胫骨平台下低密度区骨量及体积对膝关节内软骨及半月板影响的有限元分析  

Finite element analysis of impact of bone mass and volume in low-density zone beneath tibial plateau on cartilage and meniscus in knee joint

作　　者：韩龙飞 侯文渊 陆舜 曾子俊 林锟 韩明丽 罗贵锋 田龙 杨帆 何敏聪 魏秋实 HAN Longfei;HOU Wenyuan;LU Shun;ZENG Zijun;LIN Kun;HAN Mingli;LUO Guifeng;TIAN Long;YANG Fan;HE Mincong;WEI Qiushi(The Third Clinical Medical College of Guangzhou University of Chinese Medicine,Guangzhou Guangdong,510405,P.R.China;Guangdong Academy of Traditional Chinese Medicine Orthopedics and Traumatology,Guangzhou Guangdong,510378,P.R.China;Joint Center,the Third Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou Guangdong,510378,P.R.China;State Key Laboratory of Traditional Chinese Medicine Syndrome/Orthopedics,the Third Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou Guangdong,510378,P.R.China)

机构地区：[1]广州中医药大学第三临床医学院,广州510405 [2]广东省中医骨伤研究院,广州510378 [3]广州中医药大学第三附属医院关节中心,广州510378 [4]中医证候全国重点实验室/骨科广州中医药大学第三附属医院,广州510378

出　　处：《中国修复重建外科杂志》2025年第3期296-306,共11页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：2023年广州中医药大学“双一流”与高水平大学学科后备人才培育项目(2021xk41);2022年广东省中医骨伤研究院开放基金课题青年项目(GYH202201-03);2022年广州市科技计划项目重点研发计划(202206010048)。

摘　　要：目的探讨胫骨平台下低密度区骨量及体积对膝关节内软骨及半月板最大von Mises应力的影响。方法研究纳入1名健康成年志愿者(获取CT)及1名膝骨关节炎(knee osteoarthritis,KOA)患者(获取X线片),在正常膝关节模型基础上建立包含低密度区的膝关节静力模型。在有限元分析中,加载1000 N和1800 N轴向载荷至股骨头上表面负重区,分别用于模型验证及有限元研究,对股骨软骨、内外侧胫骨软骨、内外侧半月板的最大von Mises应力进行观测,同时对内/外侧组件应力占比进行分析。并针对不同低密度区KOA患者标本进行HE染色及碱性品红染色观察。结果模型验证结果表明构建的模型符合正常解剖结构且与既往文献计算结果具有一致性。静力分析结果示,正常膝关节内侧组件的最大von Mises应力最低,随着低密度区进展,其最大von Mises应力随之升高;而外侧组件则呈相反趋势,正常膝关节外侧组件的最大von Mises应力最高,随着低密度区进展,其最大von Mises应力随之降低。内侧组件在整个膝关节内所承受的应力占比亦越来越高。HE染色示,随着低密度区范围增大,软骨细胞层逐渐磨损甚至消失;碱性品红染色示,骨小梁微断裂严重程度随低密度区范围扩大逐渐增高。结论胫骨平台下低密度区的存在可能会加重关节退变,临床实践中需重视胫骨平台下低密度区的改变,并积极采取有效措施强化胫骨平台下低密度区骨质状态,恢复膝关节完整生物力学功能,以延缓或逆转骨关节炎进展。Objective To investigate the impact of bone mass and volume of low-density zones beneath the tibial plateau on the maximum von Mises stresses experienced by the cartilage and meniscus in the knee joint.Methods The study included one healthy adult volunteer,from whom CT scans were obtained,and one patient diagnosed with knee osteoarthrisis(KOA),for whom X-ray films were acquired.A static model of the knee joint featuring a low-density zone was established based on a normal knee model.In the finite element analysis,axial loads of 1000 N and 1800 N were applied to the weight-bearing region of the upper surface of the femoral head for model validation and subsequent finite element studies,respectively.The maximum von Mises stresses in the femoral cartilage,as well as the medial and lateral tibial cartilage and menisci,were observed,and the stress percentage of the medial and lateral components were concurrently analyzed.Additionally,HE staining,as well as alkaline magenta staining,were performed on the pathological specimens of patients with KOA in various low-density regions.Results The results of model validation indicated that the model was consistent with normal anatomical structures and correlated with previous calculations documented in the literature.Static analysis revealed that the maximum von Mises stress in the medial component of the normal knee was the lowest and increased with the advancement of the hypointensity zone.In contrast,the lateral component exhibited an opposing trend,with the maximum von Mises stress in the lateral component being the highest and decreasing as the hypointensity zone progressed.Additionally,the medial component experienced an increasing proportion of stress within the overall knee joint.HE staining demonstrated that the chondrocyte layer progressively deteriorated and may even disappear as the hypointensity zone expanded.Furthermore,alkaline magenta staining indicated that the severity of microfractures in the trabecular bone increased concurrently with the expansion of the h

关 键 词：骨关节炎 低密度区 有限元分析 软骨 半月板 

分 类 号：R684[医药卫生—骨科学] R816.8[医药卫生—外科学]