关键词: 腓骨近端骨折, 有限元分析, 生物力学, 半月板, 关节软骨

Abstract: BACKGROUND: The traditional view is that proximal fibular fractures do not require fixation. Others and our research suggest that the proximal fibular structure plays an important role in the stability of the posterolateral structure of the knee joint, and its mechanism of action is worth studying.
OBJECTIVE: To investigate the biomechanical effects of proximal fibular fractures on various structures of the knee joint in an extended state.
METHODS: Finite element method was used to conduct simulated biomechanical experiments. A healthy young male volunteer was selected to establish a finite element model of the knee joint in an extended state using MRI and CT image data, and four proximal fibular shapes were simulated (Model A: intact, Model B: 1 cm fracture below the fibular head, Model C: 1 cm tip defect fracture from the proximal end of the fibula to the distal end, and Model D: 2 cm bone defect from the proximal end of the fibula). A longitudinal concentrated load of 1 500 N was applied to the femoral shaft to compare and analyze the distribution and changing trend of the maximum equivalent stress and maximum first principal stress of each structure of the knee joint in an extended state under four working conditions. 
RESULTS AND CONCLUSION: (1) In Model A, the maximum equivalent stress in the tibial cartilage and lateral compartment of the meniscus was greater than that in the medial compartment, while the maximum first principal stress in the tibial plateau and medial compartment of the meniscus was greater than that in the lateral compartment. The maximum equivalent stress of the medial condyle of the femoral cartilage was greater than that of the lateral condyle, and the maximum first principal stress of the medial condyle of the femoral cartilage was greater than that of the medial condyle. (2) Compared to Model A, there was no significant difference in the magnitude and distribution of the maximum equivalent stress and maximum first principal stress in the cartilage and meniscus of Model C. (3) Compared to Model A, the maximum equivalent stress increase amplitude of Model B was in the order of medial tibial cartilage (14.9%), medial condyle of femoral cartilage (13.6%), and medial meniscus (6.6%). The maximum first principal stress increase amplitude was the medial meniscus (11.06%), the medial tibial cartilage (8.65%), and the medial condyle of the femoral cartilage (7.46%). The maximum equivalent stress increase amplitude of the ligament was as follows: popliteal arch ligament (33.2%)>anterior cruciate ligament (21.3%)>fibular collateral ligament (17%)>posterior cruciate ligament (14.3%)>anterior lateral collateral ligament (13.2%)>medial collateral ligament (10.1%). (4) Compared to Model A, the maximum equivalent stress increasing trend of Model D followed the medial tibial cartilage (19.5%), femoral cartilage medial condyle (17.9%), and medial meniscus (9.9%). The maximum first principal stress in sequence was the medial meniscus (14.04%), the medial tibial cartilage (13.03%), and the medial condyle of the femoral cartilage (11.37%). The increasing trend of maximum equivalent stress in ligaments was as follows: anterior cruciate ligament (25.2%)>posterior cruciate ligament (18.9%)>medial collateral ligament (18.5%)>anterior lateral collateral ligament (12.7%). (5) It is suggested that when the knee joint is extended, a 1 cm fracture below the fibular head and a 2 cm fibular tip bone defect have a significant impact on the structure of the medial ventricular cartilage, anterior cruciate ligament, and posterior lateral ligament complex.  

Key words: proximal fibular fracture, finite element analysis, biomechanics, meniscus, articular cartilage