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研究生：	王炳惠 Wang, Ping-Hui
論文名稱：	以有限元素分析法模擬股骨頭缺血性壞死之崩蹋 Simulation of Femoral Head Collapse in Avascular Necrosis
指導教授：	張志涵 Chang, Chih-Han
共同指導教授:	賴國安 Lai, Kuo-An
學位類別：	碩士 Master
系所名稱：	工學院 - 醫學工程研究所 Institute of Biomedical Engineering
論文出版年：	2010
畢業學年度：	98
語文別：	中文
論文頁數：	66
中文關鍵詞：	股骨頭缺血性壞死、生物力學、有限元素
外文關鍵詞：	avascular necrosis of femoral head, biomechanical, finite element
相關次數：	點閱：100 下載：1
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股骨頭缺血性壞死(avascular necrosis of femoral head)是一種股骨頭血流循環不良造成之疾病。它常常發生在三十到五十歲之成人，其中又以男性占大部分。在台灣因藥物及酗酒等因素，其發生比例逐年增加。股骨頭缺血性壞死最終將走到人工髖關節置換手術之地步，對個人生活、經濟乃至社會成本影響至鉅。造成股骨頭缺血性壞死之成因除了血管因素外，生物力學亦是另一重要因素。本研究利用有限元素(finite element)的方法模擬股骨頭缺血性壞死過程中，壞死區域的演進方向及過程。所得之結果並和臨床之核磁共振影像及實體作比較以驗證其合理性。

研究中在股骨頭上外側假設為股骨頭缺血性壞死之起始區域，並給予單腳站立為負荷。模擬過程中壞死區域在股骨頭之海綿骨中擴散，起先侷限在壞死區域平行面，中期往平行面及遠端增長，後期主要是遠端增長。最終呈現類似新月型薄殼的形狀。這和臨床上中期股骨頭缺血性壞死在X光呈現之新月徵象(crescent sign)是相吻合的。研究中顯示壞死區域之擴散，可能的機制是局部骨組織承受於不正常的高應力下。由此可知血管因素扮演起始因子，但後續的壞死及最終的崩塌，生物力學扮演了重要的角色。相關資料的了解有助於在保守治療過程及後續減壓或補強手術中提供訊息，並為後續研究建立基礎。

Avascular necrosis of femoral head (AVNFH) is a disease of impaired osseous blood flow. It commonly affects patients from the third to fifth decade of life and is dominant in male patients. In Taiwan, due to factors such as corticosteroid and alcohol abuse, its incidence was increasing year by year. Avascular necrosis of femoral head will eventually come to total hip replacement surgery in end stage, that is a tremendous impact of individual’s lifestyle, economy and social costs. In spite of vascular factor, the biomechanical factor is another influent factor on AVNFH. In this study, finite element analysis is used to simulate the process of avascular necrosis of femoral head and investigate the direction and process of the evolution of the necrotic region. The results are compared with clinical magnetic resonance imaging to verify its legitimacy.

In the research, the superiolateral femoral head is assumed to be the initiation of avascular necrotic region. Single leg standing condition was applied as loading. Simulation of the process of necrosis is from the sponge bone layer which spread internally, eventually render the crescent shell. This is coincided with crescent sign in clinical patient’s X-ray of mid-stage avascular necrosis of femoral head. The Study shows that the possible mechanism of proliferation of necrotic region is the local bone tissue to withstand the abnormally high stress. The vascular factors play an initiation factor, but biomechanics play an important role in subsequent necrosis and eventual collapse. Relevant information will help in the conservative treatment policy and planning decompression or reinforced surgery. It provides information and establishes a foundation for further study.

中文摘要……………………………………………………………………………I
英文摘要……………………………………………………………………………II
致謝…………………………………………………………………………………IV
目錄…………………………………………………………………………………V
表目錄……………………………………………………………………………VIII
圖目錄………………………………………………………………………………IX

第一章 導論…………………………………………………………………………1
1-1 研究背景………………………………………………………………………1
1-1-1 髖關節………………………………………………………………………1
1-1-2 股骨頭缺血性壞死簡介……………………………………………………2
1-2 相關文獻回顧…………………………………………………………………9
1-2-1 股骨頭缺血性壞死之自然歷程……………………………………………9
1-2-2 股骨頭缺血性壞死生物力學之相關研究………………………………10 
1-2-3 股骨頭缺血性壞死有限元素分析之相關研究…………………………12
1-3 研究動機與目的……………………………………………………………15

第二章  研究材料及方法…………………………………………………………16
 2-1 研究流程概述………………………………………………………………16
2-2 建立髖關節三維實體模型…………………………………………………17
2-2-1 影像取得…………………………………………………………………17 
2-2-2 實體模型建立……………………………………………………………17 
2-3 髖關節模擬模型之建立……………………………………………………19
2-3-1 有限元素模擬模型建立…………………………………………………19
2-3-2 材料性質設定……………………………………………………………20
2-3-3 網格化……………………………………………………………………23
2-3-4 負荷及邊界條件設定……………………………………………………24
  2-4 股骨頭缺血性壞死過程之模擬…………………………………………26
  2-4-1以位移為負荷求解………………………………………………………26
    2-4-2 以Von Mises stress為指標之模擬……………………………26
2-4-3 以Von Mises total strain為指標之模擬…………………………28
1.相對標準-von Mises total strain增加50%之元素……………………28

2.絕對標準-von Mises total strain最高1%之元素……………………28
2-4-4 壞死區域材料特性改變之比較…………………………………………30
2-5 臨床股骨頭缺血性壞死核磁共振影像之比較……………………………31 
2-5-1 X光分期…………………………………………………………………31
2-5-2 核磁共振分期……………………………………………………………31
    2-6 臨床股骨頭缺血性壞死電腦斷層影像重建之比較…………………33
   
第三章 研究結果…………………………………………………………………34
3-1 實體模擬模型………………………………………………………………34
3-1-1 建立實體模型……………………………………………………………34 
3-1-2 不同彈簧係數之比較……………………………………………………35
3-1-3 完整及精簡模型之比較…………………………………………………38
3-2 Von Mises stress為指標之模擬分析結果……………………………41
3-2-1 Stress increase ratio(SsIR)50%................................41
3-2-2 Stress increase ratio(SsIR) 30%................................43
3-2-3 Stress increase ratio(SsIR) 70%................................44
3-3 Von Mises total strain為指標之模擬分析結果……………………46
3-3-1 Von Mises total strain相對變化量指標…………………………46
3-3-2 Von Mises total strain絕對變化量指標…………………………48
3-4 壞死區域材料特性改變之比較……………………………………………49
3-5 臨床股骨頭缺血性壞死核磁共振影像之分析結果………………………51
3-5-1 X光分期……………………………………………………………………51
3-5-2 核磁共振影分期…………………………………………………………51
3-6 臨床股骨頭缺血性壞死電腦斷層重建影像之分析結果……53         

第四章 討論………………………………………………………………………54
4-1 精簡模型與完整模型比較…………………………………………………54
4-2 彈簧係數之影響……………………………………………………………55
4-3 施力方式之影響……………………………………………………………56
4-4 Von Mises stress及Von Mises total strain指標之模擬………57
4-5 模擬結果和臨床比較.………………………………………………………60
4-5-1 和臨床影像之比較………………………………………………………60
4-5-2 和臨床檢體之比較………………………………………………………60
4-6 實驗限制……………………………………………………………………61

第五章 結論及未來展望…………………………………………………………62
參考文獻……………………………………………………………………………64

                                    

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