有限元建模分析牵开成形治疗踝关节骨性关节炎的生物力学响应  

Biomechanical response of ankle traction arthroplasty for ankle osteoarthritis through finite element modeling

作　　者：夏煜博 唐晓霞[1] 罗文 徐永升 袁长飞 王喆 周晓寒 田苗 王涛[1] 郭英[1] Xia Yubo;Tang Xiaoxia;Luo Wen;Xu Yongsheng;Yuan Changfei;Wang Zhe;Zhou Xiaohan;Tian Miao;Wang Tao;Guo Ying(Kunming Municipal Hospital of Traditional Chinese Medicine,Kunming 650500,Yunnan Province,China)

机构地区：[1]昆明市中医医院,云南省昆明市650500

出　　处：《中国组织工程研究》2023年第22期3469-3475,共7页Chinese Journal of Tissue Engineering Research

基　　金：云南省科技厅科技计划项目(202001AZ070001-070),项目参与人:夏煜博。

摘　　要：背景:目前踝关节骨性关节炎的手术方式包括关节置换和关节融合,但2种方式均存在一定问题,因此保踝治疗成为踝关节骨性关节炎初期治疗的首选方式。牵开成形是一种重要的保踝治疗术式,有利于缓解踝关节疼痛和改善功能,有助于关节软骨的自我修复,但现在仍缺乏确切的生物力学证据。目的:通过有限元建模探究踝关节牵开成形治疗早中期无明显力线改变的踝关节骨性关节炎的力学因素,为临床治疗提供力学证据。方法:将1名27岁志愿者足踝CT扫描数据DICOM文件导入有限元软件中,进行三维重建及曲面拟合,再进行网格划分,建立含有骨骼、韧带、肌腱和软骨的精细足踝有限元模型,对比踝骨关节炎组、外固定架组分别在中立0°、跖屈20°、背屈20°3种不同工况下的胫距关节面应力、距骨应力及距骨应变的生物力学响应。结果与结论:(1)经过有限元仿真计算发现,从踝关节整体受力来说,两组模型在中立位0°时最小,从中立位逐渐跖屈或背屈时,随着踝关节活动发生变化,应力值也逐渐增加,且在同等屈曲的条件下,背屈要比跖屈的整体应力增幅明显;(2)从胫距关节的应力峰值来说,踝骨关节炎组的胫距关节面应力峰值较正常组增幅明显,外固定架组的胫距关节面应力峰值降幅明显;(3)针对踝关节整体形变,踝骨关节炎组在中立位状态时整体形变增幅最大,而外固定架组整体变形降幅最大;(4)从距骨应力来说,踝骨关节炎组3种工况下距骨应力均有不同程度的增加,外固定架组距骨应力有所降低,尤其在中立位时降幅明显;(5)就关节距骨前移距离而言,踝骨关节炎组距骨前移距离相对正常组明显减小,外固定架组距骨前移距离增幅不明显;(6)提示经过踝关节2种模型不同工况下的有限元仿真分析,证实临床应用踝关节牵开成形能够改变踝关节骨性关节炎患者胫距关节面及距�BACKGROUND:At present,the surgical methods for ankle osteoarthritis include joint replacement and joint fusion,but both methods have certain problems.Therefore,ankle preservation therapy has become the first choice for the initial treatment of ankle osteoarthritis.Ankle distra ction arthroplasty is an important ankle-preserving procedure,which is beneficial to relieve ankle pain and improve function,and contribute to the self-repair of articular cartilage,but there is still a lack of definite biomechanical evidence.OBJECTIVE:To explore the mechanical fa ctors of ankle osteoarthritis without obvious force line change in the early and middle periods using ankle distra ction arthroplasty thro ugh the finite element modeling to provide mechanical evidence for clinical treatment.METHODS:The DICOM file of CT scan data of the foot and ankle of a 27-year-old volunteer was imported into the finite element software for three-dimensional reconstruction and curved surface fitting.The mesh was divided to establish a fine foot and ankle finite element model with bones,ligaments,tendons and cartilage.The biomechanical responses of tibiotalar joint surfa ce stress,talus stress,and talus strain under three different working conditions of 0° neutral,20°plantar flexion,and 20° dorsiflexion were compared between the ankle osteoarthritis and external fixator groups.RESULTS AND CONCLUSION:(1) Through the finite element simulation calculation,it was found that the overall stress of the ankle joint was smallest in the two groups of models when the neutral position was 0°.When the neutral position was gradually flexion or dorsiflexion,the stress value gradually increased with the change of ankle joint activity.Under the same flexion condition,the overall stress of dorsiflexion was significantly greater than that of the plantar flexion.(2) In terms of the peak stress of the tibiotalar ankle joint,the peak value of the stress of the talar joint surface in the ankle osteoarthritis group increased significantly than that in the normal gr

关 键 词：牵开成形术 踝关节 骨性关节炎 生物力学 有限元分析 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] O242.21[理学—计算数学]