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Fatigue properties of titanium alloy custom short stems fabricated by electron beam melting

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Journal of Materials Science & Technology 2020年第17期52卷 180-188页

作者： Liao Wang Shujun Li mengning yan Yubo Cheng Wentao Hou Yiping Wang Songtao Ai Rui yang Kerong Dai Shanghai Key Laboratory of Orthopaedic Implants Department of Orthopaedic SurgeryShanghai Ninth People’s HospitalShanghai Jiao Tong University School of MedicineShanghai Jiao Tong UniversityShanghai 200030China Titanium Alloy Laboratory Institute of Metal ResearchChinese Academy of SciencesShenyang 110016China Image Medraw Technology(Shanghai)Company Limited Shanghai 201100China

The fatigue properties of titanium alloy short-stems with four different lengths,manufactured by electron beam melting(EBM)technology,were investigated by in vitro test and finite element(FE)*** simulation results indicate that the maximum tensile stress concentrates at the lateral side of the stem *** magnitude of the concentrated tensile stress increases and the corresponding area of the axial section decreases with increasing of stem *** from fatigue tests demonstrate that fatigue cracks mainly initiate from the rough surface of the stem where the maximum tensile stress *** fatigue strength decreases with the increase of stem length,which is attributed to the higher stress concentration on the longer stem *** addition,it is found that post EBM treatment via hot isostatic processing(HIP)is able to enhance the fatigue properties of the stems,since the pores generated during EBM are mostly closed during *** work also demonstrates that the stress concentration on the stem surface can be effectively mitigated and the corresponding fatigue properties of the EBM-fabricated titanium alloy short stem can be considerably improved by optimizing the design in the stem length.

关键词： Custom short stem Titanium alloy Electron beam melting Fatigue property

Association Between Knee Alignment,Disease Severity and Subchondral Trabecular Bone Microarchitecture in Patients with Knee Osteoarthritis

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医用生物力学 2019年第A1期34卷 67-68页

作者： Xuequan Han Zihao He Linyang Chu Kai Xie Xu Jiang mengning yan Zhifeng Yu Shanghai Key Laboratory of Orthopaedic Implants Department of Orthopaedic SurgeryShanghai Ninth People’s HospitalShanghai Jiao Tong University School of Medicine

Objective Most patients with knee osteoarthritis(OA)have alignment deformity with the change of Hip-knee-ankle(HKA)*** knee alignment influences load distribution at the tibial ***,change of subchondral trabecular bone microstructure is related to load bearing and OA ***,the relationship between knee alignment on the changes of subchondral trabecular bone microstructure and OA severity have been poorly *** main goal of this work was to investigate variation in tibial plateaus subchondral trabecular bone microstructure in knee OA patients and their association with the severity of OA with the change of knee *** Seventy-one knee OA patients planning to undergo total knee arthroplasty were enrolled in this *** HKA angle and OA disease severity(OARSI score,compartment-specific Kellgren-Lawrence(K-L)grade and OARSI Atlas grade)based on full-leg standing posteroanterior radiographs were evaluated preoperatively in all *** tibial plateau collected during surgery was first used for micro-computed tomography(μCT)to analyze the subchondral trabecular bone microstructures,and then used for pathological sections to analyze cartilage degeneration(OARSI score).Pearson and spearman correlations were used to examine linear relationships between knee alignment,OA disease severity and subchondral trabecular bone *** were then divided into group I(HKA angle exceeds 0°in the valgus direction),group II(varus angle<10°)and group III(varus angle≥10°).The differences in subchondral trabecular bone microstructural parameters between the three groups were analyzed by the one-way ANOVA with a post hoc Tukey *** HKA angle was significantly correlated with all tibial plateau subchondral trabecular bone microstructure *** of the medial or lateral tibia,HKA angle was most strongly correlated with bone volume fraction(BV/TV),M:(r=0. 613,P<0.01);L:(r=-0.490,P<0.01).In additio

关键词： Disease Severity Subchondral Trabecular Bone Microarchitecture Knee Osteoarthritis

力学刺激通过microRNA调控骨重建的研究进展

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医用生物力学 2023年第4期38卷 844-850页

作者：孙林严孟宁上海交通大学医学院附属第九人民医院骨科上海市骨科内植物重点实验室上海200011

骨骼结构完整性和骨量的维持需要一定的力学刺激。研究表明,力学刺激可通过调控多种调节因子(例如激素、转录因子和信号分子等)参与骨重建过程。力学刺激可以通过调控微小RNA(microRNA,miRNA)表达在骨重建过程中起着至关重要的作用。然... 详细信息

骨骼结构完整性和骨量的维持需要一定的力学刺激。研究表明,力学刺激可通过调控多种调节因子(例如激素、转录因子和信号分子等)参与骨重建过程。力学刺激可以通过调控微小RNA(microRNA,miRNA)表达在骨重建过程中起着至关重要的作用。然而,受力学刺激调控的miRNA在骨重建过程中的作用和机制尚不完全清楚。本文综述受力学刺激调控的miRNA在骨重建过程中的作用及其机制,并强调其在治疗骨质疏松中的潜在应用。

关键词：骨重建微小RNA 骨质疏松力学刺激力学敏感性

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软骨细胞力学信号转导在骨性关节炎中的作用

医用生物力学 2021年第3期36卷 485-490页

作者：阚天佑严孟宁上海交通大学医学院附属第九人民医院骨科上海市骨科内植物重点实验室上海200011

异常力学负荷是骨关节炎发生的主要危险因素,可导致胶原降解、糖胺聚糖丢失和软骨细胞凋亡,引起软骨和软骨下骨破坏。然而,由于对软骨细胞力学传导认识不足,以及各种软骨修复再生手段的效果并不理想,故迫切需要了解软骨细胞力学传导过... 详细信息

异常力学负荷是骨关节炎发生的主要危险因素,可导致胶原降解、糖胺聚糖丢失和软骨细胞凋亡,引起软骨和软骨下骨破坏。然而,由于对软骨细胞力学传导认识不足,以及各种软骨修复再生手段的效果并不理想,故迫切需要了解软骨细胞力学传导过程以及软骨机械性损伤发生机制,以期望为研究软骨损伤修复和再生提供参考。详细介绍力学信号如何从细胞外经由细胞膜传至细胞内力学感受器,并着重讨论相关力学传导的信号通路在骨性关节炎中的作用。

关键词：软骨细胞力学传导力学感受器骨性关节炎

Image Registration Technique for Assessing the Accuracy of Intraoperative Osteotomy for Pelvic Tumors by 3D-Printed Patient-Specific Templates

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Journal of Shanghai Jiaotong university(Science) 2021年第3期26卷 306-311页

作者：曲扬严孟宁李小敏吴兵柳思宇王燎武文艾松涛 Department of Radiology Shanghai Jiao Tong University School of MedicineShanghai200011China Shanghai Key Laboratory of Orthopaedic Implants Department of OrthopaedicsShanghai Ninth People’s HospitalShanghai Jiao Tong University School of MedicineShanghai200011China

The study aimed to explore the feasibility of an image registration technique for assessing the accuracy of intraoperative osteotomy of pelvic tumors by 3-dimensional(3D)-printed patient-specific *** with malignant pelvic tumors who were admitted to our hospital between March 2014 and December 2020 were retrospectively *** underwent hemi-pelvic resection and reconstruction by 3D-printed individualized *** registration between the designed model and the postoperative segmented model of the prosthesis was used to obtain the intraoperative osteotomy plane and reduce metal artifacts in postoperative computed tomography(CT)*** distance and angle between the planned and actual osteotomy planes were then used to assess the accuracy of the intraoperative *** patients with 13 osteotomy planes were enrolled,including four males and four *** median age at the time of imaging examination was 44 years(range,33–54 years).All intraoperative osteotomy planes were assessed *** mean distance between the planned and true intraoperative osteotomy planes was−0.69 cm(−7.5–7.35 cm),and the mean angle was 6.57°±3.36°(1.05°–11.88°).This new assessment method of registering the designed model and the postoperative CT segmented model of the prosthesis may be used to assess the accuracy of intraoperative osteotomy for pelvic tumors,using 3D printed patient-specific templates.

关键词： pelvic tumor image registration 3D-printed patient-specific template intraoperative osteotomy

Using a Patient-Specific 3D-Printed Surgical Guide for High Tibial Osteotomy:A Technical Note

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Journal of Shanghai Jiaotong university(Science) 2021年第3期26卷 339-345页

作者：江旭谢凯李波胡旭民吴海山高梁斌王燎严孟宁 Shanghai Key Laboratory of Orthopaedic Implants Department of Orthopaedic SurgeryShanghai Ninth People’s HospitalShanghai Jiao Tong University School of MedicineShanghai200011China Department of Orthopaedic Surgery Sun Yat-Sen Memorial HospitalSun Yat-Sen UniversityGuangzhou510120China

Patient-specific instrumentation(PSI)enables a more accurate alignment of the lower limbs in a high tibial osteotomy(HTO)than in traditional surgery;however,the current design of commercial PSIs is not ***,we designed a new patient-specific surgical guide to improve the accuracy of the osteotomy and verified its reliability through a clinical ***,we describe a patient with isolated medial-compartment bilateral knee osteoarthritis,accompanied by a varus deformity of the proximal *** patient was treated with HTO using a patient-specific 3D-printed surgical *** concluded that the patient-specific 3D-printed surgical guide improved the accuracy of the osteotomy and the alignment of the lower limb.

关键词： high tibial osteotomy(HTO) 3D printing patient-specific instrumentation(PSI) wedge augment

无菌性松动人工全髋关节假体周围界膜组织血管化的研究

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中国修复重建外科杂志 2016年第1期30卷 39-43页

作者：武文严孟宁朱振安戴尅戎上海交通大学医学院附属第九人民医院骨科上海200011

目的研究人工全髋关节假体无菌性松动后假体周围组织的血管化程度,探讨其与假体周围骨溶解的关系。方法取2009年10月-2012年6月22例（22髋）因假体无菌性松动行髋关节翻修术患者假体周围界膜组织,其中男12例,女10例;年龄53~81岁;假体使... 详细信息

目的研究人工全髋关节假体无菌性松动后假体周围组织的血管化程度,探讨其与假体周围骨溶解的关系。方法取2009年10月-2012年6月22例（22髋）因假体无菌性松动行髋关节翻修术患者假体周围界膜组织,其中男12例,女10例;年龄53~81岁;假体使用寿命6~14年。术中根据假体周围标准分区法,结合术前影像学表现,将假体周围界膜组织分为骨溶解区组和非骨溶解区组。另取同期8例（8髋）行人工全髋关节置换的骨关节炎患者滑膜组织作为对照组,其中男3例,女5例;年龄58~72岁。行HE染色观察组织学特征,根据骨溶解区组金属或聚乙烯颗粒数量行磨损程度分级。采用CD34免疫组织化学染色对组织内的血管进行标记,计算微血管密度及微血管指数,比较不同组间血管化程度以及不同磨损程度下血管化程度的变化。结果组织学观察骨溶解区组界膜组织中可见磨损颗粒聚集以及单核-巨噬细胞浸润广泛,非骨溶解区组以纤维细胞为主。免疫组织化学染色示,非骨溶解区组微血管密度和微血管指数较骨溶解区组和对照组显著降低（P〈0.05）;骨溶解区组以上指标较对照组低,但差异无统计学意义（P〉0.05）。金属、聚乙烯颗粒重度磨损组织微血管密度和微血管指数均较对应的轻度磨损组织明显减少（P〈0.05）;相同磨损程度时,聚乙烯磨损颗粒以上指标均较金属磨损颗粒高,但差异无统计学意义（P〉0.05）。结论界膜组织内单核细胞发挥吞噬功能需要一定数量的微血管和血供,假体-骨界面组织微血管损伤或者血供减少,可能是造成假体周围骨整合不良和假体无菌性松动的重要原因。

关键词：无菌性松动人工全髋关节置换血管化微血管密度

3D-Printed Porous Titanium Augments for Reconstruction of Massive Bone Defect in Complex Revision Total Knee Arthroplasty:Implant Design and Surgical Technique

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Journal of Shanghai Jiaotong university(Science) 2021年第3期26卷 334-338页

作者：阚天佑谢凯曲扬艾松涛姜闻博吴海山王燎严孟宁 Shanghai Key Laboratory of Orthopaedic Implants Department of Orthopaedic SurgeryShanghai Jiao Tong University School of MedicineShanghai200011China Department of Radiology Shanghai Jiao Tong University School of MedicineShanghai200011China Clinical and Translational Research Center for 3D Printing Technology Shanghai Ninth People’s HospitalShanghai Jiao Tong University School of MedicineShanghai200011China

Reconstruction of severe bone defects in revision total knee arthroplasty(TKA)remains a challenge for *** progression of medical imaging and additive manufacturing technology has enabled the rapid manufacture of custom-made implants,and 3D-printed augments with interconnected pore structures have become an alternative approach for the reconstruction of bone defects in revision TKA,especially in patients with complex bone *** size and location of the bone defect were determined by thin-layer computed tomography(CT;layer thickness is 1 mm)after reduction of *** 3D reconstruction models of the host bone were obtained based on thin-layer CT *** custom-made augmentation was designed according to the 3D reconstruction bone *** augmentation had an interconnected porous structure on the bone-implant interface to achieve biological *** the design was complete,the 3D model of augment was exported in STL format,and augments were fabricated with Ti6Al4V powder using electron beam ***-layer CT and 3D reconstruction bone models are accurate methods for evaluating periprosthetic bone loss after artifact *** 3D-printed augments perfectly match the bone defects during surgery.3D-printed augmentation is an effective approach for the reconstruction of bone defects in revision ***,surgeons and engineers should carefully evaluate the bone defect during augment design to avoid a mismatch between the augment and host bone.

关键词： 3D printing revision total knee arthroplasty bone defect

非截骨全髋关节置换术治疗单侧CroweⅣ型髋关节发育不良

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中华骨科杂志 2014年第12期34卷 1205-1211页

作者：李慧武朱振安毛远青严孟宁岳冰上海交通大学医学院附属第九人民医院 200011

目的探讨非截骨全髋关节置换术治疗单侧CrowelW型髋关节发育不良的临床疗效。方法2007年10月至2010年1月应用非截骨全髋关节置换术治疗单侧CroweⅣ型髋关节发育不良患者32例，男12例，女20例；年龄23-60岁，平均（49．429．7）岁。对侧... 详细信息

目的探讨非截骨全髋关节置换术治疗单侧CrowelW型髋关节发育不良的临床疗效。方法2007年10月至2010年1月应用非截骨全髋关节置换术治疗单侧CroweⅣ型髋关节发育不良患者32例，男12例，女20例；年龄23-60岁，平均（49．429．7）岁。对侧髋关节正常15例，无关节炎及脱位表现的轻度髋臼发育不良17例。通过有限软组织松解、撬拨复位实现真臼重建，不行股骨短缩截骨。术后对患者满意度、髋关节功能恢复、双下肢不等长、骨盆倾斜等情况进行评估。结果所有患者均获得随访，随访时间1-6年，平均（4．0±1．5）年。Harris髋关节评分由术前（36．5±10-3）分（20-63分）提高至末次随访时（89．8±4．9）分（80~97分），两者差异有统计学意义。Harris髋关节评估优16例、良16例，优良率100％。患者满意率93．8％（30／32）。术后均有不同程度的骨盆向患侧倾斜，随时间延长双下肢相对长度差逐渐缩小，骨盆倾斜逐渐矫正。末次随访时双下肢相对长度差（7．3±4．4）mm，髂腰角-0．1°±1．4°。9例出现术后膝关节轻度外翻，末次随访时仍有4例残存膝关节轻度外翻，长距离行走出现大腿外侧及膝关节酸胀不适。2例有术后股神经牵拉损伤，未行特殊处理，分别于术后1个月和3个月完全恢复。随访期间无髋关节脱位、假体感染、假体松动或失败发生。结论在脊柱柔韧性较好的前提下，通过非截骨全髋关节置换术治疗单侧CroweIV型髋关节发育不良可获得令人满意的手术效果，术后短期内的术侧肢体过长会随着骨盆倾斜的恢复而逐渐得到矫正。

关键词：髋脱位先天性关节成形术置换髋髋臼成年人