基于MRI的有限元建模和分析在髋臼周围截骨术中的应用

doi:10.11938/cjmr20233058

摘要/Abstract

摘要：

髋臼周围截骨术（PAO）是一种矫正发育性髋关节发育不良(DDH)髋臼方向的手术方法．本文基于DDH患者的髋关节磁共振成像（MRI）数据，构建有限元模型，进行PAO虚拟手术规划研究．通过计算髋臼从原始中心边缘（CE）角以5°增量变化旋转时，骨盆和股骨软骨间的峰值接触压力和接触面积，确定PAO中髋臼的最佳位置．此外，我们进一步利用有限元分析对术前和获得最佳位置的计划模型进行6个方向的模拟运动，并对所有方案的术前模型和计划模型进行了比较．分析结果表明，该患者髋臼最佳手术位置在CE角为20°时，且在髋关节运动过程中，计划模型中的峰值接触压力均低于术前模型，接触面积均大于术前模型，从生物力学的角度验证了虚拟手术规划的有效性．

关键词: 磁共振成像, 有限元分析, 发育性髋关节发育不良, 髋臼周围截骨术, 虚拟手术规划

Abstract:

Periacetabular osteotomy (PAO) is a surgical procedure to correct acetabular orientation in developmental dysplasia of the hip (DDH). In this work, magnetic resonance imaging-based finite element models of hip joint were introduced to perform virtual surgery planning for patients with DDH. The optimal position of acetabulum following PAO was determined by analyzing the peak contact pressure and contact area between the femoral and pelvic cartilage when the acetabulum rotated from the original center edge (CE) angle in increments of 5°. Furthermore, with finite element analysis, we simulated joint movements in both the preoperative model and the planned model with the optimal position for the six cases. A comparison between the preoperative and planned models for all scenarios was made. The outcomes of finite element analysis revealed that the optimal position of acetabulum was at a CE angle of 20°. In all evaluated scenarios, the planned model showed lower peak contact pressure and larger contact area than the preoperative model did. The efficacy of virtual surgery planning was thus validated from a biomechanical perspective.

Key words: magnetic resonance imaging, finite element analysis, developmental dysplasia of the hip, periacetabular osteotomy, virtual surgical planning

中图分类号:

O482.53

周甜丽, 张典, 吴继志, 贾慧惠, 常严, 盛茂, 杨晓冬. 基于MRI的有限元建模和分析在髋臼周围截骨术中的应用[J]. 波谱学杂志, 2023, 40(4): 397-409.

ZHOU Tianli, ZHANG Dian, WU Jizhi, JIA Huihui, CHANG Yan, SHENG Mao, YANG Xiaodong. Application of MRI-based Finite Element Modeling and Analysis in Periacetabular Osteotomy[J]. Chinese Journal of Magnetic Resonance, 2023, 40(4): 397-409.

图/表 13

图1

图2

图3

表1

表2

表3

图4

图5

图6

图7

图8

图9

图10

参考文献 31

[1]	YANG S, ZUSMAN N, LIEBERMAN E, et al. Developmental dysplasia of the hip[J]. Pediatrics, 2019, 143(1).
[2]	Wu M D, Feng J, Jia H H, et al. MRI-based morphological quantification of developmental dysplasia of the hip in children[J]. Chinese J Magn Reson, 2020, 37(4): 434-446.
	吴明娣, 冯洁, 贾慧惠, 等. 儿童发育性髋关节脱位的磁共振形态学定量[J]. 波谱学杂志, 2020, 37(4): 434-446.
[3]	GANZ R, KLAUE K, VINH T S, et al. A new periacetabular osteotomy for the treatment of hip dysplasias. Technique and preliminary results[J]. Clin Orthop Relat R, 1988, (232): 26-36. pmid: 3383491
[4]	HAKIM N S, KING A I. A three dimensional finite element dynamic response analysis of a vertebra with experimental verification[J]. J Biomech, 1979, 12(4): 277-285 & 287-292. pmid: 468853
[5]	TANNE K, SAKUDA M. Biomechanical and clinical changes of the craniofacial complex from orthopedic maxillary protraction[J]. Angle Orthod, 1991, 61(2): 145-152. pmid: 2064072
[6]	GAMBOA A, COSA A, BENET F, et al. A semiautomatic segmentation method, solid tissue classification and 3D reconstruction of mandible from computed tomography imaging for biomechanical analysis[C]// Barcelona, SPAIN:9th IEEE International Symposium on Biomedical Imaging (ISBI) - From Nano to Macro, 2012: 1483-1486.
[7]	WANG Y C, YANG D, ZHAO L H, et al. Finite element analysis of mechanical characteristics of internal fixation for treatment of proximal femoral osteolytic lesions in children[J]. Orthop Surg, 2023, 10.1111/os.13591.
[8]	ZHAO X, CHOSA E, TOTORIBE K, et al. Effect of periacetabular osteotomy for acetabular dysplasia clarified by three-dimensional finite element analysis[J]. J Orthop Sci, 2010, 15(5): 632-640. doi: 10.1007/s00776-010-1511-z pmid: 20953924
[9]	LEE K J, PARK S J, LEE S J, et al. Biomechanical study on the efficacy of the periacetabular osteotomy using patient-specific finite element analysis[J]. Int J Precis Eng Man, 2015, 16(4): 823-829. doi: 10.1007/s12541-015-0108-z
[10]	LIU L, ECKER T M, SCHUMANN S, et al. Evaluation of constant thickness cartilage models vs. patient specific cartilage models for an optimized computer-assisted planning of periacetabular osteotomy[J]. PLoS One, 2016, 11(1): e0146452. doi: 10.1371/journal.pone.0146452
[11]	PARK S J, LEE S J, CHEN W M, et al. Computer-assisted optimization of the acetabular rotation in periacetabular osteotomy using patient’s anatomy-specific finite element analysis[J]. Appl Bionics Biomech, 2018: 9730525.
[12]	KITAMURA K, FUJII M, IWAMOTO M, et al. Effect of coronal plane acetabular correction on joint contact pressure in periacetabular osteotomy: a finite-element analysis[J]. BMC Musculoskelet Disord, 2022, 23(1): 48. doi: 10.1186/s12891-022-05005-5
[13]	TIAN H, XU P, LU N, et al. The effect of pelvic modeling on outcome in preoperative planning for bernese acetabular osteotomy[J]. Journal of Medical Biomechanics, 2020, 35(6): 712-717.
	田昊, 许平, 鲁宁, 等. Bernese髋臼截骨术术前规划中骨盆建模对结果的影响[J]. 医用生物力学, 2020, 35(6): 712-717.
[14]	ZHANG L L, WANG X Y, CHEN X D. Study on finite element analysis method for the pre-operative planning of bernese periacetabular osteotomy[J]. Journal of Biomedical Engineering, 2016, 33(3): 455-460.
	张琳琳, 王旭义, 陈晓东. Bernese髋臼周围截骨术术前规划的有限元分析方法研究[J]. 生物医学工程学杂志, 2016, 33(3): 455-460.
[15]	STARLY B, FANG Z, SUN W, et al. Three-dimensional reconstruction for medical-CAD modeling[J]. Computer-aided Design and Applications, 2005, 2(1-4): 431-438. doi: 10.1080/16864360.2005.10738392
[16]	YANG Z G, GAN L, YE J X. Construction and stability of finite element models of distal tibial fractures[J]. Chinese Journal of Tissue Engineering Research, 2016, 20(17): 2540-2545.
	杨志刚, 甘霖, 叶俊星. 胫骨远端骨折有限元模型的建立及稳定性分析[J]. 中国组织工程研究, 2016, 20(17): 2540-2545.
[17]	SOWMIANARAYANAN S, CHANDRASEKARAN A, KUMAR R K. Finite element analysis of a subtrochanteric fractured femur with dynamic hip screw, dynamic condylar screw, and proximal femur nail implants - a comparative study[J]. P I Mech Eng H, 2008, 222(1): 117-127. doi: 10.1243/09544119JEIM156
[18]	AKRAMI M, CRAIG K, DIBAJ M, et al. A three-dimensional finite element analysis of the human hip[J]. J Med Eng Technol, 2018, 42(7): 546-552. doi: 10.1080/03091902.2019.1576795 pmid: 30875263
[19]	BERGMANN G, DEURETZBACHER G, HELLER M, et al. Hip contact forces and gait patterns from routine activities[J]. J Biomech, 2001, 34(7): 859-871. doi: 10.1016/s0021-9290(01)00040-9 pmid: 11410170
[20]	BERGMANN G, GRAICHEN F, ROHLMANN A, et al. Hip joint forces during load carrying[J]. Clin Orthop Relat R, 1997, (335): 190-201. pmid: 9020218
[21]	BAY B K, HAMEL A J, OLSON S A, et al. Statically equivalent load and support conditions produce different hip joint contact pressures and periacetabular strains[J]. J Biomech, 1997, 30(2): 193-196. pmid: 9001941
[22]	PHILLIPS A T M, PANKAJ P, HOWIE C R, et al. Finite element modelling of the pelvis: inclusion of muscular and ligamentous boundary conditions[J]. Med Eng Phys, 2007, 29(7): 739-748. pmid: 17035063
[23]	ZOU Z, CHAVEZ-ARREOLA A, MANDAL P, et al. Optimization of the position of the acetabulum in a ganz periacetabular osteotomy by finite element analysis[J]. J Orthop Res, 2013, 31(3): 472-479. doi: 10.1002/jor.22245 pmid: 23097237
[24]	GENDA E, IWASAKI N, LI G A, et al. Normal hip joint contact pressure distribution in single-leg standing—effect of gender and anatomic parameters[J]. J Biomech, 2001, 34(7): 895-905. doi: 10.1016/S0021-9290(01)00041-0
[25]	HARRIS M D, ANDERSON A E, HENAK C R, et al. Finite element prediction of cartilage contact stresses in normal human hips[J]. J Orthop Res, 2012, 30(7): 1133-1139. doi: 10.1002/jor.22040 pmid: 22213112
[26]	AKRAMI M, QIAN Z, ZOU Z, et al. Subject-specific finite element modelling of the human foot complex during walking: sensitivity analysis of material properties, boundary and loading conditions[J]. Biomech Mode Mechan, 2018, 17(2): 559-576.
[27]	WU Z, CHEN S, LI Y, et al. Effect of centre-edge angle on clinical and quality of life outcomes after arthroscopic acetabular labral debridement[J]. Int Orthop, 2016, 40(7): 1427-1432. doi: 10.1007/s00264-015-2923-3 pmid: 26220148
[28]	KOLBER M J, CHEATHAM S W. Orthopedic management of the hip and pelvis[M]. St. Louis: Elsevier Health Sciences, 2015.
[29]	WU G, SIEGLER S, ALLARD P, et al. ISB recommendation on definitions of joint coordinate system of various joints for the reporting of human joint motion - part 1: ankle, hip, and spine[J]. J Biomech, 2002, 35(4): 543-548. doi: 10.1016/S0021-9290(01)00222-6
[30]	XIONG B, YANG P, LIN T, et al. Changes in hip joint contact stress during a gait cycle based on the individualized modeling method of “gait-musculoskeletal system-finite element”[J]. J Orthop Surg Res, 2022, 17(1): 267. doi: 10.1186/s13018-022-03094-5
[31]	MA Y, XING C J, XIAO L. Knee joint image segmentation and model construction based on cascaded network[J]. Chinese J Magn Reson, 2022, 39(2): 184-195.
	马岩, 邢藏菊, 肖亮. 基于级联网络的膝关节图像分割与模型构建[J]. 波谱学杂志, 2022, 39(2): 184-195.

部件	单元类型	杨氏模量/MPa	泊松比
皮质骨	四面体	17000	0.3
松质骨	四面体	70	0.2
软骨	四面体	15	0.45

韧带	韧带刚度/（N/mm）	数量	弹簧刚度/（N/mm）
圆韧带	68	1	68
坐股韧带	39.6	10	3.96
耻股韧带	36.9	6	6.15
髂股下韧带	100.7	4	25.175
髂股上韧带	97.8	4	24.375

网格尺寸/mm	网格数量	峰值接触压力/MPa	变化率/%	接触面积/mm2	变化率/%
1	52564	11.783	-	227.836	-
0.7	113422	12.446	5.627	219.494	3.661
0.5	257067	12.484	0.305	216.635	1.303