多孔结构设计人工踝关节衬垫生物力学的优化方案  

Biomechanical optimization scheme of artificial ankle inserts based on porous structure design

作　　者：徐志 刘子铭 李豫皖 陈雨飞 金瑛 饶敬澄 田守进[7] Xu Zhi;Liu Ziming;Li Yuwan;Chen Yufei;Jin Ying;Rao Jingcheng;Tian Shoujin(Department of Orthopedics,Zhangjiagang Fifth People’s Hospital,Zhangjiagang 215600,Jiangsu Province,China;Department of Sports Medicine,Peking University Third Hospital,Institute of Sports Medicine of Peking University,Beijing Key Laboratory of Sports Injuries,Beijing 100191,China;Department of Orthopedics,The First Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310009,Zhejiang Province,China;Suzhou Kangli Orthopaedic Equipment Co.,Ltd.,Zhangjiagang 215600,Jiangsu Province,China;Department of Orthopedics,Affiliated Hospital of Zunyi Medical University,Zunyi 563000,Guizhou Province,China;Department of Orthopedics,Suqian Hospital Affiliated to Xuzhou Medical University,Suqian 223800,Jiangsu Province,China;Department of Orthopedics,Zhangjiagang Hospital Affiliated to Soochow University,Zhangjiagang 215600,Jiangsu Province,China)

机构地区：[1]张家港市第五人民医院骨科,江苏省张家港市215600 [2]北京大学第三医院运动医学科,北京大学运动医学研究所,运动医学关节伤病北京市重点实验室,北京市100191 [3]浙江大学医学院附属第一医院骨科,浙江省杭州市310009 [4]苏州市康力骨科器械有限公司,江苏省张家港市215600 [5]遵义医科大学附属医院骨科,贵州省遵义市563000 [6]徐州医科大学附属宿迁医院骨科,江苏省宿迁市223800 [7]苏州大学附属张家港医院骨科,江苏省张家港市215600

出　　处：《中国组织工程研究》2024年第30期4817-4824,共8页Chinese Journal of Tissue Engineering Research

基　　金：国家自然科学基金青年科学基金项目(82302853),项目负责人:李豫皖;北京大学医学部青年科技创新人才培养基金(BMU2022PY007),项目负责人:李豫皖。

摘　　要：背景:假体松动和磨损是导致全踝关节置换失败的主要原因,其与骨-植入物界面的微运动、关节面的接触应力和关节运动密切相关。包括衬垫和胫/距柄假体在内的人工关节部件的设计构造是影响踝关节受力、运动、接触界面微运动的关键因素,开发新型衬垫对提高人工踝关节生存率具有重要意义。目的:构建全踝关节置换有限元模型用以检测多孔结构优化型衬垫的生物力学特性,分析多孔结构优化型衬垫在减少假体微动和改善关节面接触行为方面的作用。方法:以一名健康成年人右踝关节CT扫描数据和INBONEⅡ系统产品手册为基础,建立包括骨骼和人工关节系统的三维模型,在经过截骨和假体安装后获得全踝关节置换模型(模型A),再通过对原始衬垫进行多孔结构改造获得G50型、G60型、D50型、D60型4种新型衬垫,将不同衬垫替换原始衬垫以建立与之相对应的优化型全踝关节置换模型(模型B-E),在5个模型上施加步态载荷模拟步态工况。比较5种模型植入物-骨界面微动和关节面接触行为的差异。结果与结论:①在步态周期下4个优化型全踝关节置换模型的假体微动小于原始模型,与模型A相比,模型B-E假体微动数值上分别下降5.4%,10.1%,8.1%及20.9%,再者优化型模型在胫骨骨槽穹顶部的高微动区域较原始模型明显缩小;②4个优化型模型获得了更大的关节面接触面积,与模型A相比,模型B-E衬垫接触面积均值分别增加了11.8%,14.7%,8.1%及32.6%;③与接触面积增大的效果类似,相较于原始模型,优化型模型的关节面接触应力不同程度下降,其中模型E的数值下降最为显著(P<0.05),归功于构成D60型衬垫Diamond晶格良好的力学属性和较大的孔隙率;④结果表明全踝关节置换使用多孔结构改良衬垫可以提高衬垫的弹性,增加其吸收关节冲击力的能力,为降低植入物-骨界面微动和改善关节接触行为创造BACKGROUND:Prosthesis loosening and wear are still the main problems in the failure of total ankle replacement,which are closely related to the micromotion of the implant-bone interface,the contact stress of the articular surface and joint motion.The design of artificial joint components,including insert and tibial/talar stem prosthesis,is a key factor affecting the force,motion,and micromotion of the contact interface of the ankle joint.The development of new inserts is of great significance to improve the survival rate of artificial ankle joints.OBJECTIVE:The finite element model of the total ankle replacement model was constructed to detect the biomechanical properties of the porous structureoptimized inserts,and the effect of the porous structure-optimized inserts on reducing prosthesis micromotion and improving the contact behavior of the articular surface was analyzed.METHODS:Based on the CT scan data of the right ankle joint of a healthy adult and the INBONE II system product manual,a three-dimensional model including bone and artificial joint system was established,and the total ankle replacement model(model A)was obtained after osteotomy and prosthesis installation,and then through four new types of inserts,G50,G60,D50,and D60,were obtained by transforming the porous structure of the original insert,and the original one was replaced with different inserts to establish an optimized total ankle replacement model(models B-E)corresponding to the inserts.The gait loads were applied on the five models to simulate the gait conditions.The differences in micromotion and articular surface contact behaviors at the implant-bone interface of all five models were compared.RESULTS AND CONCLUSION:(1)In the gait cycle,the micromotion of the prosthesis of the four optimized total ankle replacement models was lower than that of the original model.Compared with model A,the micromotion of the prosthesis in models B-E decreased by 5.4%,10.1%,8.1%,and 20.9%,respectively.The high micromotion area of the tibial groove dome in th

关 键 词：全踝关节置换 人工踝关节 衬垫 多孔结构 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] R445