摘要
目的通过有限元分析方法,研究全膝关节置换术中胫骨假体在不同旋转角度放置时屈膝过程中的髌股关节峰值接触压的变化,以期为临床膝关节置换中胫骨假体旋转轴线的选择提供理论支撑。方法筛选1名健康志愿者,选取右侧膝关节CT、MRI扫描数据建立自然膝关节三维模型。参照常规全膝关节置换术方法,将胫骨假体参考Akagi线分别外旋5°、10°和内旋5°、10°安装,股骨假体相对后髁连线外旋3°固定放置,得到5组膝关节的三维模型,建立膝关节的有限元模型,计算各模型组在屈膝0°、30°、60°、90°、120°时的髌股关节峰值接触压值。结果各模型组的髌股关节峰值接触压值均随膝关节屈曲加深而增大,所有TKA膝关节模型组的接触压值均高于自然膝关节组。在胫骨假体旋转模型组中,随着内旋或外旋转度数增加,髌股关节峰值接触压值均随之升高。结论在全膝关节置换术中,当胫骨假体参照Akagi轴放置时,5°及以上的内旋或外旋均会引起髌股关节接触压值的明显升高,因此我们建议术中应尽可能根据Akagi线放置胫骨假体,并高度警惕胫骨假体的内外旋转不良。另外还发现,胫骨假体外旋5°组与内旋5°组的髌股关节峰值接触压值较为接近,外旋10°组与内旋10°组也较为接近。
Objective By means of finite element analysis,the changes in peak patellofemoral joint contact pressure during knee flexion with tibial prosthesis placed at different rotation angles in total knee arthroplasty were investigated in order to provide theoretical support for the selection of the tibial prosthesis rotation axis in clinical knee arthroplasty.Methods A healthy volunteer was selected,and CT and MRI scans of the right knee were selected to establish a three-dimensional model of the natural knee joint.Referring to the conventional total knee arthroplasty method,the tibial prosthesis was installed with 5°and 10°external rotation and 5°and 10°internal rotation respectively with reference to Akagi line,and the femoral prosthesis was placed with 3°external rotation relative to the posterior condylar line to obtain the 3D models of 5 groups of knee joints,and the finite element models of knee joints were established to calculate the peak contact pressure values of the patellofemoral joint at 0°,30°,60°,90°and 120°of knee flexion for each model group.Results The peak patellofemoral joint contact pressure values increased with deepening knee flexion in all model groups,and the contact pressure values in all TKA knee model groups were higher than those in the natural knee group.In the tibial prosthesis rotation model group,the peak patellofemoral contact pressure values increased with increasing degrees of internal or external rotation.Conclusion In total knee arthroplasty,when the tibial prosthesis was placed with reference to the Akagi axis,internal or external rotation of 5°or more caused a significant increase in patellofemoral joint contact pressure.It suggested that the tibial prosthesis should be placed according to the Akagi line as much as possible during surgery,and it should be highly alert to poor internal and external rotation of the tibial prosthesis.It was also found that the peak patellofemoral joint contact pressure values were closer in the 5°external rotation group and the 5°internal rotation group,and in the 10°external rotation group and the 10°internal rotation group.
作者
杨龙江
黄浩
吕奇
杨子肖
钟超
蔡东峰
洪嵩
Yang Longjiang;Huang Hao;Lyu Qi;Yang Zixiao;Zhong Chao;Cai Dongfeng;Hong Song(Department of Orthopaedics,the First Affiliated Hospital of Zunyi Medical University,Zunyi Guizhou 563099,China)
出处
《合肥医科大学学报》
2023年第5期466-474,共9页
Journal of Zunyi Medical University
基金
合肥市联合基金资助项目[NO:遵市科合HZ(2021)29]。
关键词
全膝关节置换
髌股关节
有限元分析
胫骨假体
接触压值
生物力学
total knee arthroplasty
patellofemoral joint
finite element analysis
tibial prosthesis
contact pressure
biomechanics
