骨盆不连续髋关节翻修术中定制带翼假体的有限元分析

Finite element analysis of a customized flange acetabular component in revision total hip arthroplasty with pelvic discontinuity

  • 摘要: 背景 个性化定制带翼髋臼假体(custom flange acetabular component,CFAC),对于耻骨侧臼翼设计及是否使用螺钉固定仍存争议,目前尚缺少相关生物力学依据。目的 全髋关节翻修术中,Paprosky Ⅲ型严重髋臼缺损的重建极具挑战。CFAC在此类型的重建中取得良好的临床疗效,但其生物力学性能,特别是耻骨翼设计及固定对整体稳定性影响缺乏深入研究。本研究旨在通过有限元分析,对比两种CFAC设计在站立负荷下的生物力学差异,为临床假体设计与优化提供参考。方法 基于一例Paprosky ⅢB型髋臼缺损合并骨盆后柱不连续患者的骨盆CT数据,重建三维模型。分别设计并构建了无耻骨翼的双翼CFAC及包含耻骨翼固定的三翼CFAC模型。使用Abaqus 软件构建有限元模型。模拟在站立姿态下,对比分析两种假体及其固定螺钉的最大应力与微动情况。结果 两种设计假体的最大应力均出现在髂骨翼与髋臼杯连接处。三翼假体最大应力为39.46 MPa,较双翼假体的52.62 MPa 降低约25%;三翼假体中螺钉最大应力为33.59 MPa,较双翼假体的45.71 MPa降低约27%。髋臼顶部与坐骨翼的固定螺钉微动高于其他部位螺钉。结论 增加耻骨翼设计并进行固定,能够降低CFAC假体及固定螺钉的峰值应力与微动,在该类型复杂髋臼缺损的重建中,耻骨翼的设计与固定具有相应的临床意义。

     

    Abstract: Background Despite the clinical application of custom flange acetabular components (CFAC), the design of the pubic flange and the necessity of adjunctive screw fixation remain controversial, primarily due to a lack of relevant biomechanical evidence.Objective The reconstruction of severe Paprosky type Ⅲ acetabular defects in revision total hip arthroplasty remains a significant challenge. Custom flange acetabular components (CFAC) have shown promising clinical outcomes in such cases. However, their biomechanical performance, particularly the role of pubic flange design and fixation in overall stability, remains unclear. This study aimed to compare the biomechanical differences between two CFAC designs under load using finite element analysis, providing a theoretical basis for clinical decision-making and prosthesis optimization. Methods A three-dimensional pelvic model was reconstructed from CT data of a patient with a Paprosky type Ⅲ B acetabular defect and posterior column discontinuity. Two CFAC models were designed: a Dualflange construct without pubic flange fixation and a Triflange construct with pubic flange fixation. Finite element models were established using Abaqus software to simulate standing conditions. Peak stress and micromotion of the two prostheses and their fixation screws were evaluated and compared.Results In both designs, peak stress was observed at the junction between the iliac flange and the acetabular shell. The Triflange prosthesis exhibited a peak stress of 39.46 MPa, approximately 25% lower than that of the Dualflange prosthesis (52.62 MPa). Peak screw stress in the Triflange group was 33.59 MPa, approximately 27% lower than that in the Dualflange group (45.71 MPa). Micromotion analysis showed that the screws at the acetabular roof and ischial flange demonstrated more pronounced micromotion compared to others.Conclusion The addition of a pubic flange with fixation reduces peak stress and micromotion of both the CFAC prosthesis and its fixation screws. In complex acetabular defects of this type, pubic flange design and fixation may provide relevant clinical benefits.

     

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