中国组织工程研究

中国组织工程研究 ›› 2024, Vol. 28 ›› Issue (9): 1347-1353.doi: 10.12307/2023.920

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

前交叉韧带部分断裂对膝关节应力影响的三维有限元分析

杨骏良1，路  坦1，徐  彪1，姜亚琼1，王富成2   

  1. 新乡医学院第一附属医院，1关节与创伤外科二病区，新乡市骨关节退行性疾病研究重点实验室，2泌尿外科，河南省卫辉市   453100
  • 收稿日期:2022-11-24 接受日期:2023-01-18 出版日期:2024-03-28 发布日期:2023-07-25
  • 通讯作者: 路坦，副主任医师，新乡医学院第一附属医院关节与创伤外科二病区，新乡市骨关节退行性疾病研究重点实验室，河南省卫辉市 453100
  • 作者简介:杨骏良，男，1996年生，贵州省黔南州人，布依族，在读硕士，医师，主要从事运动医学在三维有限元方面的研究。
  • 基金资助:
    河南省医学科技攻关计划(联合共建)项目(LHGJ20190450)，项目负责人：路坦

Three-dimensional finite element analysis of effects of partial anterior cruciate ligament rupture on knee joint stress

Yang Junliang1, Lu Tan1, Xu Biao1, Jiang Yaqiong1, Wang Fucheng2   

  1. 1Department of Joint and Trauma Surgery Ward Two, Xinxiang Key Laboratory of Bone and Joint Degenerative Disease Research, First Affiliated Hospital of Xinxiang Medical University, Weihui 453100, Henan Province, China; 2Department of Urology Surgery, First Affiliated Hospital of Xinxiang Medical University, Weihui 453100, Henan Province, China
  • Received:2022-11-24 Accepted:2023-01-18 Online:2024-03-28 Published:2023-07-25
  • Contact: Lu Tan, Associate chief physician, Department of Joint and Trauma Surgery Ward Two, Xinxiang Key Laboratory of Bone and Joint Degenerative Disease Research, First Affiliated Hospital of Xinxiang Medical University, Weihui 453100, Henan Province, China
  • About author:Yang Junliang, Master candidate, Physician, Department of Joint and Trauma Surgery Ward Two, Xinxiang Key Laboratory of Bone and Joint Degenerative Disease Research, First Affiliated Hospital of Xinxiang Medical University, Weihui 453100, Henan Province, China
  • Supported by:
    the Henan Medical Science and Technology Project (Joint Construction), No. LHGJ20190450 (to LT)

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摘要：


文题释义：

前交叉韧带损伤：在临床上较为常见，约占膝关节运动损伤的20%。前交叉韧带是维持膝关节稳定的重要结构，主要功能是防止胫骨前移，前交叉韧带损伤后降低了关节稳定性，容易导致膝关节半月板及关节软骨的继发性损伤。

有限元分析：利用数学近似的方法对真实物理系统进行模拟，最初应用于飞机结构的静力和动力特性分析，随后将其应用于骨科生物力学的研究，随着高分辨 CT及MRI设备的发展和有限元分析软件处理能力的强大，有限元分析已被证实在生物力学方面具有明显的优越性。


背景：前交叉韧带损伤容易导致继发性的半月板损伤和骨性关节炎，目前关于前交叉韧带损伤所致的半月板及关节软骨损伤力学研究较少。

目的：利用有限元分析方法研究前交叉韧带部分断裂对膝关节内外侧半月板及关节软骨应力的影响。
方法：选择一名健康志愿者的膝关节CT和MRI影像资料，将扫描数据导入 Mimics、 Geomagic及Solidworks软件，经配准融合后建立4种膝关节三维模型，分别为前交叉韧带完整、前交叉韧带后外侧束断裂、前交叉韧带前内侧束断裂及前交叉韧带缺失模型，最后导入Ansys软件，对膝关节施加4种模式荷载：在股骨顶端施加纵向荷载750 N；在股骨顶端施加纵向荷载750 N及胫骨后方134 N向前推力；在股骨顶端施加纵向荷载750 N及10 Nm内翻力矩，模拟膝内翻；在股骨近端面施加纵向荷载750 N及4 Nm内旋力矩，模拟膝内旋，进行膝关节半月板与软骨生物力学有限元分析。

结果与结论：①在膝关节伸直状态下，在股骨顶端施加纵向荷载750 N时，前交叉韧带前内侧束断裂和缺失使半月板总体应力及其峰值明显增大，但其应力分布无明显变化，关节软骨应力无明显变化；在股骨顶端施加纵向荷载750 N及胫骨后方134 N向前推力时，前交叉韧带前内束断裂使胫骨前移增大，半月板后角受挤压应力增大，关节软骨应力无明显变化；模拟膝内翻时，前交叉韧带不同程度损伤较完整时的外侧半月板后角应力减小，内侧半月板应力增大，关节软骨应力稍减小；模拟膝内旋时，前交叉韧带前内束断裂及缺失使股骨软骨和胫骨软骨的等效应力峰值由内侧软骨转向外侧软骨，半月板应力峰值明显增大，此时对膝关节旋转稳定性起主导作用的是前交叉韧带前内侧束；②结果显示，在膝关节处于伸直站立位、内翻及内旋时，前交叉韧带前内侧束断裂患者继发半月板损伤的风险远大于后外侧束断裂患者，而对关节软骨的影响无明显差异。

https://orcid.org/0000-0002-1829-900X (杨骏良) 

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: 前交叉韧带损伤, 有限元分析, 生物力学, 半月板, 关节软骨

Abstract: BACKGROUND: Anterior cruciate ligament injury tends to lead to secondary meniscus injury and osteoarthritis. At present, there are few studies on the mechanics of meniscus and articular cartilage injury caused by anterior cruciate ligament injury. 
OBJECTIVE: To study the effect of partial rupture of the anterior cruciate ligament on the stress of medial and lateral meniscus and articular cartilage of knee joint by finite element analysis.
METHODS: The CT and MRI images of the knee joint of a healthy volunteer were selected, and the scan data were imported into Mimics, Geomagic and SolidWorks software. After registration and fusion, four kinds of three-dimensional knee joint models were established: models of intact anterior cruciate ligament, rupture of the posterior external tract of anterior cruciate ligament, rupture of the anterior internal tract of anterior cruciate ligament, and absence of anterior cruciate ligament. Finally, data were imported into Ansys software to apply four different modes of loads to the knee joint: Longitudinal loads of 750 N were applied to the top of the femur; longitudinal load of 750 N to the top of the femur and forward thrust of 134 N behind tibia; a longitudinal load of 750 N and a varus moment of 10 Nm were applied to the top of the femur to simulate genu varus; 750 N longitudinal load and 4 Nm internal rotation moment were applied to the proximal end of the femur to simulate knee internal rotation. The finite element analysis of biomechanical stress changes of the meniscus and articular cartilage of the knee joint was carried out.  
RESULTS AND CONCLUSION: (1) In the straight position of the knee joint, when the anterior medial tract of the anterior cruciate ligament was broken and the anterior cruciate ligament was missing under longitudinal loads of 750 N at the top of the femur, the total stress and peak value of meniscus increased significantly, but the stress distribution of the meniscus and the stress of articular cartilage did not change significantly. In longitudinal load of 750 N to the top of the femur and forward thrust of 134 N behind tibia, the fracture of the anterior internal tract of the anterior cruciate ligament increased the tibia forward, the compressive stress of posterior angle of the meniscus increased, and the stress of the articular cartilage did not change significantly. During simulating genu varus, the posterior angular stress of the lateral meniscus decreased, the stress of the medial meniscus increased, and the stress of articular cartilage slightly decreased when anterior cruciate ligament injuries were complete. When the anterior internal tract of the anterior cruciate ligament was broken or absent under knee internal rotation, the equivalent stress peak value of femoral cartilage and tibia cartilage shifted from medial cartilage to lateral cartilage, and the stress peak value of meniscus increased significantly. At this time, the anterior internal tract of the anterior cruciate ligament played a leading role in the rotational stability of the knee joint. (2) These results indicate that the risk of secondary meniscus injury in patients with anterior and medial anterior cruciate ligament band rupture was much higher than that in patients with posterior and external anterior cruciate ligament band rupture when the knee was in the upright standing position, varus and pronation, and there was no significant difference in the impact on articular cartilage.

Key words: anterior cruciate ligament injury, finite element analysis, biomechanics, meniscus, articular cartilage

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