不同骨密度对膝关节单髁置换后关节内各结构影响的三维有限元分析  

Three-dimensional finite element analysis of effects of different bone densities on various intraarticular structures after unicompartmental knee arthroplasty

作　　者：刘蒙飞 马鹏程 尹灿 姜侃[1] 巨啸晨[1] Liu Mengfei;Ma Pengcheng;Yin Can;Jiang Kan;Ju Xiaochen(Department of Joint Surgery,Sixth Affiliated Hospital of Xinjiang Medical University,Urumqi 830000,Xinjiang Uygur Autonomous Region,China;Department of Orthopedics,Shandong Public Health Clinical Center,Jinan 250000,Shandong Province,China)

机构地区：[1]新疆医科大学第六附属医院关节外科,新疆维吾尔自治区乌鲁木齐市830000 [2]山东省公共卫生临床中心骨科,山东省济南市250000

出　　处：《中国组织工程研究》2024年第24期3801-3806,共6页Chinese Journal of Tissue Engineering Research

摘　　要：背景:骨质疏松症是膝骨关节炎患者的常见合并症,不同骨密度对单髁置换的预后有何种影响是目前研究的热点。目的:通过有限元法研究不同骨密度对内侧固定平台单髁置换后关节内各结构应力大小及分布的影响,评估骨质疏松与并发症的相关性。方法:利用CT、MRI获取1名志愿者的下肢影像数据,通过Geomagic Studio、Ansys workbench、Mimics等软件构建正常骨质的膝关节有限元模型(T值≥-1.0),通过改变材料参数建立骨质减少(-2.5<T值<-1.0)和骨质疏松(T值≤-2.5)的膝关节有限元模型,并验证有效性。使用布尔运算模拟单髁置换,得到3组骨质的单髁置换模型,在3组模型的股骨髁中心施加垂直向下的1000 N载荷,观察并比较各模型中半月板、胫骨软骨、聚乙烯衬垫表面、胫骨假体下皮质骨和松质骨表面的应力数据,以及聚乙烯衬垫和胫骨假体下松质骨的应变数据。结果与结论:①相较于正常骨质组和骨质减少组,骨质疏松组半月板和聚乙烯衬垫表面的应力峰值更大,胫骨软骨的应力峰值更小;②在3组模型中,胫骨假体下皮质骨表面的高应力值随骨质的减少而增大,应力集中于皮质骨的内侧缘,胫骨假体下松质骨表面的高应力值随骨质的减少而降低,应力集中于松质骨的后内侧以及龙骨凹槽的弧形底面;③骨质疏松组聚乙烯衬垫、胫骨假体下松质骨的应变大于正常骨质组和骨质减少组;④骨质疏松会引起单髁置换后膝关节内部结构的生物力学异常,可能会增加并发症的发生率、提高翻修的风险。BACKGROUND:Osteoporosis is a common comorbidity in patients with knee osteoarthritis.The impact of osteoporosis on the prognosis of unicompartmental knee arthroplasty is a trending topic of current research.OBJECTIVE:To investigate the effect of different bone densities on the stress value and stress distribution of each structure in the joint after unicompartmental knee arthroplasty using finite element analysis,and to evaluate the correlation between osteoporosis and complications.METHODS:CT and MRI were adopted to obtain the lower limb image data of a volunteer.Geomagic Studio,Ansys workbench,and Mimics were used to establish a finite element model of the knee joint with normal sclerotin condition(T-value≥-1.0).The finite element model of the knee joint with osteopenia(-2.5<T-value<-1.0)and osteoporosis(T-value≤-2.5)was established by changing the elastic modulus,and the validity was verified.The Boolean operation was used to simulate unicompartmental knee arthroplasty,and the unicompartmental knee arthroplasty models of three groups of sclerotin conditions were established.A 1000 N vertical downward load was applied to the center of the femoral condyle of the three models.The stress data of the meniscus,the tibial cartilage,the polyethylene liner surface,and the surfaces of the cortical bone and the cancellous bone under the tibial prostheses,as well as the strain data of the polyethylene liner and the cancellous bone under tibial prostheses,were also observed and compared.RESULTS AND CONCLUSION:(1)Compared with the normal sclerotin group and the osteopenia group,the peak stress of the meniscus and the polyethylene liner surface was larger,and the peak stress of the tibial cartilage was smaller in the osteoporosis group.(2)In the three models,the high-stress value of the cortical bone under the tibial prostheses increased with osteopenia,and the stress was concentrated on the internal edge of the cortical bone.The high-stress value of the cancellous bone under the tibial prostheses decreased with osteopen

关 键 词：膝骨关节炎 单髁置换 骨质疏松 生物力学 有限元分析 

分 类 号：R459.9[医药卫生—治疗学] R-331[医药卫生—临床医学] R684.3