膝关节单髁置换胫骨优化截骨设计的生物力学研究
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湛江市科技发展专项资金竞争性分配项目( 2018A206),中国博士后科学基金( 2022M711533),广东省基础与应用基础研究基金(2020B1515120001),广东医科大学-南方医科大学结对科研团队项目(G622280009,4SG22260G)


Biomechanical Study on Optimal Tibial Osteotomy in Unicompartmental Knee Arthroplasty
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    摘要:

    目的 比较膝关节单髁置换术(unicompartmental knee arthroplasty,UKA)常规截骨、保留圆角截骨及全新扩大圆角截骨方法对术后胫骨近端生物力学特性的影响。 方法 基于 Sawbones 胫骨的 CT 数据,构建完整胫骨模型及不同截骨方式下 UKA 术后胫骨模型,采用轴向压缩工况对模型进行有限元分析,比较不同模型间胫骨近端应变情况及骨水泥应力差异。 结果 在轴向压缩工况下,扩大圆角组其截骨区皮质骨 von Mises 应变峰值较常规截骨组与保留圆角组有所增加,而松质骨 von Mises 应变峰值则分别减少 24. 3% ~ 42. 9% 、26. 0% ~ 48. 7% 。 对比截骨区松质骨与皮质骨 von Mises 应变峰值差 Δεpeak ,发现扩大圆角组其 Δεpeak 远远小于其余两组。 UKA 后不同模型间胫骨前内侧皮质骨最小主应变无明显差异,但较完整胫骨模型增加 23. 3% ~ 34. 5% 。 扩大圆角组骨水泥单元平均von Mises 应力随着圆角半径增大呈现下降趋势,且整体均小于常规截骨组与保留圆角组。 结论 全新扩大圆角截骨方法可使健康骨质条件下胫骨近端应力传递更均匀,von Mises 应变峰值更低,假体-骨界面压强更小,相比传统截骨方法及保留圆角截骨方法更有优势。

    Abstract:

    Objective To compare the biomechanical characteristics of proximal tibia after unicompartmental knee arthroplasty (UKA) between conventional osteotomy, radial-corner shape reserved osteotomy and radial-corner shape extended osteotomy. Methods On the basis of CT data from the Sawbones tibia, the complete tibia model and the UKA model under different osteotomy methods were constructed. The finite element analysis was performed on these models under axial compression condition to compare the strain situation of proximal tibia and the difference of bone cement stress. Results Under axial compression conditions, the peak von Mises strain on the resected area of cortical bone was calculated. The strain of the radial-corner shape extended group was increased compared with that in regular osteotomy group and the radial-corner shape reserved group, while the peak von Mises strain of cancellous bone was decreased by 24. 3% -42. 9% and 26. 0% -48. 7% , respectively. Comparing the peak von Mises strain difference between cancellous bone and cortical bone in the resected area, it was found that the difference of the radial-corner shape extended group was much smaller than the other two groups. There were no significant differences in the minimum principal strain on the anteromedial tibial cortex between different models after UKA, but they increased by 23. 3% -34. 5% compared with the intact tibial model. The average von Mises stress in the cement unit of the radial-corner shape extended group tended to decrease as the fillet radius of the corner increased, which was smaller than that of the regular osteotomy group and the radialcorner shape reserved group. Conclusions The new radial-corner shape extended osteotomy method results in more uniform stress transfer to the proximal tibia under healthy bone conditions, lower peak von Mises strain, and less compression at the prosthesis-bone interface, which is more advantageous than regular osteotomy method and radial-corner shape reserved osteotomy method.

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林 涛,周柏安,陈海聪,梁振明,钟 环,魏 波,邓羽平,欧阳汉斌,黄文华.膝关节单髁置换胫骨优化截骨设计的生物力学研究[J].医用生物力学,2023,38(4):730-735

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  • 收稿日期:2022-10-14
  • 最后修改日期:2022-11-26
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  • 在线发布日期: 2023-08-25
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