臺灣博碩士論文加值系統

目錄
指導教授推薦書
口試委員審定書
致謝 iii
中文摘要 iv
Abstract vii
目錄 x
圖目錄 xiv
表目錄 xix
第一章 緒論 1
1-1引言 1
1-2研究背景 2
1-3研究動機 4
1-4 研究目的 8
第二章 基礎理論 10
2-1 股骨之解剖學結構簡介 10
2-2 股骨頸骨折簡介 12
2-3 股骨幹骨折簡介 15
2-4 固定器穿出簡介 18
第三章 文獻回顧 21
3-1 骨髓內釘簡介 21
3-1-1骨髓內釘發展過程 21
3-1-2骨髓內釘開放式與閉合式手術比較 21
3-1-3骨髓內釘打法 22
3-1-4骨髓內釘治療骨折 23
3-2 股骨頸骨折之補充骨螺釘 27
3-3 骨水泥簡介 29
3-3-1 骨水泥發展過程 29
3-3-2 骨水泥固定於骨質疏鬆症 29
第四章 材料與方法 32
4-1 材料與設備 32
4-2 研究流程 34
4-2-1 研究流程圖 35
4-3 影像輪廓處理 36
4-4 同側股骨頸合併股骨幹骨折模型之建立 39
4-5 有限元素模型建構與分析 46
4-5-1 網格生成 47
4-5-2 材料性質與參數設定 50
4-5-3 邊界條件設定 51
第五章 結果 53
5-1收斂測試 53
5-2股骨位移分佈 55
5-2-1不同植入物位移比較 55
5-2-2不同骨質密度位移比較 57
5-3近端骨螺釘位移分佈 58
5-3-1不同植入物位移比較 58
5-3-2不同骨質密度位移比較 60
5-4近端骨螺釘應力分佈 61
5-4-1不同植入物應力比較 61
5-4-2不同骨質密度應力比較 62
5-5穿出風險比較 63
5-5-1位移差異量 63
5-5-2位移差異量之減少百分比 63
第六章 討論 65
6-1 三種不同骨質密度比較 66
6-2 三種不同近端骨螺釘植入方式比較 67
6-3 骨折區域分析 68
6-4 穿出風險分析 70
6-5研究條件限制 72
6-5-1同側股骨頸合併股骨幹骨折模型之假設 72
6-5-2骨髓內釘內固定器模型之假設 72
6-5-3受力情形 72
6-5-4 接觸面假設 72
第七章 結論 73
參考文獻 74
附錄 A. 82
附錄 B. 89


圖目錄
圖1-1 瑞典女性骨質疏鬆症各種骨折發生比率 3
圖 1-2以骨釘及骨板分別固定於股骨頸骨折及股骨幹骨折位置。(A)手術前(B)手術後 6
圖1-3以骨釘(screw) 及第一代髓內釘分別固定於股骨頸骨折及股骨幹骨折位置。(A).手術後股骨頸及股骨幹；(B).手術後股骨頸；圖示之三支骨釘並未穿過髓內鋼釘，而是於髓內鋼釘外圍之股骨頸尋找適當位置後，植入此三支骨釘。…………..7
圖 1-4以第二代骨髓內釘治療股骨頸同時合併股骨幹骨折。骨釘可穿過髓內鋼釘同時固定股骨頸及股骨幹兩處骨折。(A).手術前；(B).手術後。……………………………………………….8
圖1-5 近端骨螺釘植入方式:平行釘 9
圖1-6 近端骨螺釘植入方式：(左)輔助釘、(右)交錯釘 9
圖2-1 股骨結構 11
圖2-2 股骨結構：(內層)皮質骨、(外層)海綿骨 12
圖2-3 跌倒造成股骨頸骨折 13
圖2-4 股骨頸骨折部位名稱 14
圖2-5 股骨頸骨折分類 14
圖2-6 股骨幹骨折(上1/3、中1/3、下1/3) 16
圖2-7 股骨幹骨折分類(簡單型) 16
圖2-8 股骨幹骨折分類(楔型) 17
圖2-9 股骨幹骨折分類(複雜型) 17
圖2-10骨釘和骨板斷裂 19
圖2-11骨釘和第一代骨髓內釘穿出 19
圖2-12 骨釘和第二代骨髓內釘穿出 20
圖2-13 骨釘和第二代骨髓內釘斷裂 20
圖3-1 順行釘打法 22
圖3-2 逆行釘打法 23
圖3-3 遠端骨螺釘：(左)動態骨螺釘、 (右)增加靜態骨螺釘 25
圖3-6 骨髓內釘與滑動髖骨螺釘二次手術比較 26
圖3-4 股骨頸骨折：(左)股骨頭下骨折、(右)股骨頸腰骨折 28
圖3-5 骨髓內釘X-ray：(左)平行釘、(右)輔助釘 28
圖3-7 未加入與加入骨水泥比較：(左)拉伸測試、(右)扭轉測試 31
圖4-1 人造股骨 32
圖4-2 (左)骨釘和第二代骨髓內釘、(右)輔助釘 33
圖4-3 Amira建模流程圖……………………………………………..37
圖4-4 Amira之股骨：(左)未網格化、(右)網格化後 38
圖4-5 Amira存檔為STL檔 38
圖4-6 SolidWorks建模流程圖……………………………………….40
圖4-7 完整皮質骨之實體模型：
(左)皮質骨後側、(中)皮質骨內側、(右)皮質骨前側 41
圖4-8 完整海綿骨之實體模型：
(左)海綿骨後側、(中)海綿骨內側、(右)海綿骨前側 42
圖4-9 完整股骨之實體模型：
(左)股骨後側、(中)股骨內側、(右)股骨前側 42
圖4-10 骨髓內釘之Solidworks上視圖：
(左)平行釘、(中)輔助釘、(右)交錯釘 43
圖4-11 骨髓內釘之實體模型：
(左)平行釘、(中)輔助釘、(右)交錯釘 43
圖4-12 組合後之股骨頭下骨折實體模型：
(左)平行釘、(中)輔助釘、(右)交錯釘 44
圖4-13 組合後之股骨頸腰骨折實體模型：
(左)平行釘、(中)輔助釘、(右)交錯釘 45
圖4-14 完整股骨之網格化模型：
(左)後側、(中)外側、(右)前側 47
圖4-15股骨球頭下骨折實體網格模型：
(左)平行釘、(中)輔助釘、(右)交錯釘 48
圖4-16股骨頸腰骨折實體網格模型：
(左)平行釘、(中)輔助釘、(右)交錯釘 49
圖4-17完整股骨遠端之網格化模型：
(左)後側、(中)內側、(右)前側 51
圖4-18邊界條件設定 52
圖5-1 完整股骨網格化模型(1mm-5mm) 53
圖5-2 完整股骨收斂測試 54
圖5-3 植入物之股骨位移分佈 55
圖5-4 植入物之股骨球頭位移 56
圖5-5 骨質密度之股骨位移分佈 57
圖5-6 骨質密度之股骨球頭位移 58
圖5-7 植入物之近端骨螺釘位移分佈 59
圖5-8 植入物之近端骨螺釘位移 59
圖5-9 骨質密度之近端骨螺釘位移分佈 60
圖5-10 骨質密度之近端骨螺釘位移 61
圖5-11 植入物之近端骨螺釘應力分佈 62
圖5-12 骨質密度之近端骨螺釘應力分佈 62
圖5-13 股骨球頭與近端骨螺釘位移差異量 63
圖5-14 位移差異量減少百分比 64
圖6-1 骨髓內釘力矩 68
圖6-2 近端骨螺釘最大應力 69
圖6-3 骨質密度最大應力 69
圖6-4 骨螺釘穿出風險之位移差 71
圖6-5 骨折型態之植入物位移差 71

表目錄
表 4-1 材料參數設定 50
表 4-2 邊界條件設定 52
表 5-1 收斂測試之有限元素模型節點數目 54

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