不同股骨止点对内侧髌股韧带重建后髌股关节应力影响的三维有限元分析  

Three-dimensional finite element analysis of the stress of the patellofemoral joint after medial patellofemoral ligament reconstruction by different femoral reconstruction insertion points

作　　者：徐彪 路坦[1] 杨骏良 姜亚琼 阴玉娇 Xu Biao;Lu Tan;Yang Junliang;Jiang Yaqiong;Yin Yujiao(Department of Orthopedics,Xinxiang Key Laboratory of Degenerative Diseases of Osteoarthritis,First Affiliated Hospital of Xinxiang Medical College,Weihui 453100,Henan Province,China;First Department of Surgery,First Affiliated Hospital of Xinxiang Medical College,Weihui 453100,Henan Province,China)

机构地区：[1]新乡医学院第一附属医院骨外科,新乡市骨关节退行性疾病研究重点实验室,河南省卫辉市453100 [2]新乡医学院第一附属医院手术一部,河南省卫辉市453100

出　　处：《中国组织工程研究》2023年第22期3463-3468,共6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。

摘　　要：背景:髌股韧带重建有多种手术方式,其中股骨止点选取对手术实施影响较大,目前针对股骨止点的选取有多种方式,但无定论。目的:通过三维有限元软件分析膝关节不同屈曲状态下内侧髌股韧带(MPFL)股骨重建止点位置改变对髌股关节应力的影响,从而选择出合理准确的股骨重建止点。方法:获取成年人正常膝关节CT数据,导入Mimics、Geomagic及Soildworks软件进行提取模具、添加韧带,其中韧带的股骨止点选择分别为股骨内上髁与内收肌结节连线的中点、股骨内上髁、内收肌结节、股骨髁间窝顶部向内髁投射点和内收肌结节下10 mm,再将添加韧带后的模具导入机械软件Ansys,对不同股骨止点重建后髌股关节应力进行生物力学的有限元分析。结果与结论:(1)在膝关节屈曲0°和30°时,选取任一股骨止点产生的髌股关节应力大于其他屈曲角度(60°,90°,120°);无论采取哪种位点作为股骨端止点,当膝关节屈曲超过30°时,髌股关节间的接触应力大小基本无差别;(2)在膝关节屈曲0°和30°时,以内收肌结节为止点的髌股接触压力最大,以股骨内上髁与内收肌结节连线的中点为止点的接触力最小;在膝关节屈曲30°时,股骨内上髁与内收肌结节连线的中点及股骨髁间窝顶部向内髁投射点、内收肌结节下10 mm作为股骨端止点的髌股间的接触应力大小无明显差别;(3)结果显示,重建内侧髌股韧带时股骨侧止点最好选择在内收肌结节与内上髁连线的中点,能够有效恢复膝关节的稳定性,达到延缓关节及软骨退变的目的。BACKGROUND:There are many ways to reconstruct the patellofemoral ligament.Among them,the lateral insertion of the femur has a greater influence.At present,there are many ways to select femoral insertion points,but there are no conclusions.OBJECTIVE:Through the analysis of three-dimensional finite element software,the change of femoral reconstruction insertion position of medial patellofemoral ligament under diffe rent flexion states can analyze the stress of the patellofemoral joint to select a suitable femoral reconstruction insertion.METHODS:CT data of normal knee joints of adults were obtained to import Mimics,Geomagic and Soildworks software to extra ct molds and add ligaments.The femoral insertion points of the ligament were the midpoint between the medial epicondyle and the adductor tubercle,the medial epicondyle,the adductor tubercle,the projection point from the top of the femoral inte rcondylar fossa to the medial condyle and 10 mm below the adductor tubercle.The mold added with ligament was imported into the mechanical software Ansys to analyze the stress of patellofemoral joint after reconstruction of diffe rent femoral insertion points using finite element analysis.RESULTS AND CONCLUSION:(1) When the knee flexion was 0° and 30°,the stress of patellofemoral joint at any femoral insertion point of reconstructed medial patellofemoral ligament was greater than that at other angles(60°,90°,and 120°).No matter which position was used as the femoral insertion point,when the knee joint was flexed more than 30°,there was basically no difference in the conta ct stress between the patellofemoral joints.(2) At 0° and 30° of knee flexion,the patellofemoral contact pressure was the largest at the point of the adductor tubercle,and the conta ct force at the midpoint between the medial epicondyle and the adductor tubercle was the smallest.When the knee was flexed 30’,the midpoint between the medial epicondyle and the adductor tubercle,the projection point from the top of the femoral inte rcondylar fossa to

关 键 词：髌股脱位 内侧髌股韧带 网格划分 三维重建 生物力学 应力 有限元分析 等长重建 

分 类 号：R459.9[医药卫生—治疗学] R319[医药卫生—临床医学] R-331