摘要
背景:前交叉韧带损伤容易导致继发性的半月板损伤和骨性关节炎,目前关于前交叉韧带损伤所致的半月板及关节软骨损伤力学研究较少。目的:利用有限元分析方法研究前交叉韧带部分断裂对膝关节内外侧半月板及关节软骨应力的影响。方法:选择一名健康志愿者的膝关节CT和MRI影像资料,将扫描数据导入Mimics、Geomagic及Solidworks软件,经配准融合后建立4种膝关节三维模型,分别为前交叉韧带完整、前交叉韧带后外侧束断裂、前交叉韧带前内侧束断裂及前交叉韧带缺失模型,最后导入Ansys软件,对膝关节施加4种模式荷载:在股骨顶端施加纵向荷载750 N;在股骨顶端施加纵向荷载750 N及胫骨后方134 N向前推力;在股骨顶端施加纵向荷载750 N及10 Nm内翻力矩,模拟膝内翻;在股骨近端面施加纵向荷载750 N及4 Nm内旋力矩,模拟膝内旋,进行膝关节半月板与软骨生物力学有限元分析。结果与结论:①在膝关节伸直状态下,在股骨顶端施加纵向荷载750 N时,前交叉韧带前内侧束断裂和缺失使半月板总体应力及其峰值明显增大,但其应力分布无明显变化,关节软骨应力无明显变化;在股骨顶端施加纵向荷载750 N及胫骨后方134 N向前推力时,前交叉韧带前内束断裂使胫骨前移增大,半月板后角受挤压应力增大,关节软骨应力无明显变化;模拟膝内翻时,前交叉韧带不同程度损伤较完整时的外侧半月板后角应力减小,内侧半月板应力增大,关节软骨应力稍减小;模拟膝内旋时,前交叉韧带前内束断裂及缺失使股骨软骨和胫骨软骨的等效应力峰值由内侧软骨转向外侧软骨,半月板应力峰值明显增大,此时对膝关节旋转稳定性起主导作用的是前交叉韧带前内侧束;②结果显示,在膝关节处于伸直站立位、内翻及内旋时,前交叉韧带前内侧束断裂患者继发半月板损伤的风险远大于后外侧束断裂患者,而对关节软骨的影响无明显差异。
BACKGROUND:Anterior cruciate ligament injury tends to lead to secondary meniscus injury and osteoarthritis.At present,there are few studies on the mechanics of meniscus and articular cartilage injury caused by anterior cruciate ligament injury.OBJECTIVE:To study the effect of partial rupture of the anterior cruciate ligament on the stress of medial and lateral meniscus and articular cartilage of knee joint by finite element analysis.METHODS:The CT and MRI images of the knee joint of a healthy volunteer were selected,and the scan data were imported into Mimics,Geomagic and SolidWorks software.After registration and fusion,four kinds of three-dimensional knee joint models were established:models of intact anterior cruciate ligament,rupture of the posterior external tract of anterior cruciate ligament,rupture of the anterior internal tract of anterior cruciate ligament,and absence of anterior cruciate ligament.Finally,data were imported into Ansys software to apply four different modes of loads to the knee joint:Longitudinal loads of 750 N were applied to the top of the femur;longitudinal load of 750 N to the top of the femur and forward thrust of 134 N behind tibia;a longitudinal load of 750 N and a varus moment of 10 Nm were applied to the top of the femur to simulate genu varus;750 N longitudinal load and 4 Nm internal rotation moment were applied to the proximal end of the femur to simulate knee internal rotation.The finite element analysis of biomechanical stress changes of the meniscus and articular cartilage of the knee joint was carried out.RESULTS AND CONCLUSION:(1)In the straight position of the knee joint,when the anterior medial tract of the anterior cruciate ligament was broken and the anterior cruciate ligament was missing under longitudinal loads of 750 N at the top of the femur,the total stress and peak value of meniscus increased significantly,but the stress distribution of the meniscus and the stress of articular cartilage did not change significantly.In longitudinal load of 750 N to the top of the femur and forward thrust of 134 N behind tibia,the fracture of the anterior internal tract of the anterior cruciate ligament increased the tibia forward,the compressive stress of posterior angle of the meniscus increased,and the stress of the articular cartilage did not change significantly.During simulating genu varus,the posterior angular stress of the lateral meniscus decreased,the stress of the medial meniscus increased,and the stress of articular cartilage slightly decreased when anterior cruciate ligament injuries were complete.When the anterior internal tract of the anterior cruciate ligament was broken or absent under knee internal rotation,the equivalent stress peak value of femoral cartilage and tibia cartilage shifted from medial cartilage to lateral cartilage,and the stress peak value of meniscus increased significantly.At this time,the anterior internal tract of the anterior cruciate ligament played a leading role in the rotational stability of the knee joint.(2)These results indicate that the risk of secondary meniscus injury in patients with anterior and medial anterior cruciate ligament band rupture was much higher than that in patients with posterior and external anterior cruciate ligament band rupture when the knee was in the upright standing position,varus and pronation,and there was no significant difference in the impact on articular cartilage.
作者
杨骏良
路坦
徐彪
姜亚琼
王富成
Yang Junliang;Lu Tan;Xu Biao;Jiang Yaqiong;Wang Fucheng(Department of Joint and Trauma Surgery Ward Two,Xinxiang Key Laboratory of Bone and Joint Degenerative Disease Research,First Affiliated Hospital of Xinxiang Medical University,Weihui 453100,Henan Province,China;Department of Urology Surgery,First Affiliated Hospital of Xinxiang Medical University,Weihui 453100,Henan Province,China)
出处
《中国组织工程研究》
CAS
北大核心
2024年第9期1347-1353,共7页
Chinese Journal of Tissue Engineering Research
基金
河南省医学科技攻关计划(联合共建)项目(LHGJ20190450),项目负责人:路坦。
关键词
前交叉韧带损伤
有限元分析
生物力学
半月板
关节软骨
anterior cruciate ligament injury
finite element analysis
biomechanics
meniscus
articular cartilage
