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目的运用有限元分析方法,对正常及发育性髋关节发育不良(DDH)儿童股骨头近端骨骺生长板同承力情况下横断面的应力进行研究,为股骨近端截骨矫形手术提供理论依据。方法按照Tonnis分型选取40例DDH大龄儿童,其中男性11例,女性29例;年龄8～12岁,平均年龄10.14岁。分为半脱位及全脱位组。20例非DDH儿童作为正常对照组,其中男性11例,女性9例;年龄8～12岁,平均年龄10.10岁。通过二维CT技术测定各组股骨颈前倾角,通过有限元分析软件分析股骨头近端骨骺生长板在横断面上的应力情况。结果正常对照组股骨头近端骨骺生长板横断面上前内侧及后外侧的切应力和静压力相当。半脱位组及全脱位组股骨头近端骨骺生长板横断面上前内侧静压力大于后外侧,而前内侧的切应力小于后外侧。股骨颈前倾角与前后两侧静压力差呈正相关,与前后两侧切应力差呈负相关。结论 DDH大龄儿童的股骨颈前倾角随生长发育而增大。传统的股骨近端旋转截骨术在纠正发育性髋脱位儿童股骨骨骺异常应力,保证正常的头臼关系中有重要的临床意义。
OBJECTIVE: To study the cross-sectional stress of epiphyseal growth plate in proximal and proximal femoral head of normal and developing children with dysplasia of hip (DDH) by means of finite element analysis and to provide a theoretical basis for proximal osteotomy and orthopedic surgery . Methods According to Tonnis’ s classification, 40 DDH children were selected, including 11 males and 29 females. The average age was 10.14 years old, ranging from 8 to 12 years old. Divided into subluxation and dislocation group. Twenty non-DDH children served as normal control group, including 11 males and 9 females, aged from 8 to 12 years with an average age of 10.10 years. The femoral neck anteversion angle was measured by two-dimensional CT and the stress on the proximal femoral head epiphyseal growth plate was analyzed by finite element analysis software. Results In normal control group, the shear stress and static pressure on the proximal medial and posterior lateral of the proximal femoral head epiphyseal growth plate were similar. In the subluxation group and the total dislocation group, the anteromedial hydrostatic pressure in the proximal femoral head epiphyseal growth plate was larger than the posterolateral, while the anterior medial shear stress was smaller than the posterolateral. Anterior femoral neck anteroposterior pressure and static pressure on both sides before and after a positive correlation, and before and after the shear stress on both sides was negatively correlated. Conclusion The femoral neck anteversion of older children with DDH increased with the growth and development. The traditional proximal femoral osteotomy has important clinical significance in correcting abnormal stress of epiphyseal femoral epiphysis of children with developmental dislocation of the hip and ensuring normal head-socket relationship.