针刀治疗膝骨性关节炎的有限元分析

Finite Element Analysis of Needle Knife Therapy on Knee Osteoarthritis

目的:运用三维有限元技术模拟构建不同的针刀治疗骨性关节炎模型,对膝关节应力进行分析,研究针刀对骨性关节炎的生物力学影响。方法:选取1名正常男性青年膝关节横断MRI扫描片一套,扫描范围包括膝关节上、下12cm.图像经计算机处理后,按三维有限元网格划分原则,划分1 716个节点,1 215个单元,运用Super-Sap有限元计算程序,分别建立对照组(髌韧带止点及肌腱纤维粘连)、实验组1(针刀剥离髌韧带止点粘连)、实验组2(针刀疏通肌腱纤维间的粘连)、实验组3(针刀疏通剥离髌韧带止点及肌腱纤维粘连)三维有限元模型。按各组不同治疗方法模拟出膝部实际受力大小和方向,对模型加载相同载荷,计算得出模型中各节点及单元的应力值。结果:实验组1、实验组2、实验组3的髌韧带及内外侧半月板、软骨Mises应力值均较对照组减小,且关节内侧软骨及半月板比外侧受到的负荷大,这与临床上内侧型膝骨性关节炎患者多于外侧型的现象相符合。结论:针刀治疗膝骨性关节炎能解除软组织压力过高,改善关节软骨的压应力,使关节内力平衡得到恢复,延缓关节软骨退变,促进关节软骨的修复,达到"既通且松"、"阴阳平衡"的目的。

Objective.. To analyze the stress of knee joint and study the biomechanics influence of needle knife to osteoarthritis by three-dimensional finite element technology. Methods： A set of knee joint MRI scan of 1 normal young male was selected, and the scan range was 12 cm above and below the knee joint. The images processed by computer are divided into 1 716 nodes and 1 215 units, according to the classification principle of three-dimensional finite element grid. Using the super-sap finite element computer program to establish the three-dimensional finite element models of control group （patellar ligament check point and tendon fibers adhesion）, experimental group 1 （needle knife striping the adhesion of patellar ligament check point）, experimental group 2 （needle knife striping tendons fibers） and experimental group 3 （needle knife striping the adhesions of patellar ligament check point and tendon fibers）. According to the different treated method to simulate the actual stress size and direction of knee joint, and loading the same load to the models, to calculate the stress of each node and unit in the models. Results： The patellar ligaments, inside and outside meniscus of experimental group 1, experimental group 2 and experimental group 3, and the Mises stress of cartilage are reduced than those of the control group, And the press of inside cartilage and meniscus are larger than that of the outside. It conforms to the phenomenon that the patient suffered from medial knee osteoarthritis is more than that from the lateral knee osteoarthritis. Conclusion： Needle knife therapy for knee osteoarthritis can remove the pressure of soft tissue, and improve the compressive stress ofarticular cartilage. It also can recover the intra-articular force balance, delay the degeneration and promote the repair of articular cartilage. All of that can achieve the goal of patency, relaxation and the balance of Yin and Yang.