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大学・研究所にある論文を検索できる 「整形外科における生体力学問題に対するCT-FEMと機械学習の応用」の論文概要。リケラボ論文検索は、全国の大学リポジトリにある学位論文・教授論文を一括検索できる論文検索サービスです。
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整形外科における生体力学問題に対するCT-FEMと機械学習の応用

呉, 順 WU, SHUN シュン, ウー 九州大学

2021.09.24

概要

最近、超高齢社会を迎えた我が国において、様々な骨や関節関連の疾患が問題となっている。たとえば、高齢女性に多い骨粗鬆症は、骨が脆弱化し脊椎の椎体骨折や大腿骨の頚部骨折等を引き起こし、治癒状態が悪い場合は寝たきりの状態となってしまう。一方、中高年の女性に多い変形性股関節症は、病状が悪化すると人工股関節置換術（THA）が唯一の方法であり、THA を施さない場合は、やはり寝たきりの状態となり得る疾病である。骨粗鬆症は、測定された大腿骨や脊椎の平均的骨密度及びYAM 値が診断に利用され、骨折危険性についても臨床的指導が行われるが、このような骨密度がどの程度骨折危険性と相関があるのかについては、いまだ明らかになっていない。また、THA については、様々なデザインの人工股関節が臨床で用いられているものの、特に人工股関節ステムの形状が大腿骨に及ぼす生体力学的影響については不明な点が多い。

本論文は、100 名を超えるの患者の脊椎CT データから抽出した椎体CT 画像を用いて3 次元数値モデルを作成し、CT 画像を利用した有限要素法（CT-FEM）を用いて椎体圧縮強度を評価し、強度と骨密度との相関関係について検討している。さらに、骨強度に関連していると考えられる、いくつかの骨構造や骨密度に関連するパラ―メタを選定し、強度との相関について調査している。また、得られた結果を用いて、新しい構造・骨密度パラメータを提案している。さらに、機械学習を用いて、複数のパラメータを入力値として骨折危険性の予測を行う試みを行っている。一方、3 種類の大転子肩部の形状が異なる3 種類のステムを埋入した大腿骨モデルを作成し、CT-FEM で解析することで、ステム形状が固定性に及ぼす影響について考察している。

１章では、研究の背景と目的について述べている。まず、骨粗鬆症と骨粗鬆症に起因する椎体圧迫骨折について概説し、続いて骨密度と圧迫骨折の関係について説明している。次に、CT- FEM を用いた骨強度評価法について説明し、献体実験結果との整合性について述べている。さらに、現在の臨床における骨折危険性の評価法について説明し、機械学習法の臨床医学への応 用について概説している。本研究は、このような背景の下、CT-FEM で評価した椎体の圧縮強度 と骨密度との相関性について明らかにすることを目的としている。さらに椎体強度と強い相関 性を示す新しい構造・骨密度パラメータを見出すことを目的としている。また、機械学習法を 用いて、複数の評価パラメータを総合的に考慮した骨折危険性予測法の構築を目的としている。

２章では、116 名の患者の脊椎CT データから抽出した362 個の椎体CT 画像を用いて3D 椎体モデルを作成し、圧縮強度を評価している。得られた強度データと各患者の骨密度および椎体と大腿骨のYAM 値との相関について調査し、強い相関が得られない原因、ならびにYAM による臨床診断の問題点について説明している。次に、椎体強度と強い相関を示すと考えられるいくつかのパラメータ、たとえば海綿骨平均骨密度、最小断面積、低骨密度域の体積率等を提案し、これらのパラメータが強度と強い相関を示すことを見出している。さらに複数のパラメータを組み合わせることで、より強い相関を示す新しいパラメータの創製を実現している。

３章では、骨温存型として広く使用されている Zweymüller 型ステムと大転子肩部のデザインを変更した2 種類のステム、計3 種類のステムを高齢者CT 画像より作成した大腿骨3 次元モデルに挿入した解析モデルを作成し、応力解析を試みている。その結果、大転子肩部を大幅にとり除いたデザインでも、十分な回旋固定性が得られることが示唆されている。この結果より、従来型では近位部の骨を大きく取り除く必要があるが、変更したデザインのステムを用いることで、骨が温存できる可能性があることが明らかになっている。

４章は総括であり、各解析から得られた重要事項について説明し、本研究のさらなる発展の可能性と今後の展開について説明している。

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