前交叉韧带重建术股骨隧道角度与隧道壁承受应力关系的研究  

The relation between the orientation of femoral tunnel and contact pressures in the femoral tunnel walls in anterior cruciate ligament reconstructions

作　　者：沈光思[1] 徐又佳[1] 周海斌[1] 郭霞[2] 牛文鑫[3] 丁祖泉[3] 董启榕[1] 

机构地区：[1]苏州大学附属第二医院骨科,江苏苏州215004 [2]香港理工大学康复医疗科学系 [3]同济大学生命科学与技术学院,上海200092

出　　处：《临床骨科杂志》2008年第5期469-472,共4页Journal of Clinical Orthopaedics

基　　金：江苏省六大高峰人才项目(编号:07-B-032);江苏省医学重点人才项目(编号:RC2007100);香港理工大学应用研究项目(编号:HKPolyUG-YE98);苏州市科技发展计划项目(编号:SS0712)

摘　　要：目的研究股骨隧道角度对股骨隧道壁接触应力的影响以及前交叉韧带(ACL)重建术后股骨隧道扩大面积最小的最佳股骨隧道角度。方法基于MRI图像,建立不同股骨隧道角度的ACL重建后膝关节三维有限元模型,对模型进行加载计算,所得结果用文献报道的离体实验结果进行验证,对不同模型结果进行比较分析。结果矢状位与股骨纵轴成10°及40°的隧道模型接触应力分别在后壁和前壁明显高于其他隧道模型接触应力;矢状位与股骨纵轴成25°的股骨隧道模型与与股骨纵轴成20°的股骨隧道模型相比,两者前壁接触应力无差别,但后者的后壁接触应力更大;矢状位与股骨纵轴成25°的股骨隧道模型与股骨纵轴成30°的股骨隧道模型相比,两者后壁接触应力无差别,但后者的前壁接触应力更大。结论股骨隧道角度对股骨隧道壁的接触应力确有影响,与股骨纵轴成25°的股骨隧道能最大程度地降低隧道壁接触应力,可能会缓解股骨隧道的扩大。Objective To explore whether the angle of the femoral tunnel has effect on the femoral tunnel enlargement and find the best femoral tunnel with the aim of minimizing bone tunnel enlargement after anterior cruciate ligament （ACL） reconstruction. Methods Based on the MRI images, the 3D finite element models of knee joint and bone tunnels were constructed, and then the loading calculation and analysis of result were carried out. The results obtained were validated with other studies that existed in the literature. Results The contact pressures in the femoral tunnel walls which were 10° and 40° relative to the midcoronal plane were significantly higher than those of other femoral tunnel models. With respect to the femoral tunnels which were 25° and 20° relative to the mideoronal plane, the difference of the contact pressure in the anterior wall was not significant, while the contact pressure in the posterior wall of the later was higher than that of the former. Concerning the femoral tunnel models which were 25° and 30° relative to the midcoronal plane, the difference of the contact pressure in the posterior wall was not significant, while the contact pressure in the anterior wall of the later was higher than that of the former. Conclusions The femoral tunnel angle has much effect on the contact pressure in the femoral tunnel which could lead to femoral tunnel enlargement and the 25° femoral tunnel is the best femoral tunnel minimizing contact pressure in the femoral tunnel wall, which may lessen the femoral tunnel enlargement after ACL reconstruction.

关 键 词：隧道扩大 隧道角度 有限元分析 前交叉韧带重建术 生物力学 

分 类 号：R687.2[医药卫生—骨科学] R687.4[医药卫生—外科学]