臺灣博碩士論文加值系統

除了生物化學及細胞改變之外，力學因素對於荷重關節的軟骨型態改變及軟骨下方骨基座的重塑佔有重要之角色。有許多研究利用有限元素法對於關節接觸進行應力分析，但並無相關研究集中針對髖關節部位，探討軟骨、軟骨下骨及骨基座的力學性質改變對於關節接觸應力之敏感程度，尤其在關節接觸表面以及軟骨與軟骨下骨等特徵位置的應力分佈變化。本研究建立一個髖關節二維有限元素模型，分別針對股骨頭軟骨厚度、軟骨下骨厚度與彈性模數、股骨頭彈性模數及股骨頸彈性模數等參數改變來進行各項分析。由結果得知，在軟骨與軟骨下骨介面的最高之最大剪應力，其對於軟骨厚度參數改變之敏感度皆要比軟骨下骨厚度或是彈性模數等力學參數的改變要來得高；因此對於關節接觸應力，軟骨厚度變化為最主要之力學影響參數。此外，對於軟骨下方骨基座力學性質的改變，相較於股骨頭及股骨頸而言，軟骨下骨彈性模數的改變，對於上方軟骨接觸應力為最主要之材料力學影響參數，因此對於軟骨退化過程具有重要之力學效應。此外，本研究結果可單純地就力學角度來說明退化性關節炎之軟骨破壞應該與較高的近端股骨勁度具有相關性。

Besides biochemical and cellular changes, it has been widely suggested that mechanical factors play an important role in cartilage geometry and bone remolding. Few studies have stressed on the sensitivity of stress distribution of different mechanical properties of the articular cartilage and the underlying bone, especially in cartilage surface and bone/cartilage interface. A finite element model of hip joint was established to study the stress distributions associated with the changes of cartilage thickness, subchondral bone thickness and modulus, femoral head modulus, and femoral neck modulus. Our results demonstrated that the decrease of cartilage thickness has more significant effect than the increase of subchondral bone modulus or thickness on the shear stress levels in subchondral bone/cartilage interface. Therefore, the decrease of cartilage thickness acts as a major influence on the distribution of the contact stresses. For the effects of mechanical property changes of the underlying bone, the contact stress of cartilage is more sensitive to the subchondral plate than that to the femoral head or neck. Thus the subchondral plate has a higher effect on the contact stress in cartilage. Our results could also offer a mechanical explanation that the cartilage failure with OA is associated with higher proximal bone stiffness.

第一章 前言 1
1-1 關節軟骨的組成與解剖構造 1
1-2 軟骨下骨之組成與解剖構造 8
1-3 近端股骨之組成與解剖構造 10
1-4 骨質疏鬆症與退化性關節炎 12
1-5退化性關節炎發展過程中軟骨與下方骨基座力學性質之改變 15
1-6 關節接觸之有限元素分析研究回顧 24
1-7研究動機 26
1-8 研究目的 28
第二章 材料與方法 29
2-1 有限元素幾何外型建立 29
2-2 材料性質與元素建立 39
2-3 受力狀態及邊界條件 43
2-4 關節面接觸條件 44
2-5 收斂測試 45
2-6 軟骨及軟骨下骨力學參數改變之應力分析 47
2-7 軟骨下骨、股骨頭及股骨頸參數改變之應力分析 55
第三章 結果 58
3-1 有限元素模型之驗證 58
3-2 靜態分析：軟骨及軟骨下骨力學參數變化對於關節表面應力分佈之效應 60
3-3 靜態分析：軟骨及軟骨下骨力學參數變化對於軟骨與軟骨下骨介面應力分佈之效應 65
3-4 靜態分析：軟骨力學參數變化對於軟骨下骨應力分佈之效應 71
3-5 動態分析：軟骨下方大塊骨結構力學參數變化對於軟骨表面應力分佈之效應 74
3-6 動態分析：軟骨下方大塊骨結構力學參數變化對於軟骨與軟骨下骨介面應力分佈之效應 81
3-7 動態分析：軟骨下方大塊骨結構力學參數變化對於軟骨應變能密度之效應 84
第四章 討論 86
4-1 有限元素模型之限制 86
4-2 軟骨退化過程之探討與模型限制 87
4-2.1 軟骨退化過程之張力力學行為 88
4-2.2 軟骨退化過程之壓力力學行為 89
4-2.3 軟骨退化過程之剪力力學行為 91
4-2.4 模擬軟骨退化過程之模型限制 92
4-3 分析參數之討論 95
4-4 靜態分析：軟骨力學參數變化對於接觸應力之效應 99
4-5 靜態分析：軟骨下骨力學參數變化對於接觸應力之效應 101
4-6 動態分析：軟骨下骨力學參數變化對於接觸應力之效應 103
4-7 動態分析：軟骨下骨與股骨頭力學參數變化對於接觸應力之效應 104
4-8 動態分析：股骨頸力學參數變化對於接觸應力之效應 106
4-9 有限元素模型材料性質之限制 109
4-9.1 軟骨材料性質之限制 109
4-9.2 骨頭材料性質之限制 117
第五章 結論 123
參考文獻 125

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