中国组织工程研究 ›› 2023, Vol. 27 ›› Issue (18): 2824-2830.doi: 10.12307/2023.293

• 骨与关节生物力学 bone and joint biomechanics • 上一篇    下一篇

步态周期下内侧半月板后根部分撕裂对膝关节生物力学的影响

徐  志1,李豫皖2,金  瑛3,刘  毅3   

  1. 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遵义医科大学附属医院骨科,贵州省遵义市   563000
  • 收稿日期:2022-04-18 接受日期:2022-05-21 出版日期:2023-06-28 发布日期:2022-09-16
  • 通讯作者: 刘毅,硕士,主任医师,遵义医科大学附属医院骨科,贵州省遵义市 563000
  • 作者简介:徐志,男,1993年生,安徽省泾县人,汉族,2019年遵义医科大学毕业,硕士,医师,主要从事四肢创伤与运动医学的研究。 李豫皖,男,1991年生,河南省镇平县人,汉族,2020年重庆医科大学毕业,博士,主治医师,主要从事运动医学与关节病的研究。
  • 基金资助:
    北京大学医学部青年科技创新人才培养基金(BMU2022PY007号),项目负责人:李豫皖

Effect of partial posterior root tear of medial meniscus on biomechanics of the knee joint during gait cycle

Xu Zhi1, Li Yuwan2, Jin Ying3, Liu Yi3   

  1. 1Department of Orthopedics, Zhangjiagang Fifth People’s Hospital, Zhangjiagang 215600, Jiangsu Province, China; 2Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing 100191, China; 3Department of Orthopedics, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
  • Received:2022-04-18 Accepted:2022-05-21 Online:2023-06-28 Published:2022-09-16
  • Contact: Liu Yi, Master, Chief physician, Department of Orthopedics, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China2022-04-18
  • About author:Xu Zhi, Master, Physician, Department of Orthopedics, Zhangjiagang Fifth People’s Hospital, Zhangjiagang 215600, Jiangsu Province, China Li Yuwan, MD, Attending physician, Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing 100191, China Xu Zhi and Li Yuwan contributed equally to this article.
  • Supported by:
    a grant from Fostering Young Scholars' Scientific & Technological Innovation of Peking University Health Science Center, No. BMU2022PY007 (to LYW)

摘要:

文题释义:
步态周期:指人行走过程中一侧足跟从第一次着地到该侧足跟再次着地时行进的过程。一个步行周期分为支撑相和摆动相两个阶段,其中前者占步行周期时长的60%,后者约占其中的40%。
内侧半月板后根撕裂:是指发生在内侧半月板后根部止点骨性附着区1 cm范围内的放射性撕裂抑或撕脱性损伤。

背景:目前针对内侧半月板后根撕裂加速膝关节退变相关生物力学研究大多数仅限于在静态仿真设计的基础上对内侧半月板后根完全撕裂模型进行测试,而对内侧半月板后根部分撕裂在完整步态周期下的生物力学行为尚不清楚。
目的:运用动态有限元分析的方法来比较正常膝关节模型与内侧半月板后根部分撕裂模型在完整步态周期下生物力学的差异。
方法:以健康成年人右膝关节CT扫描数据为基础,建立包括骨、半月板、关节软骨在内的健康膝关节有限元模型,并在健康模型基础上进一步构建膝关节内侧半月板后根撕裂模型。分别在2种模型上施加ISO标准步态载荷进行仿真测试。比较2种模型对应部件在各时相下应力、位移和接触面积的差异。
结果与结论:①在完整步态周期下,健康模型内侧半月板后根云图应力分布均匀,而病理模型则在损伤区出现应力集中表现,健康模型最大应力出现在30%时刻外侧半月板内缘,值为29.68 MPa,病理模型最大应力出现在50%时刻外侧半月板内缘,值为30.34 MPa;②在完整步态周期下,健康和病理模型胫骨软骨应力分布大体一致,2种模型承受最大应力分别出现在步态周围50%,20%时刻,值大小分别为5.11,6.85 MPa;③2种模型的内侧间室组内差异大于外侧间室组内差异;病理模型各时相内侧胫骨平台应力均值比正常模型高9.3%,最大值为5.73 MPa,出现在支撑相中期;股骨、胫骨接触面积峰值均出现在40%时刻,病理模型各时相股骨软骨接触面积均值比正常模型减少14.6%;④研究结果表明在内侧半月板后根部分撕裂发生后膝关节生物力学特性的改变增加了骨关节炎的发病风险。

https://orcid.org/0000-0003-3298-8765 (徐志);https://orcid.org/0000-0001-8959-6805 (李豫皖) 

中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程

关键词: 内侧半月板后根撕裂, 有限元分析, 生物力学, 步态周期, 膝关节

Abstract: BACKGROUND: At present, most of biomechanical studies on medial meniscus posterior root tearing to accelerate knee joint degeneration are limited to testing the complete tear model of the posterior root of the medial meniscus on the basis of static simulation design. However, the biomechanical behavior of medial meniscus posterior root tear in the full gait cycle is not clear. 
OBJECTIVE: To compare the biomechanical differences between the normal knee joint model and the medial meniscus posterior root partial tear model in the complete gait cycle using dynamic finite element analysis method.
METHODS: Based on the CT scan data of the right knee joint of healthy adults, the finite element model of healthy knee joint including bone, meniscus and articular cartilage was established, and the posterior root tear model of medial meniscus of knee joint was further established on the basis of healthy model. The standard gait load of ISO was applied to the two models for simulation test. The differences of stress, displacement and contact area of the corresponding parts of the two models were compared.  
RESULTS AND CONCLUSION: (1) Under the complete gait cycle, the stress distribution of the posterior root of the medial meniscus in the healthy model was uniform, while the pathological model showed stress concentration in the injured area. The maximum stress of the former appeared at the inner edge of the lateral meniscus at 30% time, with a value of 29.68 MPa. The latter maximum stress appeared at the inner edge of the lateral meniscus at 50% time, with a value of 30.34 MPa. (2) During the complete gait cycle, the stress distribution of tibial cartilage in healthy and pathological models was roughly the same. The maximum stress of the two models appeared at 50% and 20% around the gait, respectively, and the values were 5.11 MPa and 6.85 MPa, respectively. (3) The difference between the medial intercompartment group and the lateral intercompartment group was greater than that in the lateral intercompartment group. The average stress of the medial tibial plateau of the pathological model was 9.3% higher than that of the normal model, and the maximum value of 5.73 MPa appeared in the middle of the support phase. The peak contact area of femur and tibia appeared at 40% time, and the average contact area of femoral cartilage in each phase of the pathological model decreased by 14.6% compared with the normal model. (4) The results show that alterations in the biomechanical properties of the knee joint after a partial tear of the medial meniscus posterior root increase the risk of osteoarthritis.

Key words: medial meniscus posterior root tears, finite element analysis, biomechanics, gait cycle, knee joint

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