HCD和CD不同减压通道治疗股骨头坏死的生物力学研究

目的 蜂巢式髓芯减压术（honeycomb core decompression surgery，HCD）和髓芯减压术（Core decompression surgery，CD）生物力学对比研究，为早中期股骨头坏死(Osteonecrosis of the Femoral Head，ONFH)选择保留髋关节治疗方法提供依据。方法 根据成人股骨头坏死诊疗专家共识（2019版）选择ONFH（ARCO分期I期）1例进行研究。CT平扫获得股骨近端数据，应用Mimics 21.0 、Geomagic Studio 2013、Hypermesh 2019、 Abaqus 2020 软件进行建模、网格划分和优化、装配、设定载荷量、约束条件的界定、有限元及力学分析,模拟手术减压通道孔径均为5mm。SPSS 22.0 对数据进行处理，计算股骨头内应力。在股骨头内应力部位均匀选取30个节点，并计算其均值，运用SPSS 20.0 软件对数据进行分析处理，计量资料以均数±标准差表示。多组间比较采用单因素方差分析，两组间比较采用独立样本t检验。结果 1. HCD组应力值：0孔：0.168±0.053，3孔：0.250±0.044，4孔：0.264±0.020，5孔：0.272±0.086，6孔：0.378±0.008。2.CD组应力值：0孔：0.168±0.053，3孔：0.686±0.168，4孔：0.963±0.398，5孔：1.077±1.127，6孔0.985±0.308。结论1.HCD治疗ONFH创伤小，安全性高，骨折风险小；综合安全性和骨折风险及减压效果，以5孔减压最理想。2.相同孔数的HCD和CD在相同减压通道时，HCD对股骨近端的生物力学性能影响更小，骨折风险更小，是一种较为理想的保髋术式。

Study on the biomechanics of the treatment of avascular necrosis of the femoral head by applicating the relief channel different numbers in honeycomb core decompression surgery

Objective To compare the biomechanics of Honeycomb Core Decompression Surgery (HCD) and Core Decompression Surgery (CD). To provide evidence for the selection of hip sparing methods for Osteonecrosis of the Femoral Head (ONFH). Methods According to the expert consensus of diagnosis and treatment of adult femoral head necrosis (2019 edition), one case of ONFH (ARCO stage I) was selected for the study. CT plain scan to obtain data of the proximal femur, Apply Mimics 21.0, Geomagic Studio 2013, HyperMesh 2019, and Abaqus 2020 Modeling, mesh division and optimization, assembly, load setting, constraint conditions definition, finite element and mechanical analysis were carried out by software. The aperture of decompression channel in simulated surgery was all 5mm. SPSS 22.0 processed the data and calculated the internal stress of the femoral head. Thirty nodes were evenly selected in the stress position of the femoral head, and their mean values were calculated. SPSS 20.0 software was used to analyze and process the data, and the measurement data was expressed as mean ± standard deviation. One-way analysis of variance was used for comparison between multiple groups, and independent sample t test was used for comparison between two groups. Results 1. The stress value of HCD group: 0 hole: 0.168±0.053, 3 hole: 0.250±0.044, 4 hole: 0.264±0.020, 5 hole: 0.272±0.086, 6 hole: 0.378±0.008. 2. The stress value of group CD: 0 hole: 0.168±0.053, 3 hole: 0.686±0.168, 4 hole: 0.963±0.398, 5 hole: 1.077±1.127, 6 hole: 0.985±0.308. Conclusion 1.HCD treatment of ONFH has low trauma, high safety and low fracture risk; Considering the safety, fracture risk and decompression effect, 5-hole decompression is the most ideal. 2. When HCD and CD with the same number of holes are in the same decompression channel, HCD has less impact on the biomechanical properties of the proximal femur and less fracture risk, so it is an ideal hip preservation surgery.