全膝关节置换假体的生物力学分析  

Biomechanical analysis of prostheses in total knee arthroplasty

作　　者：苏德君 曹雪坤 马洪浩 张吉超 董万鹏[1] 张震 董跃福 Su Dejun;Cao Xuekun;Ma Honghao;Zhang Jichao;Dong Wanpeng;Zhang Zhen;Dong Yuefu(School of Materials Science and Engineering,Shanghai University of Engineering Science,Shanghai 201620,China;Lianyungang Hospital,Xuzhou Medical University,Lianyungang 222061,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201620 [2]徐州医科大学附属连云港医院,江苏连云港222061

出　　处：《中国运动医学杂志》2024年第2期94-102,共9页Chinese Journal of Sports Medicine

基　　金：国家自然科学基金项目(31670956);上海市Ⅲ类高峰学科-材料科学与工程(高能束智能加工与绿色制造)。

摘　　要：目的:通过有限元分析方法,探究全膝关节置换(TKA)后膝关节假体在不同角度屈膝过程中的应力变化。方法:通过计算机模拟手术截骨,并装配后稳定型(PS)和后交叉韧带替代型(CS)两种膝关节假体。根据步态过程中屈膝角度和轴向载荷间的变化,选择0°、10°、20°和30°四个角度进行有限元分析。观察股骨假体、胫骨假体和衬垫上的Mises应力分布和接触面积,探究术后膝关节的生物力学行为变化。结果:在同一角度下PS型衬垫的应力峰值大于CS型衬垫,屈膝20°和30°时衬垫上出现Mises应力峰值最大值。PS型衬垫内侧的应力峰值大于外侧,而CS型则相反。衬垫的接触面积在多数情况下,外侧大于内侧。PS型衬垫内、外侧的接触面积相对平衡,但CS型衬垫则相差较多,且在屈膝10°时内侧的接触面积最小,这可能会引起衬垫磨损。金属假体的应力峰值位置多出现在与骨组织的连接部位。结论:随着屈膝角度的增加,衬垫内、外侧的Mises应力峰值表现出相应增大的趋势,应尽量减少大角度的屈膝行为,并配合适量的康复运动。同时,注意日常行走的步伐,避免内、外翻带来的假体单侧应力过大。Objective To explore the stress changes of the knee prosthesis at different flexion angles after total knee replacement(TKA)by using finite element analysis.Methods The osteotomy was simulat⁃ed using the computer and two types of knee prosthesis,posterior stabilized inserts(PS)and cruciate substituting inserts(CS),were assembled.Four angles of 0°,10°,20°and 30°were selected for finite element analysis according to the changes between bending angles and axial load of the knee during walking.Mises stress distribution and contact area on the femur,tibia and liner were observed to ex⁃plore the biomechanical changes of the knee joint after surgery.Results The stress peak value of PS liner was greater than that of CS liner at the same angle,and the maximum stress peak value ap⁃peared when the bending angles was at 20°and 30°.The stress peak on the inside of the PS liner was greater than that on the outside,while the opposite is true for the CS liner.In most cases,the contact area of the liner was greater on the outside than on the inside.However,the PS liner had a relatively balanced inner and outer contact areas,but the CS liner had a great gap between the two ar⁃eas,with the minimum inner contact area at the bending angle of 10°(causing wear).Moreover,the stress peak of metal prosthesis mostly occurred at the junction with bone tissues.Conclusion The Mises stress peak values on the inner and outer sides of the liner increase with the knee bending angle.Therefore,large-angle knee bending should be reduced as far as possible and appropriate rehabilita⁃tion exercises should be conducted.Moreover,in daily walking,internal and external rollover should be avoided to prevent excessive unilateral stress.

关 键 词：膝关节 全膝关节置换术 生物力学 有限元法 

分 类 号：R687.4[医药卫生—骨科学] R318.01[医药卫生—外科学]