臺灣博碩士論文加值系統

目前市面上有著許多不同形狀的固定用骨板應用於重建缺損，另外也有研發出新型大面積骨板以解決傳統骨板在遇到大面積面中部缺損時無法使用的問題，若使用在面中部區域會造成應變過大進而降低骨癒合效果及因植入物強度過強而導致之應力遮蔽效應，增加治療失敗機率，且對於重建面中部之力學傳導路徑並未詳加研究。因此本研究預計開發一種適用於重建面中部中大面積缺損之新型客製化植入物，並透過壓縮測試進行驗證。首先，透過病人的CT影像建構出面中部模型外觀，接著，透過逆向工程技術設計出新型植入物，並將其補塊部分晶格化以降低其楊氏係數，藉由有限元素分析獲得植入物在面中部中所受應力與其周圍新生骨質所受應變，接著使用金屬3D列印技術製作出新型植入物，最後依靠壓縮測試分別測試出各款植入物之應變量，及驗證新型植入物的機械性質。結果顯示，晶格化之新型客製化植入物在面中部具有最小所受應力，且三款植入物周圍新生骨質所受應變數值與FEA結果之誤差值皆小於20%，具有促進骨癒合之效果。另外在經過FEA的計算後，顯示出晶格化新型客製化植入物在重建面中部力學傳導路徑方面相較實心及傳統骨板皆更加完整。

Currently, there are many different shapes of fixation bone plates available on the market for reconstructing defects. Additionally, new large-area bone plates have been developed to address the issue where traditional plates cannot be used for large central defects. If used in the midface area, traditional plates can cause excessive strain, thereby reducing bone healing effectiveness and leading to stress shielding due to excessive implant strength, increasing the probability of treatment failure. Moreover, the mechanical transmission pathway for reconstructing the central part of the face has not been thoroughly researched.

Therefore, this study aims to develop a novel customized implant suitable for reconstructing large defects in the midface region and validate it through compression testing. Firstly, the midface model is constructed from patient CT images. Subsequently, using reverse engineering techniques, a new implant design is created. The lattice structure of the implant block is then utilized to reduce its Young's modulus. Finite element analysis (FEA) is employed to determine the stress on the implant in the central face area and the strain on the surrounding newly formed bone. The novel implants are manufactured using metal 3D printing technology. Finally, compression tests are conducted to measure the strain levels of each implant type and verify the mechanical properties of the new implants.

Results show that the lattice-structured customized implants experience minimal stress in the central face area. The strain values on the surrounding newly formed bone for all three implant types are within 20% deviation from the FEA results, indicating a beneficial effect on bone healing promotion. Furthermore, FEA calculations demonstrate that the lattice-structured customized implants provide a more complete mechanical transmission pathway in the reconstruction of the central face area compared to solid and traditional bone plates.

摘要 i
目錄 iv
圖目錄 vii
表目錄 x
第一章 緒論 1
1.1 研究背景 1
1.1.1 面中部大範圍缺損 1
1.1.2 面中部大面積缺損重建骨板與臨床問題 5
1.1.3 植入物設計 6
1.1.4 重建之面中部需考量力學傳導方式 6
1.1.5 植入物骨融合問題 7
1.2 研究動機 8
1.3 文獻回顧 9
1.3.1 傳統手術特點 9
1.3.2 現今植入物形式 10
1.3.3 面中部生物力學與支撐系統 12
1.3.4 驗證植入物之固定穩定性 12
1.3.5 應力遮蔽效應與骨流失 13
1.3.6 適用於面中部之晶格介紹 14
1.3.7 晶格使周邊骨骼產生最佳應變量 17
1.3.8 金屬3D列印技術 18
1.3.9 文獻總結 19
1.4 研究目的 21
第二章 研究方法 22
2.1 設計概念探討 24
2.1.1 臨床背景諮詢 24
2.1.2 設計理念提出 24
2.2 植入物分析模型設計 26
2.2.1 分析模型設計 26
2.2.2 植入物模型設計 27
2.2.3 傳統骨板模型設計 29
2.3 生物力學分析 31
2.3.1 分析條件設定 31
2.3.2 分析網格模型 34
2.3.3 植入物分析對比評估 36
2.4 體外功能性測試 38
2.4.1 植入物模型製造 38
2.4.2 面中部模型製造 41
2.4.3 靜態壓縮測試 42
2.4.4 動態壓縮測試 43
2.4.5 誤差範圍 45
第三章 研究結果 45
3.1 面中部力學分析結果 45
3.2 靜態壓縮測試結果 50
3.3 動態壓縮試驗結果 56
第四章 研究討論 60
4.1 固定用骨板外型討論 61
4.2 應力遮蔽效應、骨融合效果討論 62
4.3 靜態壓縮測試結果討論 63
4.4 動態壓縮測試結果討論 63
4.5 研究限制 65
第五章 結論 67
參考文獻 68

 
圖目錄
圖一、面中部大面積缺損 1
圖二、現今手術方式流程圖 3
圖三、傳統式骨板示意圖 5
圖四、支撐系統之完整力學傳遞路徑圖 7
圖五、骨融合階段示及復原所需時間 8
圖六、傳統式骨板固定示意圖 10
圖七、現今常用骨板形式及種類 11
圖八、新研究之片型骨板 11
圖九、新研究之片型骨板及固定方法 12
圖十、骨流失所造成中下臉的整體老化 14
圖十一、人體股骨之髖關節受力示意圖 15
圖十二、人體之頸椎受力示意圖 16
圖十三、頸椎之晶格化植入物 16
圖十四、單一晶格設計參數 17
圖十五、以金屬3D列印製造多孔性結構 18
圖十六、客製化之3D列印 19
圖十七、研究方法流程圖 23
圖十八、新型植入物示意圖 24
圖十九、患者CT檔之3D模型 27
圖二十、經逆向工程重建之面中部3D模型 27
圖二十一、獲取植入物之外型、尺寸 28
圖二十二、植入物組裝 29
圖二十三、傳統式骨板及其固定示意圖 30
圖二十四、骨板分析模型 30
圖二十五、面中部生物力學分析示意圖 33
圖二十六、面中部網格化模型 35
圖二十七、傳統式骨板網格化模型 35
圖二十八、新型客製化植入物網格化模型 35
圖二十九、固定用骨釘之網格化模型 36
圖三十、傳統式骨板與面中部組裝圖 37
圖三十一、新型客製化植入物與面中部組裝圖 37
圖三十二、傳統式骨板網格化模型 37
圖三十三、AMP-160機台 39
圖三十四、Fortus 250mc機台 42
圖三十五、靜態壓縮測試架設圖 43
圖三十六、動態壓縮測試架設圖 44
圖三十七、面中部之分析結果 47
圖三十八、三款植入物所受之最大應力 48
圖三十九、面中部之節點力分析 49
圖四十、HL化植入物靜態壓縮試驗圖 51
圖四十一、新型植入物之靜態壓縮試驗圖 52
圖四十二、傳統骨板之靜態壓縮試驗圖 53
圖四十三、HL化植入物動態壓縮試驗圖 57
圖四十四、HL化植入物動態壓縮試驗結果 57
圖四十五、新型植入物動態壓縮試驗圖 58
圖四十六、新型植入物動態壓縮結果 58
圖四十七、傳統骨板動態壓縮試驗圖 59
圖四十八、傳統骨板動態壓縮試驗結果 59
圖四十九、量測之定位點示意圖 61
圖五十、兩款新型客製化植入物所受之應力 62
圖五十一、各款植入物動態壓縮之位移量平均值 64

 
表目錄
表一、材料特性 33
表二、各模型接觸條件 34
表三、AMP-160機台資訊 40
表四、晶格列印參數 40
表五、植入物列印參數(solid) 41
表六、分析中三款植入物重建後面中部模型之最小應變量 46
表七、分析中三款植入物所受之最大應力 947
表八、HL化植入物靜態壓縮結果 54
表九、新型植入物靜態壓縮結果 54
表十、傳統式骨板靜態壓縮結果 55
表十一、HL化植入物動態壓縮數據 57
表十二、新型植入物之動態壓縮數據 58
表十三、傳統骨板之動態壓縮數據 59
表十四、各定位點量測之結果 62

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