進階搜尋


下載電子全文  
系統識別號 U0026-3108201514514400
論文名稱(中文) 使用微創內固定手術於人工髖關節置換後股骨附近骨折的骨鬆病患--生物力學分析與最佳化設計
論文名稱(英文) Biomechanical study and Finite Element Analysis of Surgical Fixation in the Patients with Proximal Femoral Periprosthetic Fractures Following THA: Single Screw-Cap Unit
校院名稱 成功大學
系所名稱(中) 生物醫學工程學系
系所名稱(英) Department of BioMedical Engineering
學年度 103
學期 2
出版年 104
研究生(中文) 林佳緯
研究生(英文) Chia-Wei Lin
學號 P86021134
學位類別 碩士
語文別 中文
論文頁數 39頁
口試委員 指導教授-胡晉嘉
口試委員-張志涵
口試委員-陳世豪
中文關鍵字 人工髖關節周圍骨折  微創手術  骨質疏鬆  互鎖式解剖型鋼板  新型合併抗旋轉鋼板 
英文關鍵字 Total hip arthroplasty  anatomic locking plate  cable-ready  non-contact bridging periprosthetic plate  minimal invasive surgery  and osteoporosis  Finite element 
學科別分類
中文摘要 人工髖關節周圍骨折越來越常見,臨床上常以骨板搭配骨釘及鋼線纏繞固定,但骨折固定術後仍發現有骨板斷裂或固定系統鬆脫等問題。觀察發現: 雖為同類型斷裂模式,仍有不同的骨折斷裂走向,固定時骨釘數與鋼線數搭配模式雖依醫師經驗判斷,衍伸出生物力學議題:1.不同斷裂走向對骨質受力,可能有不同影響程度;2.不同的鋼線數與骨釘數搭配植入模式,可能產生不同生物力學行為。本研究利用生物力學實驗探討溫哥華(Vancouver classification)B1,B2類型骨折--包含兩種斷裂模式、兩種負載給定與多種不同固定模式進行多參數探討。
骨折常併發手術骨癒合不正,不良及固定物失敗,乃因此處有極重要的人體重力分佈區(trabecular zone),尤其在步態站立時需傳導很大力量經過此重力分佈區。生物力學實驗曾經評估很多種固定器之使用; 股骨近端互鎖式鋼板已經開發,提供比動態加壓式鋼板螺釘更多優點,提供骨頭較強的抓力和壓迫力,避免傳統股骨骨折於骨鬆病患之不足。本研究探討傳統加壓式鋼板,互鎖式股骨近端解剖型鋼板與新型Doll miles, Cable readygrip, NCB PP fixation systems合併抗旋轉鋼板之設計。實驗採用微創、閉合復位方式探討以上五種固定器於人工髖關節周圍骨折之骨鬆病患穩定效應。實驗模型在人造股骨的人工髖關節(穩定或不穩定)周圍製造一個間距骨折,擺上上述五種固定物(共10具人造股骨),進行動態疲勞測試以模仿人體術後三個月內之步態使用,固定器失敗或位移五毫米為實驗之終止條件,觀察以上五種固定器之穩定效果及骨釘-骨板或人工髖關節周圍之應力分佈;另外有限元素分析模型也依此建立最佳化設計,藉此提供臨床醫師使用各種固定器於人工髖關節周圍骨折之參考。
英文摘要 Proximal femoral periprosthetic fracture following THA is a gradually common problem occurring in recent years. Its difficulty and complexity of clinical treatment using plate and screw fixation draws many researchers’ attention. A new design, NCB-PP plate and screws, which were proposed with few discussed biomechanical property on cap-screw mechanism, was made clearer through our study. A biomechanical experiment and finite element analysis was conducted to show when the screw was fixed at zero degree, screw- cap construct has higher stiffness than that at 15 degree. Interestingly, screws fixed at 30 degree, over suggested design, has similar stiffness as zero degree. Further experiment and finite element analysis towards whole construct should be studied.
論文目次 Contents VIII
Chapter1 介紹 1
1.1 前言 1
1.2 研究動機&目的 2
1.2.1研究動機 2
1.2.2研究目的 2
1.2.3 NCB(Non-contact bridging) Periprosthetic Femur System 系統概述 3
1.3 文獻探討 4
1.3.1 基本理論 4
1.3.2人工髖關節周圍骨折固定失敗因素 14
Chapter2 研究方法 16
2.1 實驗部分 16
2.1.1 實驗材料與設備 16
2.1.2 實驗方法 16
2.2 模擬部分 18
2.2.1 軟體與儀器 18
2.2.2有限元素分析架構圖 18
2.2.3 模擬流程 19
Chapter3 結果 25
3.1 實驗部分 25
3.1.1 實驗結果 25
3.1.2 數據整理 27
3.2 模擬部分 28
3.3 實驗與模擬比較 29
3.4 模擬之初步修正 30
Chapter4 結果與討論 32
4.1 實驗部分 32
4.2 實驗與模擬之比較 33
Reference 37
參考文獻 1. Kamineni, S., R. Vindlacheruvu, and H.E. Ware, Peri-prosthetic femoral shaft fractures treated with plate and cable fixation. Injury, 1999. 30(4): p. 261-268.
2. Lee, Y.-S., et al., Internal fixation of undisplaced femoral neck fractures in the elderly: a retrospective comparison of fixation methods. Journal of Trauma and Acute Care Surgery, 2008. 64(1): p. 155-162.
3. Chen, S.-H., et al., Biomechanical comparison between lumbar disc arthroplasty and fusion. Medical engineering & physics, 2009. 31(2): p. 244-253.
4. Kavanagh BF. Charnly low-friction arthroplasty of the hip. J Arthroplasty, 1994; 9: 229–234.

5. Kim YH. Cementless porous-coated anatomic medullary locking total hip prostheses. J Arthroplasty, 1994; 9: 243–252.

6. Mohler CG. Early loosening of the femoral component at the cement-prosthesis interface after total hip replacement. J Bone Joint Surg, 1995; 77A: 1315–1322.

7. Kamineni S. Peri-prosthetic femoral shaft fractures treated with plate and cable fixation. Injury, 1999; 30: 261–268.

8. Giannoudis PV. Principles of internal fixation and selection of implants for periprosthetic femoral fractures. Injury, 2007; 38: 669–687.

9. Berry DJ. Epidemiology: hip and knee. Orthop Clin North Am, 1999; 30: 183–190.

10. Lindahl H. Risk factors for failure after treatment of a periprosthetic fracture of the femur. J Bone Joint Surg [Br], 2006; 88-B: 26–30.

11. Duncan CP. Fractures of the femur after hip replacement. Instr Course Lect, 1995; 44: 293–304.

12. Venu KM. Dall-Miles cable and plate fixation for the treatment of peri-prosthetic femoral fractures-analysis of result in 13 cases. Injury, 2001; 32: 395–400.

13. Schmotzer H. Surgical management of intra- and postoperative fractures of the femur about the tip
of the stem in total hip arthroplasty. J Arthroplasty, 1996; 11: 709.

14. Dennis MG. Fixation of Periprosthetic Femoral Shaft Fractures Occurring at the Tip of the Stem. J Arthroplasty, 2000; 15: 523–304.

15. Dennis MG. Fixation of Periprosthetic Femoral Shaft Fractures: A Biomechanical Comparsion of Two Techniques. J Orthop Trauma, 2001; 15: 177–180.

16. Mark Lenz .The locking attachment plate for proximal fixation of periprosthetic femur fractures—a biomechanical comparison of two techniques. International Orthopaedics 2012; 36:1915–1921

17. Mehmet G. The biomechanical assessment of fixation methods in periprosthetic femur fractures. Acta Orthop Traumatol Turc 2011;45(4):266-269

18. Martin R. Biomechanical evaluation for mechanisms of periprosthetic femoral fractures. Journal of Trauma, Injury, Infection, and Critical Care. 2011: 70(4); E62-65
19. Mehran M. Periprosthetic fracture fixation of the femur following total hip arthroplasty: A review of biomechanical testing. Clinical Biomechanics 2011; 26:13–22

20. Jorg Kampshoff. The treatment of periprosthetic fractures with locking plates: effect of drill and screw type on cement mantles: a biomechanical analysis. Arch Orthop Trauma Surg 2010:130:627–632
21. Shah S. The biomechanics of plate fixation of periprothetic femoral fractures near the tip of a total hip implant: cables, screws, or both? J.Engineering in medicine Part H. 2011;225: 845-856

22. Lever LP. The biomechanical analysis of three plating fixation systems for periprothetic femoral fracture near the tip of a total hip arthroplasty. Clin Orhop 2011;5; 45-52
23. Chen DW. Finite element analysis of different repair methods of Vancouver B1 periprosthetic fractures after total hip arthroplasty. Injury, 2012; 43: 1061–1065
論文全文使用權限
  • 同意授權校內瀏覽/列印電子全文服務,於2015-09-10起公開。
  • 同意授權校外瀏覽/列印電子全文服務,於2020-09-10起公開。


  • 如您有疑問,請聯絡圖書館
    聯絡電話:(06)2757575#65773
    聯絡E-mail:etds@email.ncku.edu.tw