Modélisation biomécanique de la hanche dans le risque de fracture du fémur proximal.

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Jolivet, Erwan (2007) Modélisation biomécanique de la hanche dans le risque de fracture du fémur proximal. Doctorat Biomécanique, ENSAM 2007ENAM0019 p.176.

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Résumé

Les fractures de l’extrémité supérieure du fémur représentent un problème de santé publique. 90% des fractures du col fémoral résultent d’une chute du sujet sur la hanche. Pour étudier le rôle des muscles, une modélisation préliminaire en éléments finis de la hanche incluant ses tissus mous est proposée dans cette thèse. Cette modélisation a nécessité la mise au point d’une méthode originale de reconstruction des volumes musculaires et de quantification du tissu musculaire à partir d’un nombre réduit de coupes CT-scan. La méthode s’appuie sur une déformation sous contrainte d’un modèle paramétré pré-personnalisé de chaque muscle. Avec seulement quatre coupes par muscle, l’erreur d’estimation du volume est alors inférieure à 6% en comparant avec le volume reconstruit entièrement manuellement. L’étude de 98 sujets a alors permis d’établir les valeurs de références et la variabilité inter-individuelle pour ces données quantitatives et a également mis en évidence des invariants.

La modélisation en éléments finis intègre les structures osseuses et les tissus mous, avec une gestion des contacts de surface entre les composants. Les lois matériaux utilisées pour les tissus mous sont de type hyperélastique incompressible isotrope. Les premières évaluations de ce modèle, soumis à une compression latérale en quasi-statique, ont permis de vérifier la cohérence du comportement du modèle pour dix sujets et de mettre en relief l’importance d’une modélisation personnalisée.

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Table des Matières

INTRODUCTION 1



CONTEXTE D’ÉTUDE ET ANALYSE BIBLIOGRAPHIQUE 5

CHAPITRE 1: CONTEXTE D’ÉTUDE 7

1.1. INTRODUCTION 7

1.2. ANATOMIE DE LA HANCHE 7

1.2.1. Les Structures Osseuses 7

1.2.2. Le tissu musculaire strié squelettique 9

1.2.3. Les muscles de la hanche 9

1.2.4. La graisse sous cutanée 12

1.2.5. La peau 13

1.2.6. Le tissu osseux 13

1.3. LA FRACTURE DE L’ÉXTRÉMITÉ SUPÉRIEURE DU FÉMUR 14

1.3.1. L’ostéoporose et les fractures de l’extrémité supérieure du fémur 14

1.4. ÉVALUATION DU RISQUE DE FRACTURES DE L’EXTRÉMITÉ SUPÉRIEURE DU FÉMUR 15

1.4.1. La densité minérale osseuse 15

1.4.2. Muscles, tissus mous et évaluation du risque de fracture 16

1.5. APPORT DE LA MODÉLISATION NUMÉRIQUE DANS L’ÉVALUATION DU RISQUE DE FRACTURE 18

1.6. L’IMAGERIE DES TISSUS MOUS 18

1.6.1. Le CT-scan 19

1.6.2. L’imagerie par résonance magnétique 20

1.7. INTERÊT DE L’ÉVALUATION QUANTITATIVE MUSCULAIRE 21

1.8. SYNTHÈSE ET OBJECTIFS DE LA THÈSE 22

CHAPITRE 2: REVUE DE LITTÉRATURE : ÉVALUATION QUANTITATIVE MUSCULAIRE 25

2.1. INTRODUCTION 25

2.2. LA GÉOMÉTRIE MUSCULAIRE 25

2.2.1. La section musculaire 29

2.2.2. Le volume musculaire 29

2.2.3. Reconstruction tridimensionnelle du muscle squelettique 30

2.3. LA QUALITÉ DU TISSU MUSCULAIRE 31

2.4. VARIATION DE LA QUALITE MUSCULAIRE ENTRE ET DANS LES GROUPES MUSCULAIRES 37

2.5. CONCLUSION 37

CHAPITRE 3: REVUE DE LITTÉRATURE : ABSORPTION DE L’ÉNERGIE D’IMPACT 39

3.1. ABSORPTION DE L’ÉNERGIE D’IMPACT 39

3.1.1. Importance de l’absorption d’énergie 39

3.1.2. Évaluation de l’absorption d’énergie 39

3.1.3. Modélisation de l’absorption de l’énergie d’impact 41

CHAPITRE 4: REVUE DE LITTÉRATURE : MODÉLISATION D’UN SYSTÈME MUSCULO-SQUELETTIQUE PAR ÉLÉMENTS FINIS 43

4.1. INTRODUCTION 43

4.2. MODÈLES ÉLÉMENTS FINIS MUSCULO-SQUELETTIQUE 43

4.3. LOI MATÉRIAU POUR MODÉLISER LE COMPORTEMENT MÉCANIQUE DU TISSU MUSCULAIRE 51

4.3.1. L’hyperélasticité 51

4.3.2. L’incompressibilité 52

4.3.3. L’anisotropie 52

4.3.4. La viscosité 53

4.3.5. L’activation musculaire 53

4.4. CONCLUSION 57

SYNTHÈSE ET OBJECTIFS DE L’ÉTUDE 59



TRAVAIL PERSONNEL 63

CHAPITRE 5: ÉVALUATION QUANTITATIVE DES MUSCLES DE LA HANCHE 65

5.1. INTRODUCTION 65

5.2. MATÉRIEL ET MÉTHODE 65

5.2.1. Méthode de reconstruction volumique des muscles 65

5.2.2. Amélioration du logiciel de contourage musculaire 72

5.2.3. Gestion des interpénétration 73

5.2.4. Quantification de l’infiltration graisseuse intra-musculaire 74

5.2.5. Évaluation de la méthode 75

5.3. RÉSULTATS 77

5.4. ANALYSE DES RÉSULTATS ET DISCUSSION SUR LA MÉTHODE 83

5.5. CONCLUSIONS ET PERSPECTIVES 84

CHAPITRE 6: ÉTUDE QUANTITATIVE PAR CT-SCAN DE LA VARIABILITE DES MUSCLES DE LA HANCHE 87

6.1. INTRODUCTION 87

6.2. MATÉRIEL ET MÉTHODE 88

6.2.1. Acquisition CT-scan 88

6.2.2. Analyse quantitative musculaire 88

6.3. RÉSULTATS ET DISCUSSION 93

6.3.1. Fiabilité des mesures de volume et estimation des incertitudes de mesures 93

6.3.2. Analyse descriptive de l’évaluation quantitative musculaire 101

6.4. SYNTHÈSE ET CONCLUSION 111

CHAPITRE 7: MODÉLISATION PERSONNALISÉE PAR ÉLÉMENTS FINIS DE LA HANCHE 112

7.1. INTRODUCTION 112

7.2. MATÉRIEL ET MÉTHODE 113

7.2.1. Génération du maillage 113

7.2.2. Lois matériaux 122

7.2.3. Évaluation quasi-statique du modèle 123

7.2.4. Résultat de l’évaluation quasi statique du modèle 125

7.3. DISCUSSION ET CONCLUSION 129

SYNTHÈSE GÉNÉRALE ET CONCLUSION 131



PUBLICATIONS 135



BIBLIOGRAPHIE 139



INDEX 151



ANNEXE 157

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