北京生物醫(yī)學(xué)工程

全膝關(guān)節(jié)置換脛骨平臺截骨后傾角對關(guān)節(jié)接觸力的影響

The influence of different posterior tibial slope on tibio-femoral contact force after total knee arthroplast

作者：杜明明張寬曾紀洲閆松華

單位：首都醫(yī)科大學(xué) 生物醫(yī)學(xué)工程學(xué)院（北京 100069）; 首都醫(yī)科大學(xué) 臨床生物力學(xué)應(yīng)用基礎(chǔ)研究北京市重點實驗室（北京 100069）; 首都醫(yī)科大學(xué)附屬北京潞河醫(yī)院骨關(guān)節(jié)外科（北京 101149）

關(guān)鍵詞：全膝關(guān)節(jié)置換；脛骨平臺截骨后傾角；有限元分析；接觸應(yīng)力；應(yīng)力分布

分類號：R318.01

出版年·卷·期（頁碼）：2021·40·3（227-232）

摘要：

目的通過膝關(guān)節(jié)有限元模型模擬脛骨平臺不同截骨后傾角(posterior tibial slope,PTS)，計算全膝關(guān)節(jié)置換(total knee arthroplasty , TKA)后聚乙烯襯墊、脛骨截骨面以及脛骨干處的應(yīng)力分布，探索脛骨平臺不同截骨后傾角對脛股關(guān)節(jié)接觸力的影響。方法根據(jù)1例膝骨關(guān)節(jié)炎患者的下肢CT及MRI圖像，建立術(shù)前膝關(guān)節(jié)三維模型，而后進行模擬全膝關(guān)節(jié)置換，分別建立脛骨平臺0°、3°、6°、9°截骨后傾的膝關(guān)節(jié)有限元模型。在Abaqus中進行仿真計算，選擇靜止站立進行加載，施加軸向載荷300 N。結(jié)果隨著脛骨平臺截骨后傾角的增加，聚乙烯襯墊內(nèi)外側(cè)接觸合力百分比沒有明顯變化，但各部位的應(yīng)力峰值隨之增加。聚乙烯襯墊內(nèi)側(cè)接觸應(yīng)力峰值從0°時的4.51 MPa增加到9°時的6.13 MPa；外側(cè)接觸應(yīng)力峰值從3.57 MPa增加到6.02 MPa。脛骨截骨面處的接觸應(yīng)力峰值從0°時的0.84 MPa增加到9°時的1.09 MPa。脛骨干處的應(yīng)力峰值從0°時的1.97MPa增加至9°時的3.23 MPa。結(jié)論脛骨平臺截骨后傾角的增加會加大聚乙烯襯墊、脛骨截骨面、脛骨干處的應(yīng)力峰值。應(yīng)力峰值過大會增加假體磨損及松動的風(fēng)險，使得術(shù)后關(guān)節(jié)疼痛或假體翻修的可能性加大。脛骨平臺截骨后傾角直接影響到術(shù)后的膝關(guān)節(jié)功能，有待于開展大量的相關(guān)研究，綜合探索截骨規(guī)律。

Objective To explore the influence of different posterior tibial slopes (PTS) on tibio-femoral contact forces after total knee arthroplasty (TKA) by calculating the stress distribution on tibial polyethylene insert, the bone-implant surface of tibia and tibial shaft.Methods Based on CT and MRI images of a patient with knee osteoarthritis, a three dimensional knee joint model before the surgery was established, and then a TKA was performed. Finite element models of knee joints with PTS of 0°, 3°, 6°, and 9° during static standing were established, and were analyzed in Abaqus with an axial load of 300N.Results With the increase of PTS, the percentages of the contact force on the medial and lateral sides of the tibial polyethylene insert did not change significantly, but the maximum Von-Mises stress on both sides increased. The maximum Von-Mises stress on medial tibial polyethylene insert increased from 4.51MPa at 0° to 6.13MPa at 9°, and increased from 3.57MPa at 0° to 6.02MPa at 9° on lateral. The maximum Von-Mises stress on the bone-implant surface of tibia increased from 0.84 MPa at 0° to 1.09 MPa at 9°.The maximum Von-Mises stress on tibial shaft increased from 1.97 MPa at 0° to 3.23 MPa at 9°.Conclusions The maximum Von-Mises stress on tibial polyethylene insert, the bone-implant surface of tibia and tibial shaft increases as the PTS increases after TKA. Stress spikes increase the risk of prosthesis wear and loosening, making joint pain or prosthesis revision more likely after surgery. The PTS directly affects the function of the knee after surgery, and the related studies need to be widely carried out in the future to comprehensively explore the influence of PTS.

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