Significance of preoperative planning for prophylactic augmentation of osteoporotic hip: A computational modeling study
Significance of preoperative planning for prophylactic augmentation of osteoporotic hip: A computational modeling study
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DOI：
10.1016/j.jbiomech.2019.07.012
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发表时间：
2019-09-20
影响因子：
2.4
通讯作者：
Armand, Mehran
中科院分区：
文献类型：
--
作者：
Farvardin, Amirhossein;Basafa, Ehsan;Armand, Mehran
预防骨质疏松性髋部骨折的一种潜在有效治疗方法是通过注射骨水泥来增强股骨的机械性能。然而，这种疗法仅处于研究阶段，可以从计算模拟中受益匪浅，以优化水泥注射模式。一些研究考虑了针对骨质疏松髋关节增强术 (OHA) 的患者特定规划范例。尽管具有生物力学优势，但定制计划需要先进的手术系统来实施。因此，其他研究提出了更通用的注射策略。本研究的目的是调查与文献中尝试的通用注射策略相比，针对特定患者的计划的额外计算开销是否可以显着提高骨强度。为此，根据高分辨率 CT 图像 (n = 4) 开发了数值模型。通过有限元分析和流体动力学模拟，我们将定制的水泥基增强材料的生物力学效率与之前开发的三种通用注射策略进行了比较。研究了两个系列的模拟，一组具有均匀的骨质疏松骨材料特性，另一组具有不均匀的骨质疏松骨材料特性。定制的水泥基增强不均匀模型显示，仅注射10 ml骨水泥即可显着增加骨质疏松股骨的屈服载荷（79.6%，P < 0.01）和屈服能量（199%，P < 0.01）。这一增幅明显高于之前提出的广义注入的增幅（平均23.8%）。我们的研究结果表明，OHA 可以从确定注射水泥的模式和体积的患者特定计划中获益匪浅。 (C) 2019 Elsevier Ltd. 保留所有权利。
A potential effective treatment for prevention of osteoporotic hip fractures is augmentation of the mechanical properties of the femur by injecting it with bone cement. This therapy, however, is only in research stage and can benefit substantially from computational simulations to optimize the pattern of cement injection. Some studies have considered a patient-specific planning paradigm for Osteoporotic Hip Augmentation (OHA). Despite their biomechanical advantages, customized plans require advanced surgical systems for implementation. Other studies, therefore, have suggested a more generalized injection strategy. The goal of this study is to investigate as to whether the additional computational overhead of the patient-specific planning can significantly improve the bone strength as compared to the generalized injection strategies attempted in the literature. For this purpose, numerical models were developed from high resolution CT images (n = 4). Through finite element analysis and hydrodynamic simulations, we compared the biomechanical efficiency of the customized cement-based augmentation along with three generalized injection strategies developed previously. Two series of simulations were studied, one with homogeneous and one with inhomogeneous material properties for the osteoporotic bone. The customized cement-based augmentation inhomogeneous models showed that injection of only 10 ml of bone cement can significantly increase the yield load (79.6%, P < 0.01) and yield energy (199%, P < 0.01) of an osteoporotic femur. This increase is significantly higher than those of the generalized injections proposed previously (23.8% on average). Our findings suggest that OHA can significantly benefit from a patient-specific plan that determines the pattern and volume of the injected cement. (C) 2019 Elsevier Ltd. All rights reserved.