非对称型假体设计及全膝关节置换后的力学分析  

Design of asymmetric prosthesis and mechanical analysis of total knee arthroplasty

作　　者：苏德君 董万鹏[1] 董跃福 张吉超 张震 Su Dejun;Dong Wanpeng;Dong Yuefu;Zhang Jichao;Zhang Zhen(School of Materials Science and Engineering,Shanghai University of Engineering Science,Shanghai 201620,China;Lianyungang Hospital,Xuzhou Medical University,Lianyungang 222061,Jiangsu Province,China)

机构地区：[1]上海工程技术大学材料科学与工程学院,上海市201620 [2]徐州医科大学附属连云港医院,江苏省连云港市222061

出　　处：《中国组织工程研究》2025年第3期510-516,共7页Chinese Journal of Tissue Engineering Research

基　　金：基金资助:国家自然科学基金项目(31670956),项目负责人:董跃福。

摘　　要：背景:全膝关节置换是治疗膝关节晚期病症的有效手段,但假体衬垫容易因内部应力变化而产生磨损失效,寿命有限且术后患者的活动能力降低。如何对假体进行改进设计来满足患者更多的需求是假体研究的重要方向。目的:基于半月板的形态设计一种非对称型假体,并与对称设计的后稳定型假体进行比较,分析2种假体的应力分布情况和衬垫的接触面积变化,以探究非对称型假体设计是否存在优势。方法:通过有限元方法对1例膝骨关节炎患者进行模拟截骨和假体装配,建立基于非对称型假体及对称设计的后稳定型假体的全膝关节置换术后膝关节模型。在0°,10°,20°,30°的屈膝条件下,探究股骨假体、胫骨假体以及衬垫上的Mises应力,并通过对比衬垫内外侧的接触面积,分析全膝关节置换后膝关节生物力学变化和运动行为的改变。结果与结论:(1)在0°-30°的屈膝过程中,2种假体衬垫上的Mises应力峰值均表现出先减小后增大的趋势,且内侧始终大于外侧。(2)非对称型设计的假体与后稳定型假体相比,应力峰值更低;在屈膝30°时,非对称型假体衬垫内外侧的Mises应力峰值分别为15.81 MPa和11.95 MPa,后稳定型衬垫为16.70 MPa和13.76 MPa,两者内侧差值约为5.33%,而外侧则相差13.15%;对比股骨假体和胫骨假体上的Mises应力峰值,非对称型假体在屈膝过程中始终低于后稳定型假体。(3)在0°站立位时,后稳定型假体衬垫的内侧接触面积为17.96 mm^(2)、外侧为34.10 mm^(2);而非对称型假体衬垫的内外侧接触面积分别为105.47 mm^(2)和107.80 mm^(2),具有更大的接触面积且两侧差距更小。(4)结果表明,非对称型假体的生物力学表现更好,且能够对维持膝关节稳定性、提升关节活动度有所帮助。这种设计能够在一定程度上还原膝关节以内侧髁为轴进行外旋的运动机制,是一种更为有效的膝关节假体选择方案。BACKGROUND:Total knee arthroplasty serves as an effective intervention for the treatment of late-stage knee joint disorders.However,prosthetic liners are prone to wear and failure due to internal stress variations,resulting in limited lifespan and decreased postoperative patient activity.Addressing how to enhance prosthetic design to meet a broader range of patient needs constitutes a significant focus in prosthesis research.OBJECTIVE:Based on the morphological design of the meniscus,we propose an asymmetric design prosthesis and compare it with a symmetric posterior stabilized prosthesis.The stress distribution patterns and variations in the contact area of the liners for both prostheses were analyzed to explore whether the asymmetric prosthesis design offers advantages over the symmetric design.METHODS:Using the finite element method,we simulated the osteotomy and prosthesis assembly in a knee osteoarthritis patient.Two different prostheses(asymmetric design and posterior stabilized)were employed to establish post-total knee arthroplasty knee joint models.Under flexion conditions at 0°,10°,20°,and 30°,we investigated the Mises stress on the femoral and tibial components as well as the liner.Additionally,by comparing the contact area on the inner and outer sides of the liner,we aimed to explore the changes in biomechanics and alterations in motion behavior in the post-total knee arthroplasty knee joint.RESULTS AND CONCLUSION:(1)Throughout the flexion range from 0 to 30 degrees,the Mises stress peak on the liner exhibited a trend of initial decrease followed by an increase,with the stress on the medial side consistently surpassing that on the lateral side.(2)In comparison to the posterior stabilized prosthesis,the asymmetrically designed prosthesis demonstrated smaller stress peaks.At a flexion angle of 30 degrees,the Mises stress peak values of the medial and lateral parts of the asymmetric prosthesis were 15.81 MPa and 11.95 MPa,and those of the posterior stabilization prosthesis were 16.70 MPa and 13.76 MP

关 键 词：膝关节 全膝关节置换 非对称型假体设计 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]