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The Investigation of Curative Effect and the Finite Element Analysis about Cemented Long and Short Stem Prosthetic Replacement in Comminuted Intertrochanteric Fracture of Aged Patients

Author: LiuShengHou
Tutor: WangShaoJin
School: Shandong University
Course: Surgery
Keywords: Artificial hip replacement Bone cement Comminuted intertrochanteric fracture Advanced age Three - dimensional finite element Biomechanics
CLC: R687.3
Type: Master's thesis
Year: 2009
Downloads: 62
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Abstract

Objective To compare the length of stem prosthesis replacement for elderly patients with comminuted intertrochanteric fracture of the short-term clinical efficacy, to explore the impact of the calcar different treatment on the clinical efficacy of long-handled prosthetic replacement; establish the length of the shank prosthesis replacement for elderly patients with comminuted tuberosity between three-dimensional finite element model of fracture of the femur, length of cementless stem prosthesis, bone cement stress distribution trends, the size of the research to guide clinical work. Materials and Methods Shandong University Qilu Hospital from May 2002 to May 2007, 54 patients (54 hips) for senior citizens crushing cementless artificial hip replacement surgery intertrochanteric fracture were divided into two groups, depending on the type of prosthesis, the first group for the long-handled prosthetic replacement group of 31 patients, the second group of ordinary handle prosthetic replacement of the 23 cases (ie the glandulifera group) group. Surgical methods are basically the same as the conventional prosthesis replacement difference is processing calcar parts, based on the the calcar site fractures, take the three methods, namely cement reconstruction calcar calcar of the indirect reduction of the wire suture intertrochanteric crest, wire cerclage calcar. A follow-up after a year and recently hip Harris score parallel hip X-ray examination, observation the periprosthetic imaging performance. Clinical follow-up on the basis of satisfactory outcome, the use of medicine digital images the communication standard DICOM3.0, and the the Mimics graphics processing software to generate femur characteristics of structure contours, and then complete femur real reconstruction of three-dimensional solid CAD modeling software Unigraphics, and then create different lengths of artificial femoral hip prosthesis, three-dimensional solid model of bone cement. Finally, the finite element analysis software ABAQUS6.5 dimensional finite element model of the femur bone cement and prosthesis were established, and then the stress of the model for finite element analysis, the femur and the length of the handle artificial hip femoral prosthesis, bone cement stress The distribution and size. Results ① skillet prosthetic replacement group (# 4) 31 cases were followed up for an average follow-up time of 28 months In addition to deaths year postoperative Harris score 66 to 95 points (average 83.7 points), good rate of 86.67 %; ordinary prosthetic replacement group (# 3) 23 cases were followed up for an average follow-up time of 31 months, the postoperative year Harris score 57-91 points (average 78.2 points), good rate of 82.6%; difference between the two groups was not statistically significance. ② X-ray group were followed up for three cases of heterotopic ossification in skillet prosthesis replacement were Brooker grade Ⅰ, two cases appear the periprosthetic translucent with outside addition to the the one case calcar parts deformity healing, but the width is less than 2mm; calcar fracture healing are satisfied; ordinary stem prosthesis replacement group 2 patients had heterotopic ossification case periprosthetic are Brooker grade Ⅰ translucent with a width of less than 2mm; calcar fracture healing are satisfied. (3) long-handled prosthesis replacement approach calcar three different cement reconstruction group was significantly longer than the other two groups in terms of postoperative bed time, the postoperative functional comparison was not statistically significant. ④ length handle artificial hip prosthesis stress distribution in the upper part of the prosthesis neck and in the lower part, close to the junction of the collodiaphyseal each with a stress concentration area peak # 169.9Mpa, 207.5Mpa; 4 # 191.5Mpa, 227.4 Mpa; the prosthesis collodiaphyseal the junction, the inner and outer one on each remote stress concentration area, peak, respectively 3 # 85.91Mpa, 56.11Mpa 121.83Mpa, 4 # 108.52Mpa 94.13Mpa, 182.426Mpa ⑤ intertrochanteric stress distribution law of the remaining femur fracture line hip replacement proximal to distal stress gradually increased in the medial and lateral to the femoral shaft under paragraph 1/3 of the apparent concentration of the junction is reduced again to the end of the inside and outside peak were # 83.35 Mpa, 96.86Mpa; 4 # 82.11Mpa, 95.88Mpa. ⑥ the glandulifera prosthesis corresponding bone cement prosthesis interface near the end the outside of each form a stress concentration area, the peak for 10.9Mpa 21.3Mpa skillet prosthesis corresponding to the interface in the middle of the medial and distal internal and external each side form a stress concentration area, peak 4.78Mpa, 2.48 MPa, respectively, 14.83 Mpa. ⑦ to rebuild the calcar of bone cement inside and outside the two interfaces have the same stress distribution, thickness cement transition area the the medial calcar osteotomy surface contact area for stress concentration area, internal and external peak 3 # 4.31Mpa , 10.06Mpa, 4 # 6.03Mpa, 13.67Mpa. Conclusion. Cement type long, short prosthesis replacement for elderly patients with comminuted intertrochanteric fracture Recent clinical efficacy were satisfied, compared to no statistical difference, but the long-term effects to be studied. 2 long-handled prosthesis replacement treatment of comminuted intertrochanteric fracture calcar, whichever method you choose to deal with short-term clinical efficacy is not affected. 3 for senior citizens comminuted intertrochanteric fracture line artificial joint replacement remaining femur with normal human femur stress distribution law. Replacement after contrast skillet prosthetic replacement of the femoral stress distribution is smaller, more suitable for human femur biomechanical requirements. Stress distribution law of length of stemless femoral prosthesis was no significant difference with conventional replacement prosthesis stress distribution is similar, except that the the prosthesis shank in the comminuted intertrochanteric fractures replacement model a smaller increase in the medial proximal stress concentration area. 5. Cement reconstruction femur moment not a cement fracture, no change in the residual stress distribution law of the femur from a biomechanical point of view to consider, are not caused by the loosening of the prosthesis, in line with the biomechanical requirements. Glandulifera prosthetic replacement, resulting in bone cement - prosthesis interface stress distribution changed significantly, its peak more than the fatigue strength of cement, loosening significantly increased risk; skillet prosthetic replacement of the interfacial stress distribution law and conventional After the replacement of the prosthesis similar, so the treatment of senior citizens comminuted intertrochanteric fractures cement type skillet prosthetic replacement forward loosening may be lower than the probability glandulifera prosthetic replacement.

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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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