中国组织工程研究

中国组织工程研究 ›› 2025, Vol. 29 ›› Issue (3): 464-470.doi: 10.12307/2025.107

• 数字化骨科 digital orthopedics • 上一篇    下一篇

骨质疏松患者单髁置换过程中股骨假体置入位置优化的有限元分析

刘蒙飞，陈  刚，史易晗，曾  林，姜  侃，依力哈木江•吾斯曼   

  1. 新疆医科大学第六附属医院，新疆维吾尔自治区乌鲁木齐市   830000
  • 收稿日期:2023-10-25 接受日期:2023-12-14 出版日期:2025-01-28 发布日期:2024-06-03
  • 通讯作者: 依力哈木江•吾斯曼，硕士，主治医师，新疆医科大学第六附属医院关节外科，新疆维吾尔自治区乌鲁木齐市 830000
  • 作者简介:刘蒙飞，男，1992年生，河南省洛阳市人，汉族，新疆医科大学在读硕士，主要从事骨与关节损伤研究。 共同第一作者：陈刚，男，1997年生，新疆维吾尔自治区阿克苏地区人，硕士，医师，主要从事骨与关节损伤的研究。

Finite element analysis of optimization of femoral prosthesis implantation position in unicompartmental knee arthroplasty in osteoporotic patients

Liu Mengfei, Chen Gang, Shi Yihan, Zeng Lin, Jiang Kan, Yilihamujiang•Wusiman   

  1. Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi 830000, Xinjiang Uygur Autonomous region, China
  • Received:2023-10-25 Accepted:2023-12-14 Online:2025-01-28 Published:2024-06-03
  • Contact: Yilihamujiang•Wusiman, Master, Attending physician, Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi 830000, Xinjiang Uygur Autonomous region, China
  • About author:Liu Mengfei, Master candidate, Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi 830000, Xinjiang Uygur Autonomous region, China Chen Gang, Master, Physician, Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi 830000, Xinjiang Uygur Autonomous region, China Liu Mengfei and Chen Gang contributed equally to this article.

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摘要：

文题释义：

单髁置换：是一项微创、精准的手术技术，只置换病损部位，替代病变的关节软骨、半月板而保留膝关节正常的韧带和其他组织的一种微创关节置换手术，优点在于不影响膝关节其他间室的正常功能，可最大限度保留本体感觉和关节功能。
有限元分析法：是一种基于计算机仿真技术的生物力学研究方法，在骨科植入物的安全性评价等方面应用广泛。在骨科力学方面，有限元分析法可以施加不同的负荷、材料属性、边界条件，对应力、应变、刚度、位移情况等进行分析，成为研究骨科力学重要的工具。

摘要
背景：骨质疏松患者行单髁置换过程中，股骨假体的合理置入范围尚未见研究，既往的相关研究常建立在正常骨质的单髁置换模型上，而对于非正常骨质模型的力学研究较少。单髁置换后的并发症已经被证实与骨质疏松高度相关。
目的：采用有限元法分析Sled固定平台股骨假体冠状倾斜度对骨质疏松患者单髁置换后生物力学的影响，并且寻找骨质疏松与单髁置换后中远期并发症的相关性。
方法：基于数字化影像技术获取膝关节和假体的数据，再通过Mimics、Geomagic studio等专用软件建立一个正常骨质膝关节模型。基于已验证的正常骨质膝关节模型，通过改变材料参数创建骨质疏松膝关节模型。以Sled固定平台股骨假体标准位置(0°)为基准，正常骨质组与骨质疏松组分别依次建立股骨假体内、外翻3°，6°，9°，共计14个单髁置换模型，计算并分析所有单髁置换模型中聚乙烯衬垫表面、胫骨假体下松质骨和皮质骨的应力变化。
结果与结论：①在骨质疏松模型中，聚乙烯衬垫表面和胫骨假体下松质骨的高应力值随股骨假体倾斜角度的增加而增加，胫骨假体下皮质骨表面的高应力值随假体外翻角度的增加而增加，随内翻角度的增加而减小；②对于聚乙烯衬垫表面以及胫骨假体下皮质骨表面，骨质疏松组各倾斜角度模型的高应力值均大于正常骨质组中对应的模型；对于胫骨假体下松质骨表面，骨质疏松组各倾斜角度模型的高应力值均小于正常骨质组中对应的模型；③骨质疏松可能会引起单髁置换术后膝关节内部结构的生物力学异常，增加术后假体无菌性松动和假体周围骨折的潜在风险；骨质疏松性膝关节行Sled固定平台内侧单髁置换时应尽可能避免股骨假体在冠状面上内翻/外翻。

https://orcid.org/0000-0003-2277-2223 (刘蒙飞) 

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: 膝, 单髁置换, 骨质疏松, 股骨组件, 生物力学, 有限元分析

Abstract: BACKGROUND: The reasonable implantation range of femoral prosthesis in unicompartmental knee arthroplasty in patients with osteoporosis has not been investigated, and previous studies have often been based on unicompartmental knee arthroplasty models in normal bone, with fewer mechanical studies in models with non-normal bone. Complications after unicompartmental knee arthroplasty have been shown to be highly associated with osteoporosis. 
OBJECTIVE: To analyze the biomechanical effects of the coronal inclination of the Sled fixed platform femoral prosthesis on unicompartmental knee arthroplasty in patients with osteoporosis and to find the correlation between osteoporosis and mid- and long-term complications after unicompartmental knee arthroplasty.
METHODS: Based on the digital imaging technology to obtain the data of the knee joint and prosthesis, a normal bone knee model is then created by using specialized software such as Mimics and Geomagic studio. Based on a validated normal bone knee model, an osteoporotic knee model was created by changing the material parameters. Totally 14 unicompartmental knee arthroplasty finite element models were created using Sled fixed platform femoral prosthesis: standard position (0°), varus and valgus angles: 3°, 6°, 9° in the normal bone and osteoporosis groups. Stress changes on the surface of polyethylene liner, cancellous bone under tibial prosthesis, and cortical bone were calculated and analyzed in all unicompartmental knee arthroplasty models.
RESULTS AND CONCLUSION: (1) In the osteoporotic models, the high stress values of the polyethylene liner surface and the cancellous bone under the tibial prosthesis increased with the increase of the tilt angle of the femoral prosthesis, and the high stress values of the cortical bone surface under the tibial prosthesis increased with the increase of the prosthesis valgus angles and decreased with the increase of the varus angles. (2) For the polyethylene liner surface as well as the subcortical bone surface of the tibial prosthesis, the high stress values of the models for each inclination angle in the osteoporosis group were greater than those of the corresponding models in the normal bone group. For the surface of the cancellous bone under the tibial prosthesis, the high stress values of the tilt angle models of the osteoporosis groups were smaller than those of the normal bone groups. (3) Osteoporosis may cause biomechanical abnormalities in the internal structures of the knee after unicondylar replacement, increasing the potential risk of postoperative aseptic loosening of the prosthesis and periprosthetic fractures. Varus and valgus of the femoral prosthesis in the coronal plane should be avoided as much as possible when performing medial unicompartmental knee arthroplasty with a Sled fixation platform in osteoporotic knees.

Key words: knee, unicompartmental knee arthroplasty, osteoporosis, femoral component, biomechanics, finite element analysis

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