[1]周晓寒,李宗武,钱超,等.复发性髌骨脱位重建髌股韧带的有限元分析[J].中国中医骨伤科杂志,2024,32(09):58-64+69.[doi:10.20085/j.cnki.issn1005-0205.240912]
　ZHOU Xiaohan,LI Zongwu,QIAN Chao,et al.Finite Element Analysis of Patellofemoral Ligament Reconstruction in Recurrent Patellar Dislocation[J].Chinese Journal of Traditional Medical Traumatology & Orthopedics,2024,32(09):58-64+69.[doi:10.20085/j.cnki.issn1005-0205.240912]
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复发性髌骨脱位重建髌股韧带的有限元分析()
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《中国中医骨伤科杂志》[ISSN:1005-0205/CN:42-1340/R]

卷:
第32卷
期数:
2024年09期
页码:
58-64+69
栏目:
临床研究
出版日期:
2024-09-15

文章信息/Info

Title:
Finite Element Analysis of Patellofemoral Ligament Reconstruction in Recurrent Patellar Dislocation
文章编号:
1005-0205(2024)09-0058-07
作者:
周晓寒1; 李宗武1; 钱超1; 罗文1; 夏煜博1; 代颖1; 温辉1; 王涛1△; 郭英1△
1昆明市中医医院(昆明,650504)
Author(s):
ZHOU Xiaohan1; LI Zongwu1; QIAN Chao1; LUO Wen1; XIA Yubo1; DAI Ying1; WEN Hui1; WANG Tao1△; GUO Ying1△
1Kunming Traditional Chinese Medicine Hospital,Kunming 650504,China.
关键词:
筋束骨;  内侧髌股韧带;  膝关节;  复发性髌骨脱位;  有限元分析
Keywords:
tendon bundle bone;  medial patellofemoral ligament;  knee joint;  recurrent patellar dislocation;  finite element analysis
分类号:
R684.7
DOI:
10.20085/j.cnki.issn1005-0205.240912
文献标志码:
A
摘要:
目的:基于传统“筋束骨”理论,通过有限元建模研究内侧髌股韧带(MPFL)与复发性髌骨脱位的力学关联,分析内侧髌股韧带股骨侧止点重建的最佳效应点。方法:选取29岁健康成年男性志愿者1名,摄右下肢64排螺旋 CT片。另选取2022年4月至2022年6月收治的5例复发性髌骨脱位患者,收集并比较手术前后Lysholm膝关节评分、疼痛视觉模拟量表(VAS)评分、髌股适合角(CA)、胫骨结节-股骨滑车间距(TT-TG )及髌骨倾斜角(PTA)情况。建立6个分组(正常组、内侧髌股韧带损伤组、内侧髌股韧带重建A组、内侧髌股韧带重建B组、内侧髌股韧带重建C组、内侧髌股韧带重建D组),观察分析膝关节屈曲4种工况(30°,60°,90°,120°)下力学关联指标(髌股关节内外侧接触压力、接触面积、等效应力、内侧髌股韧带张拉应力、内侧髌股韧带长度、髌骨位移变化量)。结果:建立的膝关节有限元模型中,模拟膝关节屈曲的4种工况下,髌股关节内外侧接触压力、髌股关节接触面积、髌股关节等效应力、髌骨位移程度的变化量指标在30°～90°逐渐增大,90°～120°逐渐减小; 内侧髌股韧带屈伸30°～90°张拉应力逐渐增大,90°～120°逐渐减小。其中内侧髌股韧带重建D组对应的髌股关节内外侧压力值、关节面接触面积、髌骨位移较接近膝关节正常组。手术后患者的Lysholm膝关节评分显著高于手术前,疼痛VAS评分、髌股适合角、胫骨结节-股骨滑车间距、髌骨倾斜角显著低于手术前,差异有统计学意义(P<0.05)。结论:验证了股骨侧内侧髌股韧带重建的最佳效应点,证实了等效点对治疗复发性髌骨脱位的力学作用,为临床内侧髌股韧带重建股骨侧定位的选取提供了力学依据。
Abstract:
Objective:Based on the traditional “tendon bone” theory,this study investigates the mechanical relationship between the medial patellofemoral ligament(MPFL)and recurrent patellar dislocation through finite element modeling,and investigates the optimal effect point for the reconstruction of the femoral lateral insertion point of the MPFL.Methods:One healthy adult male volunteer aged 29 was selected to undergo 64 slice spiral CT of the right lower limb.Another 5 patients with recurrent patellar dislocation from April 2022 to June 2022 were selected to collect and compare the Lysholm knee joint score,pain visual analogue scale(VAS)score,congruance angle(CA),tibial tubercletrochlear groove distance(TT-TG),and patellar tilt angle(PTA)before and after surgery.Establish 6 groups(normal group,MPFL injury group,MPFL reconstruction group A,MPFL reconstruction group B,MPFL reconstruction group C,MPFL reconstruction group D)to study 4 working conditions of knee joint flexion(30°,60°,90°,120°),and analyze and observe mechanical related indicators(patellofemoral joint internal and external contact pressure,contact area,equivalent stress,MPFL ligament tensile stress,MPFL ligament length,patellar displacement changes).Results:In the finite element model of knee joint,the internal and external contact pressure of patellofemoral joint,patellofemoral joint contact area,patellofemoral joint equivalent stress and patellofemoral displacement degree gradually increased from 30° 90°,and gradually decreased from 90°120°.The tensile stress of MPFL at 30°90° was gradually increased,and that at 90°120° was gradually decreased.In MPFL reconstruction group D,the internal and lateral pressure values of patellofemoral joint,joint surface contact area and patellar displacement were closer to those of normal knee joint group.After surgery,Lysholm knee joint score of patients was significantly higher than before surgery(P<0.05),and pain VAS score,CA,TT-TG and PTA were significantly lower than before surgery(P<0.05).Conclusion:The optimal effect point of MPFL reconstruction on femoral side was verified,and the mechanical effect of equivalent point on the treatment of recurrent patellar dislocation was confirmed,which provided a mechanical basis for the selection of clinical MPFL reconstruction on femoral side.

参考文献/References:

[1] 王琦,柯贤鹏.关节镜下外侧支持带松解术联合小切口MPFL-R术治疗复发性髌骨脱位疗效观察[J].海南医学,2023,34(21):3108-3113.
[2] 代朋乙,常祺,王战朝.改良的髌骨单隧道重建内侧髌股韧带手术治疗复发性外侧髌骨脱位[J].中国骨与关节损伤杂志,2023,38(12):1297-1300.
[3] 安江东,夏亚一,安丽萍,等.MPFL重建术中股骨等距点的研究[J].中国矫形外科杂志,2015,23(22):2089-2093.
[4] 郑礼,秦大平,李磊,等.筋骨平衡在骨质疏松症防治中的意义[J].中国骨质疏松杂志,2023,29(7):1065-1068.
[5] CANALE S T,BEATY J H.坎贝尔骨科手术学[M].10版.卢世璧,王继芳,王岩,等译.济南:山东科学技术出版社,2005:2284-2288.
[6] 陈彦飞,鲁超,赵勇,等.基于筋束骨理论铍针松解髌骨外侧支持带改善髌股关节应力集中的有限元分析[J].中国骨伤,2021,34(2):126-130.
[7] 刘蒙飞,马鹏程,尹灿,等.不同骨密度对膝关节单髁置换后关节内各结构影响的三维有限元分析[J].中国组织工程研究,2024,28(24):3801-3806.
[8] LI J.Development and validation of a finite-element musculoskeletal model incorporating a deformable contact model of the hip joint during gait[J].J Mech Behav Biomed Mater,2021,113:104136.
[9] 曾露露,谢红.有限元法预测运动护膝在不同运动状态下对膝关节韧带的影响[J].中国组织工程研究,2023,27(36):5771-5777.
[10] 陈彦飞,鲁超,赵勇,等.基于CT影像动态膝关节有限元模型的构建及仿真力学分析[J].中国骨伤,2020,33(5):479-484.
[11] 王雄,曹烈虎.复发性髌骨脱位诊治进展[J].国际骨科学杂志,2021,42(6):348-352.
[12] 陈奕历,黄晓宇,成永忠,等.基于筋束骨理论逆移位复位手法对尸体模型旋后-外旋型踝关节骨折的作用[J].中华中医药杂志,2022,37(5):2764-2768.
[13] 班林强,秦伟凯,魏光成,等.基于筋束骨理论探讨理筋动髌手法治疗髌股关节炎[J].北京中医药大学学报,2022,45(8):855-859.
[14] 邝高艳,刘力菠,卢敏,等.“筋骨并重”理念对腰椎管狭窄症的诊治思路[J].江西中医药,2023,54(9):15-17.
[15] YUAN B,MO Z,ZHANG K,et al.The effect of different posterior inclinations of tibial component on tibiofemoral contact pressures after unicompartmental knee arthroplasty[J].J Orthop Surg Res,2023,18(1):909.
[16] 孔朝勒门,齐岩松,吴海贺,等.复发性髌骨脱位的治疗现状及最新进展[J].国际骨科学杂志,2023,44(1):10-15.
[17] 徐彪,路坦,杨骏良,等.不同股骨止点对内侧髌股韧带重建后髌股关节应力影响的三维有限元分析[J].中国组织工程研究,2023,27(22):3463-3468.
[18] 印钰,陈临新,梅宇,等.内侧股四头肌腱股骨韧带重建联合单骨道内侧髌股韧带重建治疗复发性髌骨脱位的临床疗效[J].中国运动医学杂志,2021,40(12):936-941.

备注/Memo

备注/Memo:
基金项目:云南省科技厅科技计划项目(202001AZ070001-070)
△通信作者 E-mail:183070775@qq.com(王涛) gy1200@126.com(郭英)
更新日期/Last Update: 2024-09-05