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中文核心期刊

前交叉韧带损伤的继发性生物力学影响

The biomechanical study of the subsequent injury of an acl deficient knee

  • 摘要: 前交叉韧带(anterior cruciate ligament, ACL)损伤往往会导致半月板及周边韧带的继发性损伤. 由于离体实验和临床研究的局限性,损伤的机理仍未得到清晰的认识. 基于核磁共振断层扫面图像重建了一个比较完整和精确的膝关节三维有限元模型. 采用文献报道的解剖测量数据对关节的解剖尺寸进行了检验,证明模型在几何上比较准确. 并且对文献报道的膝关节实验作了模拟,得出的计算结果与实验比较吻合,证明模型能够在一定程度上再现膝关节真实的运动情况. 然后利用该模型对ACL损伤前后的膝关节进行模拟,分别在屈膝0^\circ和30^\circ的姿态下对胫骨施加前后方向和竖直方向的载荷. 结果表明, ACL的损伤改变了关节组织上的应力分布:内侧半月板后段的应力显著增加;外侧半月板、后交叉韧带以及侧副韧带上的应力改变程度则取决于载荷的类型和屈膝的角度. 该研究有助于认识ACL损伤之后周边组织的继发性损伤现象,并对容易诱发损伤的高危动作进行分析和预防,对研究ACL的损伤和治疗具有重要的意义.

     

    Abstract: Meniscus and ligament ruptures are common in anteriorcruciate ligament (ACL) deficient knee. The mechanism of injuries is stillunclear, and was mainly inferred from ex vivo experiments and clinicalstudies. In this study, a three dimensional finite element model of kneejoint was reconstructed from magnetic resonance images. The geometry data ofthe knee from literature was used to validate the model. Tibial displacementand in situ force in ACL in response to the anterior tibial loads werecalculated and coincided with the published experimental data. Thesimulations of the models with and without ACL were performed under anteriortibial loads and axial tibial loads at 0^\circ and 30^\circ flexion. Our resultssuggest that ACL deficiency could lead to abnormal stress distribution: thestress near the posterior insertion of the medial meniscus increasedsignificantly; the changes of the stress in the lateral meniscus, posteriorcruciate ligament and collateral ligaments depended on the loads and theflexion angles. This study may help to explain the higher subsequent injuryrate of ACL-deficient knee, and to predict the injury risk positions in thejoint. Furthermore, this model could shed some light on the mechanism of ACLinjuries and the treatments.

     

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