隨著人口老化，癌症的人口越來越多，雖然許多新的治療方式的出現，讓癌症病人的壽命得以延續，但也讓癌症骨轉移的病人越來越多。傳統上，癌症骨轉移多半伴隨著病理性骨折及劇烈疼痛，多以保守治療、放射治療、疼痛控制等方式處理。特別是髖臼的腫瘤轉移，因為髖臼在身體骨骼的最深處，手術困難，但卻又是支撐我們身體重量及行走的重要關節，一旦轉移常常伴隨嚴重的疼痛及病理性骨折，使病人喪失行走及生活自理能力，導致生活品質大幅下降。
傳統的髖臼骨癌症轉移因為治療困難，所以可以選擇的治療方式極少，例如以哈靈頓桿(Harrington rod)做固定，其早在1981年被提出並使用，至今已超過三十年，雖被廣泛地使用，但仍常常伴隨固定失敗，致使病人疼痛及無法行走等問題。隨著對髖臼生物力學的了解以及新手術方式、新醫療器材出現，均讓這些棘手問題有新的解決方式。本文提出柱螺釘合併骨水泥充填此新手術方式試著幫助此類病患，截至目前為止，此一手術方式連個案報告都極少，因此希望先以有限元素分析法分析此手術方式與傳統手術方式在力學支撐上的差別，並透過設計模擬步態機構，以驗證分析結果是否正確。
且透過分析後的數據，顯示透過此手術新方法，可以提高固定的機率與減少應力的產生，以達到減低病患的疼痛，並增加術後可自理生活的目標。

As the population ages, the population of cancer is increasing. Although many new treatments have emerged to extend the lifespan of cancer patients, there are more and more patients with cancer bone metastasis. Traditionally, cancer bone metastases are often accompanied by pathological fractures and severe pain, mostly treated with conservative treatment, radiation therapy, and pain control. In particular, the acetabular tumor metastasis, because the acetabulum is at the deepest part of the body's bones, it is difficult to operate, but it is also an important joint that supports our body weight and walking. Once the metastasis is often accompanied by severe pain and pathological fracture, the patient is lost. Walking and living self-care ability lead to a significant decline in the quality of life.
Traditional acetabular cancer metastasis is difficult to treat because of the difficulty of treatment. For example, it is fixed by Harrington rod [1]. It was proposed and used as early as 1981. In the year, although it is widely used, it is often accompanied by problems such as fixation failure, which causes the patient to be painful and unable to walk. With the understanding of acetabular biomechanics and the emergence of new surgical procedures and new medical devices, there are new solutions to these difficult problems. This article proposes a new surgical method for column screws and bone cement filling to try to help such patients. So far, this surgical method has few case reports, so I hope to analyze this surgical method and traditional surgical methods with finite element analysis. The difference in mechanical support and the simulation of the gait mechanism to verify that the analysis results are correct.
The analysis of the data, it shows that through this new surgical method, it can increase the probability of fixation and reduce the occurrence of stress, so as to reduce the pain of patients and increase the goal of self-care after surgery.

摘要......i
Abstract......iii
誌謝......v
目錄......vi
表目錄......ix
圖目錄......xi
第一章 緒論......1
1-1 研究動機及目的......2
1-2 髖臼的構造......3
1-3 髖臼運動與生物力學......5
第二章 文獻回顧......7
2-1 癌症轉移併病理性骨折......7
2-2 骨盆髖臼癌症轉移骨折手術......9
2-2-1 骨釘......9
2-3 各類型建模方式......10
2-3-1 Mimics建模方式......10
2-3-2 Matlab建模方式......11
2-4 骨盆髖臼生物實驗測試......11
第三章 分析與方法......13
3-1 骨骼實體模型建立......13
3-1-1 韌帶系統與肌肉系統模擬建立......14
3-2 有限元素模擬分析......16
3-2-1 材料參數......17
3-2-2 邊界負載條件......18
3-2-3 數值模擬結果評估......19
第四章 實驗結果與討論......20
4-1 有限元素分析......20
4-1-1 收斂性分析......22
4-1-2 腰椎-骨盆模型於無韌帶與肌肉之應力結果......25
4-1-3 腰椎-骨盆模型於有韌帶與肌肉之最大應力結果......27
4-1-4 腰椎-骨盆模型於有韌帶與肌肉之最大位移結果......29
4-1-5 考慮韌帶與肌肉後模型之應力與位移前後比較......32
4-1-6 有限元素應力結果......33
4-2 實驗驗證......34
4-2-1 骨盆與骨螺釘......34
4-2-2 生物力學實驗架設......34
4-2-3 生物力學實驗......35
第五章 結果與討論與未來展望......39
5.1 結果與討論......39
5.2 未來展望......39
參考文獻......41
Extended Abstract......43

[1]Harrington KD. (1981), “The management of acetabular insufficiency secondary to metastatic malignant disease.”, JBJS, Volume 63(4), pp. 653-664.
[2]R. M. Tillman, G. J. C. Myers, A. T. Abudu, S. R. Carter, R. J. Grimer “The three-pin modified ‘Harrington’ procedure for advanced metastatic destruction of the acetabulum” THE JOURNAL OF BONE AND JOINT SURGERY, Vol. 90-B, pp. 84-87, No.1 January 2008.
[3]楊榮森，「轉移性骨癌的診治」，臺大醫院骨科部衛教資訊 2010.11。
[4]James Watkins原著，肌肉骨骼系統解剖學：構造與功能，張俊詳、陳佑安翻譯，合記圖書，台北，民國102年。
[5]Paul JP, “Forces transmitted by joints in the human body.” ProcInstnMechEngrs Vol. 181(10), pp. 8-15, January 1967.
[6]洪詩婷，「改良式人工髖關節髖臼元件之安全區與應力分析」，國立陽明大學醫學工程研究所，碩士論文，民國95年。
[7]Bergmann G, Deuretzbacher G, Heller M, et al., “Hip contact forces and gait patterns from routine activities.” J. Biomech., 34(7):859-71, 2001 July.
[8]夏銘凱，「四種臨床治療不穩定型股骨轉子間骨折(Evans V)內固定方式之比較」，國立陽明大學醫學工程研究所，碩士論文，民國93年。
[9]Jessica Rose, James Gibson GambleLippincott Williams & Wilkins, Human Walking, 2006.
[10]Harrington KD. “The management of acetabular insufficiency secondary to metastatic malignant disease.”, JBJS, Volume 63(4), pp. 653-664, Apr 1981.
[11]Paul S. Issack, Suhel Y. Kotwal, Joseph M. Lane, “A Review Article: Management of Metastatic Bone Disease of the Acetabulum,” J Am Acad Orthop Surg, 2013:21:685-695
[12]Orthopedic Hardware, https://rad.washington.edu/about-us/academic-sections/musculoskeletal-radiology/teaching-materials/online-musculoskeletal-radiology-book/orthopedic-hardware/
[13]肢體骨轉移瘤的手術治療, http://blog.xuite.net/hfhsdf464/blog/77416457-%E8%82%A2%E9%AB%94%E9%AA%A8%E8%BD%89%E7%A7%BB%E7%98%A4%E7%9A%84%E6%89%8B%E8%A1%93%E6%B2%BB%E7%99%82 , 2018.01.23。
[14]胡迎春、余兵浩、歐亞龍，人體腰椎節段CT圖像的反求建模和有限元分析，廣西科技大學學報，2014。
[15]M.A.Alagdar, M.E.Morsy, M.M.Elzalabany, MATLAB Techniques for Enhancement of Liver DICOM Images, International Journal for Research in Applied Science & Engineering Technology, Volume 3 Issue XII, December 2015.
[16]Peter T. Simonian, M. L. Chip Routt Jr, Richard M. Harrington and Allan F. Tencer, The unstable iliac fracture: a biomechanical evaluation of internal fixation, Injury Vol. 28, No. 7, pp. 469-475, 1997.
[17]Alfonso Queipo-de-Llano, Ana Perez-Blanca, Francisco Ezquerro, Felipe Luna-Gonz’alez, Simultaneous anterior and posterior compression of the pelvic ring with external fixation using a pre-tensed curved bar: A biomechanical study, Injury, Int. J. Care Injured 44 (2013) 1787–1792.
[18]Ahmad F., Vijay K.G., Ashok B., Steven R. G, Christopher M. B., “Adjacent level effects of bi level disc replacement, bi level fusion and disc replacement plus fusion in cervical spine a finite element based study” Clinical Biomechanics, Volume27, p226-223,2012.
[19]Ha S. K., “finite element modeling of multi-level cervical spinal segments (C3-C6) and biomechanical analysis of an elastomer-type prosthetic disc” Medical Engineering & Physics, Volume 28,P534-541, 2006.
[20]林啓禎，「髖關節疾病其肌肉系統的生物力學與醫學影像研究」，成功大學醫學院骨科，88-91