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Clinical Result and Finite Element Analysis of Deactived Autograft-prosthesis Composite after Resection of Bone Giant Cell Tumor in Distal Femur

Author: YangYang
Tutor: YuXiuChun
School: Second Military Medical University
Course: Surgery
Keywords: Femoral defect Autologous bone composite rotating hinge knee prosthesis Finite Element Stress distribution
CLC: R687.3
Type: Master's thesis
Year: 2011
Downloads: 41
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Abstract

Giant cell tumor (giant cell tumors, GCT) is a common type of primary bone tumors of bone tumors in China accounted for 10% -15%, 5% -8% in the United States and Europe. Seen our incidence was significantly higher than the United States and Europe. Multiple bone metaphyseal tissue of origin is not clear, and is generally believed that starting in the bone marrow mesenchymal tissue. Tendency of local invasion, recurrence and metastasis. Often face many difficulties due to the uncertainty on the biological behavior of the tumor and the local high recurrence rate, its diagnosis, treatment options and prognosis. For the treatment of giant cell tumor of bone, the main purpose is to remove the lesions, reducing local recurrence opportunities and joint function reserved. Treatment to surgical treatment. Surgical methods intralesional resection, segmental resection of two surgical techniques. Giant cell tumor of bone because of its high recurrence rate, and there are malignant or transfer possible, hence the choice of surgical procedures for satisfactory results, there are still differences of opinion. For Campanacci Ⅲ or recurrence associated with giant cell tumor invading the articular surface of pathologic fracture, segmental resection main, but what kind of surgery is minimize tumor recurrence rate, and can maintain a certain degree of joint function become Surgical treatment of giant cell tumor research focus. In view of the controversy for the surgical treatment of giant cell tumor, Campanacci Ⅲ clinical, we found that there are certain advantages to autogenous bone composite rotating hinge knee prosthesis for the treatment of distal femoral bone giant cell tumor, first: the selected segment resection surgery, the risk of tumor recurrence was significantly reduced;: As a result of autologous bone composite rotating hinge knee prosthesis, joint function in patients with certain reservations, and patients can achieve self-inactivating bone with the host bone bone healing, In the long-term can significantly increase the useful life of the prosthesis reduce refurbishment chance. In order to verify the clinical efficacy of autologous bone composite rotating hinge knee and biological stability, we designed this experiment. First: five cases Campanacci Ⅲ level distal femur bone in patients with giant cell tumor of applications from the body bone composite rotating hinge knee prosthesis surgery, evaluation MSTS functional score and ISOLS composite graft image scores. Second: the establishment of a human femur bone defects of the distal 40% composite prosthesis computational model, surgical simulation using finite element analysis method for biomechanical analysis, one hand can reduce costs, save time, and eliminate the individual differences among the specimens. The other hand, can be through the control of the experimental conditions, to accurately simulate the in vivo mechanical circumstances. The experiment consists of the following two parts: the first part of the treatment of the clinical application of the second part of the distal femur bone giant cell tumor: self-body bone composite rotating hinge knee prosthesis: self-body bone composite rotating hinge knee prosthesis repair bone defects of the distal femur The finite element analysis of early and long-term Objective: To investigate alcohol inactivated autologous bone composite rotating hinge knee prosthesis clinical efficacy for treatment of distal femur bone giant cell tumor. Methods: Retrospective January 2007 to October 2008, five cases of distal femoral bone giant cell tumor patients, the clinical application of alcohol inactivated autologous bone composite rotating hinge knee prosthesis surgery MSTS functional scores and ISOLS composite graft evaluation object image scores. Including 3 males, 2 females; an average of 29.6 years (22-40 years old); four cases left and the right; 3 cases of recurrence after surgery, patients with pathologic fracture. Results: Five patients were distal femur bone giant cell tumor classification Campanacci grade Ⅲ, with an average follow-up of 37 months (28-49 months), no infection, recurrence, loose, limb shortening and other complications. June to November after bony healing. Postoperative MSTS functional score was 25.7 points (85.7%) (25-27), ISOLS image score was 31.4 points (87.2%) (28-35) Conclusion: self-treatment of distal femoral bone composite rotating hinge knee prosthesis giant cell tumor, can reduce the recurrence rate and improve the early limb function; purpose: to establish self-body bone composite rotating hinge knee prosthesis repair of distal femoral bone defects of the three-dimensional finite element model, analyze and compare self-body bone composite rotating hinge knee short-term and long-term femur - the bone cement - prosthesis stem prosthesis implanted in the distal femur after intramedullary stress distribution. Methods: Based on a normal young volunteers left femur CT data, the use of image processing and conversion technology, the use of CAD analysis software modeling, the establishment of a three-dimensional composite rotating hinge knee prosthesis autologous bone repair and reconstruction of the femur distal 40% bone defects finite element model, using the finite element analysis software, loaded the plains Slow (3km / h) walking gait cycle and lower limbs 3 times body weight load, the stress distribution analysis of early and long-term model femur - the bone cement - prosthesis stem. Results: Since body bone composite rotating hinge knee prosthesis repair of distal femur 40% of bone defects, early postoperative maximum stress of cortical bone in the proximal femur, 145.82Mpa; the bone cement largest stress appeared in the bone cement, 1/4 paragraph inside 40.90Mpa, and the prosthesis maximum stress appears in the prosthesis previous paragraph 389.24Mpa, did not exceed the maximum stress load of the three materials, the early stability, the forward inactivation bone bone healing femoral cortical bone bone cement and prosthesis stress significantly reduced femoral stress shielding significantly reduced. Conclusion: The distal femur tumor prosthesis repair bone defects early biological stability, long-term with inactivated bone with the host bone healing, can effectively reduce the possibility of postoperative prosthesis loosening.

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CLC: > Medicine, health > Surgery > Orthopaedic Surgery ( movement system diseases,orthopedic surgery ) > Orthopedic surgery and surgery > Bone surgery
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