摘要
[目的]通过有限元分析研究AORI Ⅰ、Ⅱ型胫骨平台骨缺损对胫骨假体稳定性的影响,为临床选择合适的重建方案提供依据。[方法]将志愿者膝关节CT扫描,膝关节假体采用EinScan-S激光扫描仪进行三维扫描获得模型的点云,然后在Mimics 17.0、Geomagic2002软件建立三维模型。在CERO4.0、Hypermesh13.0装配,按照AORI分型制作出胫骨平台缺损面积分别为10%、20%、30%、40%的有限元模型。在abaqus6.1中加载压力载荷和扭转载荷,分析各模型中胫骨假体最大应力和最大位移的变化。[结果]在压力载荷作用下,AORI Ⅰ型骨缺损模型中,10%模型与20%模型之间比较差异无统计学意义(P>0.05),30%模型、40%模型比较差异有统计学意义(P<0.05)。AORIⅡ型骨缺损模型中,10%模型、20%模型、30%模型差异无统计学意义(P>0.05),但与40%模型比较差异均有统计学意义(P<0.01)。在扭转载荷作用下,AORI Ⅰ、Ⅱ型骨缺损中,10%模型、20%模型、30%模型之间比较差异无统计学意义(P>0.05),均显著小于40%模型(P<0.01)。无论是压力载荷还是扭转载荷,胫骨假体-骨界面微动的最大位移量,30%模型显著大于10%模型、20%模型(P<0.05),而30%模型、40%模型比较差异亦有统计学意义(P<0.01)。[结论]胫骨平台骨缺损面积的大小会显著影响胫骨假体的稳定,20%~30%的缺损可进行骨重建,40%及以上的骨缺损,在骨重建的同时应增加延长杆以加强假体的稳定性,避免骨重建的失败。
[Objective] To explore the influence of AORI type Ⅰ and Ⅱ tibial plateau defect on the stability of tibial component, and provide the basis for choosing the appropriate reconstruction method in clinic setting. [Methods] A volunteers’ knee joint was scanned by CT and a knee prosthesis was scanned by Ein Scan-S laser scanner to obtain the point cloud of the model. Subsequently, the 3 D models were established with Mimics17 and Geomagic 2002 software, and assembled into CERO4.0 and Hypermesh13.0 software. According to AORI classification,the finite element model of with tibial plateau defect of 10%, 20%, 30% and 40% were established respectively. The maximum stress and displacement of the tibial component in each model were analyzed by loading the pressure load and torsion load in ABAQUS 6.1 software. [Results] Under pressure loading, there was no significant difference in Von-Mises stress between the10% and 20% AORI type Ⅰ bone defect models(P>0.05), whereas there was a significant difference between 30% and 40% AORI type Ⅰ bone defect models(P<0.05). In addition, although there were no significant differences in the stress among 10%,20% and 30% models of AORI type Ⅱ bone defect(P>0.05), there were significant differences between these AORI type Ⅱ bone defect model and the 40% model(P<0.01). Under torsional loading, the Von-Mises stress proved not significant among10%, 20% and 30% models of AORI type Ⅰ and Ⅱ bone defect(P>0.05), which were significantly less than 40% models(P<0.05). Whether under the compression or torsion loading, the maximum displacement of tibial prosthesis-bone interface was significantly greater in 30% model than in 10% and 20% model(P<0.05), which in the 40% model was also significantly greater that that in the 30% model(P<0.05). [Conclusion] The tibial plateau bone defect does significantly affect the stability of tibial component. If the defect ranges 20%~30%, it could be rebuilt. However, as the defect is more than 40%, lengthening rods should be recommended to enhance the stability of the prosthesis and avoid the failure of bone reconstruction.
作者
陈宣煌
郑锋
蔡涵华
张国栋
吴长福
林海滨
CHEN Xuan-huang;ZHENG Feng;CAI Han-hua;ZHANG Guo-dong;WU Chang-fu;LIN Hai-bin(Department of Orthopedics,the Affiliated Hospital of Putian University,Putian 351100,China)
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2019年第21期1982-1987,共6页
Orthopedic Journal of China
基金
福建省自然科学基金项目（编号：2018J01194）
福建省临床重点专科建设项目（编号：2018145）
福建省莆田市临床重点专科建设项目（编号：2016228）
关键词
胫骨平台
骨缺损
全膝关节置换
有限元分析
tibial plateau
bone defect
total knee arthroplasty
finite element analysis
