Patient-specific chondrolabral contact mechanics in patients with acetabular dysplasia following treatment with peri-acetabular osteotomy
Patient-specific chondrolabral contact mechanics in patients with acetabular dysplasia following treatment with peri-acetabular osteotomy
复制标题
DOI：
10.1016/j.joca.2016.11.016
复制
发表时间：
2017-05-01
影响因子：
7
通讯作者：
Anderson, A. E.
中科院分区：
文献类型：
--
作者：
Abraham, C. L.;Knight, S. J.;Anderson, A. E.
目的：使用经过验证的患者特定有限元（FE）建模方案，我们评估了软骨和盂唇（即，chondrolabral）力学前后髋臼周围截骨术（PAO），以提供深入了解这种程序的能力，以改善力学发育不良hips.Design：五例髋臼发育不良患者被招募在这个病例对照，前瞻性研究。包括骨、软骨和盂唇解剖结构的模型由PAO前后采集的计算机断层扫描（CT）关节造影扫描生成。量化整体和区域的软骨和盂唇接触应力和接触面积。负载支持的盂唇，表示为总髋关节力的百分比，进行了analysed.Results：百分比软骨接触面积增加术后整体，内侧，和优越。髋臼接触应力峰值整体、外侧、前侧和上方均降低。平均接触应力整体、外侧、前部和后部均降低。只有上级盂唇上的平均接触应力和盂唇峰值应力总体上降低。负载支持的盂唇并没有显着changedsignificant.Conclusions：PAO是有效的，在内侧软骨接触，减少软骨接触应力，因此可以尽量减少有害的负荷，以局灶性软骨病变，软骨下囊肿，和软骨分层往往观察到髋臼外侧发育不良的髋关节。然而，发育不良髋关节的过度突出、肥大的盂唇仍然与股骨头接触，股骨头在PAO后继续对盂唇施加负荷。PAO后持续盂唇负荷的临床后果尚不清楚。然而，未能减少盂唇承受的载荷可能导致PAO后的终末期髋关节OA，这是合理的。(C)2016国际骨关节炎研究学会。由爱思唯尔有限公司出版。保留所有权利。
Objective: Using a validated, patient-specific finite element (FE) modeling protocol, we evaluated cartilage and labrum (i.e., chondrolabral) mechanics before and after peri-acetabular osteotomy (PAO) to provide insight into the ability of this procedure to improve mechanics in dysplastic hips.Design: Five patients with acetabular dysplasia were recruited in this case-controlled, prospective study. Models, which included anatomy for bone, cartilage, and labrum, were generated from computed tomography (CT) arthrography scans acquired before and after PAO. Cartilage and labrum contact stress and contact area were quantified overall and regionally. Load supported by the labrum, expressed as a percentage of the total hip force, was analyzed.Results: Percent cartilage contact area increased post-operatively overall, medially, and superiorly. Peak acetabular contact stress decreased overall, laterally, anteriorly, and superiorly. Average contact stress decreased overall, laterally, anteriorly, and posteriorly. Only average contact stress on the superior labrum and peak labrum stress overall decreased. Load supported by the labrum did not change significantly.Conclusions: PAO was efficacious at medializing cartilage contact and reducing cartilage contact stresses, and therefore may minimize deleterious loading to focal cartilage lesions, subchondral cysts, and cartilage delaminations often observed in the lateral acetabulum of dysplastic hips. However, the excessively prominent, hypertrophied labrum of dysplastic hips remains in contact with the femoral head, which continues to load the labrum following PAO. The clinical ramifications of continued labral loading following PAO are not known. However, it is plausible that failure to reduce the load experienced by the labrum could result in end-stage hip OA following PAO. (C) 2016 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.