高位脛骨截骨手術之新型骨板分析｜國立中央大學博碩士論文系統

簡易檢索 / 詳目顯示

回結果列表

研究生：	黃柏倉 Bo-tsang Huang
論文名稱：	高位脛骨截骨手術之新型骨板分析 A New Type Bone Plate for High Tibial Osteotomy
指導教授：	鄔蜀威 Shu-Wei Wu
口試委員:
學位類別：	碩士 Master
系所名稱：	生醫理工學院 - 生物醫學工程研究所 Graduate Institute of Biomedical Engineering
畢業學年度：	99
語文別：	中文
論文頁數：	73
中文關鍵詞：	退化性膝關節炎、全膝關節置換術、有限元素分析、高位脛骨截骨手術
外文關鍵詞：	total knee replacement, knee osteoarthritis, high tibial osteotomy, finite element analysis
相關次數：	點閱：18 下載：0
分享至:	分享至facebook 分享至twitter

查詢本校圖書館目錄查詢臺灣博碩士論文知識加值系統勘誤回報

近年來由於科技進步與醫學發達，人類平均壽命增加，伴隨而來的是各種老化造成的疾病，退化性膝關節炎即是一個很好的例子。治療退化性膝關節炎之臨床治療方式有: (1)全膝關節置換術；(2)高位脛骨截骨手術。由於全膝關節置換術為晚期治療方式，且具有不可回復性，早期治療方式較適用於高位脛骨截骨手術。
高位脛骨截骨手術在手術過程中容易造成植入物斷裂的現象，為此而設計出新形骨板來改善此缺點。為在植入物生物力學分析前進行模擬，本研究建立現有高位脛骨截骨手術所用之骨板以及新型設計之骨板，並參考一般人體站立時受力大小及位置，做有限元素分析來探討各種植入物間之剛性位移穩定程度及應力分布情形，藉此來分析出新型骨板是否能夠有較佳的表現，以便做為未來生物力學測試之參考。

Recently, human life became more and more elder because of the advance of scientific technology and the development of medicine. But it accompanies the disease caused by aging. Like the knee osteoarthritis, which the most obvious example is. There are two way to treat the knee osteoarthritis, one is total knee replacement; the other is high tibial osteotomy. Because the total knee replacement is a terminal way for treatment and it can’t return, it is a good way in early time to treat the knee osteoarthritis with high tibial osteotomy.
High tibial osteotomy caused the implant break easily in the process of a surgical operation, so there is the new design of the implant to improve the disadventage. For the implant biomechanical analysis before simulation, the study established the existing bone plate used in high tibial osteotomy and the new design of the bone plate. Using the finite element analysis investigate implant stability of the rigid displacement and the stress value with the reference to the general body in standing force and location. And investigate whether the new bone plate has better performance, so as a reference for future biomechanical testing.

摘    要......................................i
ABSTRACT.....................................ii
致  謝......................................iii
目  錄.......................................iv
圖  目  錄..................................vii
表  目  錄....................................x
一、緒論......................................1
1-1 研究背景..................................1
1-2 研究動機與目的............................1
1-3 文獻回顧..................................2
1-3-1 膝關節之解剖學與生物力學................2
1-3-2 膝關節運動學介紹........................7
1-3-3 退化性膝關節炎簡介.....................12
1-3-4 高位脛骨截骨手術(HTO)簡述..............16
1-3-5 脛骨骨板之力學分析.....................19
1-4 本文架構.................................23
二、材料與方法...............................25
2-1 三維脛骨圖檔之建立.......................25
2-1-1 醫學影像資料之蒐集.....................25
2-1-2 脛骨模型之立體重建.....................28
2-2 三維HTO骨板與骨釘模型之建立..............31
2-2-1 現有HTO骨板模型之建立..................31
2-2-2 新型HTO骨板模型之建立..................35
2-2-3 HTO骨板之骨釘模型建立..................36
2-3 脛骨與骨板之配合及材料性質...............36
2-3-1 脛骨與骨板之配合.......................36
2-3-2 脛骨與骨板之材料性質...................38
2-3-3 脛骨與骨板之結合條件...................38
2-4 受力條件與參數設定.......................39
2-5 網格設定與建立...........................41
2-5-1 網格設定...............................41
2-5-2 網格建立...............................43
2-6 有限元素分析.............................47
三、結果.....................................48
3-1 裂口位移分析結果.........................48
3-2 Von Mises Stress.........................49
四、討論.....................................53
4-1 裂口位移分析討論.........................53
4-2 Von Mises Stress討論.....................55
五、結論與未來展望...........................58
參 考 文 獻..................................59

                                

［1］ John W. Hole, Jr., Karen A. Koos., Human Anatomy，胡明一、孫穆乾、陳懿慧等譯，藝軒圖書，民國八十四年。
［2］林自勇等譯，「解剖生理學」，Martini Bartholomew著，“Essentials of Anatomy & Physiology”，全威圖書有限公司，新北市，民國92年。
［3］ Revolution Health Group LLC. http://www.revolutionhealth.com
［4］ S. Giannini F., Catani, “Gait Analysis, Methodologies and clinical applications,” 1994.
［5］弘如洋生技股份有限公司， http://www.oceanb.com.tw/column/download/ARTZ-OA-200911.pdf
［6］ J. P. Jackson & W. Waugh, “Osteotomy for osteoarthritis of the knee,” The Journal of Bone and Joint Surgery, VOL. 40-B: 826, 1958
［7］ J. N. Insall et al, “High tibial osteotomy for varus gonarthrosis-a long term study”, The Journal of bone and Joint Surgery, 66-A, NO. 7, 1040-1048, Sep, 1984
［8］ J. Debeyre & JM. Artiqou, “Long term results of 260 tibial osteotomies for frontal deviations of the knee, ” Rev Chir Orthopaedic Reparatrice Appar Mot, 58(4), 335-339, 1972
［9］ P. Lobenhoffer & J. D. Agneskirchner,” Improvements in surgical technique of valgus high tibial osteotomy, ” Knee Surg Sports Traumatol Arthrosc, 132-138, 2003
［10］ G. Magyar et al, “Open-wedge osteotomy by hemicallotasis or the close-wedge technique for osteoarthritis of the knee, ” The Journal of Bone & Joint Surgery, 81-B: 444-448, 1999
［11］ E. M. Nelissen, E. J. van Langelaan & R. G. H. H. Nelissen, “Stability of medial opening wedge high tibial osteotomy- a failure analysis, ” International Orthopaedic (SICOT), No. 34, 217-223, 2009
［12］ G.Spahn, “Complications in high tibial (medial opening wedge) osteotomy,” Arch Orthopaedic Trauma Surgury, 124 : 649–653, 2003
［13］ L. D. Blecha et al, “How plate positioning impacts the biomechanics of the open wedge tibial osteotomy; A finite element analysis, ”Computer Method in Biomechanics and Engineering, Vol. 8, No.5, 307-313,Oct. 2005
［14］ A. Yardimeden, M. H. Kelestemur & I. Esenkaya, “Biomechanical comparison of the wedge supported plates at PTO, ” International Scientific Journal, Vol. 28, No. 8:495-498, 2007
［15］ G. Spahn & R. Wittig, “Primary stability of various implants in tibial opening wedge osteotomy: a biomechanical study, ” J Orthopaedic Science, No. 7: 683-687, 2002
［16］ J. D. Agneskirchner et al, “Primary stability of four different implants for opening wedge high tibial osteotomy, ” Knee Surg Sports Traumatol Arthrosc, No. 14: 291-300, 2005
［17］ T. Fukubayashi & H. Kurosawa, “The contact area and pressure distribution pattern of the knee”,Acta Orthopaedic. Scand, No.51, 871-879, Tokyo, Japan, 1980
［18］ K. Polgar et al, “Strain distribution within the human femur due to physiological and simplified loading; finite element analysis using the muscle standardized femur model,” Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine, 217: 173-189, 2003
［19］ W. R. Taylor, M. O. Heller, G, Bergmann, G. N. Duda“ Tibio-femoral loading during human gait and stair climbing,” Journal of Orthopaedic Research, 22: 625-632, 2004

簡易檢索 / 詳目顯示

相關論文