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研究生:郭鐘懋
研究生(外文):Chung-Mao Kuo
論文名稱:高位脛骨截骨手術骨板骨釘系統在人體步態週期中之生物力學與穩定度比較
論文名稱(外文):Stress and Stability Comparison between different High Tibial Osteotomy plate Systems during gait cycle
指導教授:陸元平
口試委員:林上智曲立全
口試日期:2013-07-15
學位類別:碩士
校院名稱:國立臺北科技大學
系所名稱:製造科技研究所
學門:工程學門
學類:機械工程學類
論文種類:學術論文
論文出版年:2013
畢業學年度:101
語文別:中文
論文頁數:56
中文關鍵詞:高位脛骨截骨手術骨板骨釘系統有限元素分析
外文關鍵詞:High Tibial Osteotomybone platebone screwfinite element analysis
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由於醫學科技進步,人類死亡率逐年減少,平均壽命增加,伴隨而來的是各種因老化所產生之疾病,而退化性關節炎就是其中一例。目前在臨床治療退化性關節炎的主要手術為全膝人工關節置換,此手術適用於晚期治療上與年長之患者,而高位脛骨截骨手術是一種替代方案,適用於早期治療與年輕之患者。
然而高位脛骨截骨手術成敗的因素有很多,其中術後植入之”骨板骨釘系統”能否提供術後缺口足夠的穩定度,便是影響手術成敗因素之一。本研究使用有限元素分析,建立四種骨板骨釘系統,並參考文獻模擬脛骨在步態周期中之受力大小與位置,探討四種系統之生物力學與穩定度比較。
從分析結果中,發現鎖固式雙下擺之PI型系統其綜合應力與總位移量皆是最少的,與綜合應力最高之T型系統相比,PI系統在0度與30度中分別減少68%與56%,總位移量則減少62%與68%,發現使用鎖固式骨釘可有效降低系統內之應力,且其雙下擺設計可增加固定範圍,從脛骨後側至前側,不僅提升缺口穩定度,且可有效防止前側缺口被撐開。


Recently, human life became more and more elder because of the advance of scientific technology and the development of medicine. But it accompanies the disease caused by aging. Like the knee osteoarthritis, which the most obvious example it is. In clinical, total knee replacement is the main treatment for knee osteoarthritis. It is suitable for the treatment of late and the elderly patients, the high tibial osteotomy(HTO) is an alternative, which is suitable for the treatment of early degenerate knee or the younger patients.
However, the structure stability of the HTO fixation has been reported as one of the closely related factors for the postoperative outcome. This study simulates the biomechanical effects of the HTO systems during gait cycle by finite element analysis. Four kinds of HTO plates were constructed in Solidworks 2012, The implant Stress, and Stability were compared between the different High Tibial Osteotomy plate Systems.
According to the final results, it shows that total stress and displacement of PI system are the least. Comparing with the T construct, the total stress and displacement decrease 68% 、56% and 62%、68% at 0 and 30 degrees respectively. Using locking screws can significantly reduce the mechanical stress in the implants and around the bones. Furthermore, double hem design can increase the range fixed from the posterior to anterior of Tibia, and it can improve the stability in this system, preventing the anterior wedge are softened effectively.


目錄

摘 要 i
ABSTRACT ii
致謝 iii
目錄 iv
表目錄 vi
圖目錄 vii
第一章 緒論 1
1.1 研究背景 1
1.2 研究動機與目的 2
1.3 研究範疇 2
第二章 文獻回顧 4
2.1 膝關節解剖學 4
2.2 膝關節運動學 7
2.3 退化性關節炎 8
2.4 高位脛骨截骨手術 13
2.5 HTO骨板骨釘系統介紹 14
第三章 研究方法 18
3.1有限元素分析簡述與流程 18
3.2三維脛骨圖檔建立 20
3.3三維HTO骨板骨釘系統模型建立 22
3.3.1 三維HTO骨板模型建立 22
3.3.2 三維HTO骨釘模型建立 23
3.4 脛骨與骨板骨釘系統之配合及材料性質 25
3.4.1 脛骨與骨板骨釘系統之配合 25
3.4.2 脛骨與骨板骨釘系統之材料性質 26
3.4.3 脛骨、骨板與骨釘之介面條件 30
3.5受力條件與參數設定 30
3.5.1 接觸力與方向之設定 30
3.5.2 接觸位置與股髁輪廓面積 32
3.6 網格設定與建立 36
第四章 結果與討論 39
4.1 術後缺口位移結果與討論 39
4.2 Von Mises Stress結果與討論 42
第五張 結論與未來展望 48
參考文獻 50
作者簡介 56



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