대한의용생체공학회:학술대회논문집 (Proceedings of the KOSOMBE Conference)
- 대한의용생체공학회 1997년도 춘계학술대회
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- Pages.374-378
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- 1997
유한요소법을 이용한 대퇴 골두내 무혈성 괴사증의 다양한 수술적 기법에 대한 생체역학적 분석
A Biomechanical Analysis of Various Surgical Procedures for Osteonecrosis of the Femoral Head using a Finite Element Method
- 김정성 (인제대학교 보건대학 의용공학과) ;
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이성재
(인제대학교 보건대학 의용공학과) ;
- 신정욱 (인제대학교 보건대학 의용공학과) ;
- 김용식 (여의도 성모병원 정형외과) ;
- 최재봉 (한국과학기술연구원 의과학연구센터) ;
- 김양수 (여의도 성모병원 정형외과)
- Kim, J.S. (Dept. of Biomedical Engineering, Inje Univ.) ;
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Lee, S.J.
(Dept. of Biomedical Engineering, Inje Univ.) ;
- Shin, J.W. (Dept. of Biomedical Engineering, Inje Univ.) ;
- Kim, Y.S. (Dept. of Orthopaedic Surgery, Yoido St. Mary's Hospital) ;
- Choi, J.B. (Biomedical Research Center, KIST) ;
- Kim, Y.S. (Dept. of Orthopaedic Surgery, Yoido St. Mary's Hospital)
- 발행 : 1997.05.23
초록
Operative procedures such as core drilling with and without fibular bone grafting have been recognized as the treatment methods for osteonecrosis of femoral head(ONFH) by delaying or preventing the collapse of the femoral head. In addition, core drilling with cementation using polymethylmethacrylate (PMMA) has been proposed recently as another surgical method. However, no definite treatment modality has been found yet while operative procedures remain controversial to many clinicians In this study, a finite element method(FEM) was employed to analyze and compare various surgical procedures of ONFH to provide a biomechanical insight. This study was based upon biomechanical findings which suggest stress concentration within the femoral head may facilitate the progression of the necrosis and eventual collapse. For this purpose, five anatomically relevant hip models were constructed in three dimensions : they were (1) intact(Type I), (2) necrotic(Type II), (3) core drilled only(Type III), (4) core drilled with fibular bone graft(Type IV), and (5) core drilled with cementation(Type V). Physiologically relevant loading were simulated. Resulting stresses were calculated. Our results showed that the volumetric percentage subjected to high stress in the necrotic cancellous region was greatest in the core drilled only model(Type III), followed by the necrotic(Type II), the bone graft (Type IV), and the cemented(Type V) models. Von Mises stresses at the tip of the graft(Type IV) was found to be twice more than those of cemented core(Type V) indicating the likelihood of the implant failure. In addition, stresses within the cemented core(Type V) were more evenly distributed and relatively lower than within the fibular bone graft(Type IV). In conclusion, our biomechanical analyses have demonstrated that the bone graft method(Type IV) and the cementation method(Type V) are both superior to the core decompression method(Type III) by reducing the high stress regions within the necrotic cancellous bone. Also it was found that the core region filled with PMMA(Type V) provides far smoother transfer of physiological load without causing the concentration of malignant stresses which may lead to the failure than with the fibular bone graft(Type IV). Therefore, considering the above results along with the degree of difficulties and risk of infection involved with preparation of the fibular bone graft, the cementation method appears to be a promising surgical treatment for the early stage of osteonecrosis of the femoral head.
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