨造成最小的损伤。在这项研究中，借助有限元（FE）模拟，我们调查的生物力学性能的核心减压使用弯曲钻孔技术的存在下，正常的步态负荷。在这方面，我们比较了CCD使用骨替代品和灵活的植入物与其他传统的核心减压技术的结果。研究结果表明，与其他核心减压方法相比，CCD技术中发生在颈部上部区域的最大主应力较小（即52.847 MPa）。

英文摘要：

Osteonecrosis occurs due to the loss of blood supply to the bone, leading to spontaneous death of the trabecular bone. Delayed treatment of the involved patients results in collapse of the femoral head, which leads to a need for total hip arthroplasty surgery. Core decompression, as the most popular technique for treatment of the osteonecrosis, includes removal of the lesion area by drilling a straight tunnel to the lesion, debriding the dead bone and replacing it with bone substitutes. However, there are two drawbacks for this treatment method. First, due to the rigidity of the instruments currently used during core decompression, lesions cannot be completely removed and/or excessive healthy bone may also be removed with the lesion. Second, the use of bone substitutes, despite its biocompatibility and osteoconductivity, may not provide sufficient mechanical strength and support for the bone. To address these shortcomings, a novel robot-assisted curved core decompression (CCD) technique is introduced to provide surgeons with direct access to the lesions causing minimal damage to the healthy bone. In this study, with the aid of finite element (FE) simulations, we investigate biomechanical performance of core decompression using the curved drilling technique in the presence of normal gait loading. In this regard, we compare the result of the CCD using bone substitutes and flexible implants with other conventional core decompression techniques. The study finding shows that the maximum principal stress occurring at the superior domain of the neck is smaller in the CCD techniques (i.e. 52.847 MPa) compared to the other core decompression methods.

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