摘要
目的探讨骨质疏松膝关节单髁置换术中股骨假体错位对内部结构应变的影响。方法根据健康志愿者的影像学检查(CT、磁共振成像)数据构建正常骨质膝关节模型,并通过改变弹性模量构建骨质疏松膝关节模型,在此基础上分别建立正常骨质组、骨质疏松组的股骨假体错位单髁置换有限元模型。2组模型均施加1000 N垂直静态载荷,观察股骨假体各错位角度下内侧间室结构(聚乙烯衬垫、胫骨假体下松质骨)和外侧间室结构(半月板、胫骨软骨)的应变峰值和分布情况。结果骨质疏松组模型聚乙烯衬垫、胫骨假体下松质骨、半月板、胫骨软骨在不同内翻角度、外翻角度下的应变峰值均大于正常骨质组;骨质疏松组中,聚乙烯衬垫和胫骨假体下松质骨的应变峰值均随着股骨假体错位角度的增加而增加,但外翻错位角度下的增加幅度大于内翻错位角度,半月板和胫骨软骨的应变峰值亦随着股骨假体错位角度的增加而增加,但内翻错位角度下的增加幅度大于外翻错位角度。聚乙烯衬垫的应变集中区域位于股骨假体与衬垫接触部位的类圆形区域,松质骨的应变集中区域主要位于后外侧,半月板的应变集中区域位于前角附近,胫骨软骨的应变集中区域主要位于中部靠近髁间嵴。结论骨质疏松可能会对单髁置换术后膝关节内部结构的应变产生负面影响,股骨假体内翻错位可能加剧健侧间室(外侧间室)骨关节炎的进展,外翻错位则可能增加假体松动和翻修的风险。
Objective To investigate the impact of femoral prosthesis malposition on internal structural strain in unicompartmental knee arthroplasty for osteoporotic knees.Methods A normal bone knee joint model was constructed based on imaging studies(CT,magnetic resonance imaging)of healthy volunteers,and an osteoporotic knee joint model was constructed by altering the elastic modulus.Finite element models of femoral prosthesis malposition in unicompartmental knee arthroplasty were then established for both normal bone and osteoporotic groups.A vertical static load of 1,000 N was applied to both models,and the peak strain values and distributions were observed in the medial compartment structures(polyethylene gasket,cancellous bone under tibial prosthesis)and lateral compartment structures(meniscus,tibial cartilage)at various malposition angles of the femoral prosthesis.Results The peak strain values of the polyethylene gasket,cancellous bone under tibial prosthesis,meniscus,and tibial cartilage in the osteoporotic group were higher than those in the normal bone group at different varus and valgus angles.In the osteoporotic group,the peak strain values of the polyethylene gasket and cancellous bone under tibial prosthesis increased with the increase in femoral prosthesis malposition angle,with a greater increase at valgus angles than at varus angles.Similarly,the peak strain values of the meniscus and tibial cartilage increased with the increase in femoral prosthesis malposition angle,but the increase was greater at varus angles than at valgus angles.The strain concentration area of the polyethylene gasket was located in a circular-like area where the femoral prosthesis contacted the gasket,the strain concentration area of the cancellous bone was mainly located in the posterolateral region,the strain concentration area of the meniscus was located near the anterior horn,and the strain concentration area of the tibial cartilage was mainly located in the middle near the intercondylar eminence.Conclusion Osteoporosis may adversely affect the strain on internal structures of the knee joint after unicompartmental knee arthroplasty.Varus malposition of the femoral prosthesis may exacerbate the progression of osteoarthritis in the contralateral compartment(lateral compartment),while valgus malposition may increase the risk of prosthesis loosening and revision surgery.
作者
依力哈木江·吾斯曼
刘蒙飞
巨啸晨
孙荣鑫
Yilihamujiang·WUSIMAN;LIU Mengfei;JU Xiaochen;SUN Rongxin(Department of Joint Surgery,the Sixth Affiliated Hospital of Xinjiang Medical University,Urumqi,Xinjiang,830000)
出处
《实用临床医药杂志》
CAS
2024年第21期6-12,共7页
Journal of Clinical Medicine in Practice
基金
新疆维吾尔自治区自然科学基金资助项目(LFYKYZX2021005)。
关键词
膝
骨关节炎
骨质疏松
单髁置换术
应变
有限元分析
knee
osteoarthritis
osteoporosis
unicompartmental knee arthroplasty
strain
finite element analysis