ACL单束!/!双束重建对多屈曲角位姿的胫股关节力学特性影响

徐强; 黄荣瑛; 许勇刚; 郭云飞; 郑红光

doi:10.6052/0459-1879-2012-3-20120321

ACL单束!/!双束重建对多屈曲角位姿的胫股关节力学特性影响

北京航空航天大学机械工程及自动化学院, 北京 100191

基金项目: 国家自然科学基金资助项目(50975013).

详细信息

中图分类号: R318.01, TB12
计量
- 文章访问数: 1555
- HTML全文浏览量: 91
- PDF下载量: 689
出版历程
- 收稿日期: 2010-10-08
- 修回日期: 2012-04-08
- 刊出日期: 2012-05-17

THE EFFECT OF THE ACL SINGLE-BUNDLE/DOUBLE-BUNDLE RECONSTRUCTION ON THE BIOMECHANICS OF TIBIO-FEMORAL JOINT AT DIFFERENT FLEXION ANGLES

School of Mechanical Engineering and Automation, Beihang University, Beijing 100191, China

Funds: The project was supported by the National Natural Science Foundation of China (50975013)

摘要

摘要: 进行膝关节的轴移仿真, 在证实了单例个体膝关节的重建模型能反映不同重建术后膝关节力学特性有效性的基础上, 应用SONATA MAESTRO 1.5T扫描得到的屈曲角位姿为0°/25°/60°/80° 的膝关节MRI图像数据, 建立了对应屈曲角的正常/ACL(anterior cruciate ligament)单束/双束重建胫股关节3D模型, 通过对该系列关节模型施加轴向压力与压扭载荷, 来分析多屈曲角度位姿的ACL单束/双束重建法对胫股关节软骨、半月板和韧带应力分布影响及韧带张力特性影响. 结果表明: (1) ACL单束/双束重建关节的软骨与半月板上的应力分布改变跟屈曲角度相关, 某些角度位姿下软骨应力分布改变显著; (2) 单束重建关节的软骨和半月板上的最大等效应力有较明显的增大, 最大增幅达40%左右; 双束重建关节在各屈曲角位姿下软骨和半月板上的最大等效应力值更接近于正常关节; (3) ACL单束重建虽降低了PCL(posterior cruciate ligament)的最大等效应力值, 却使高屈曲角位姿的内侧/外侧副韧带等效应力明显增大; 双束重建后MCL(medial collateral ligament)上的最大等效应力随屈曲角的变化明显, 但LCL(lateral collateral ligament)和PCL的最大等效应力随屈曲角度的变化趋势与正常关节相一致性; (4) 单束/双束重建后MCL上平均张力要高于另外两条韧带, 而双束重建的韧带张力特性比单束重建更接近于正常关节. 总之, 综合ACL重建后软骨、半月板和3条韧带随屈曲角度的等效应力分布、张力变化等多种特性表明: ACL双束重建的胫股关节力学特性比单束重建更接近于正常关节, 且无论ACL单束还是双束重建, 都引起术后关节软骨与韧带上应力分布变化与等效应力峰值增大, 这将是诱发术后关节慢性退变与膝关节并发症的根源.
- 生物力学 /
- 有限元 /
- ACL重建 /
- 韧带 /
- 半月板 /
- 应力
Abstract: In this paper, through the simulation of the clinical pivot test at knee flexion angle of 0? for the models A and B, the accuracy and validity of the pairs of models for healthy adult A were proved. After that, MRI images of the normal human knee at different flexion angles of 0?/25?/60?/80? were obtained through SONATA MAESTRO 1.5T Scanning. Then, the corresponding 3D tibio-femoral joint models of normal/ACL single bundle/double bundle reconstruction were established. In the experiment, axial force and combined loads (axial force and torque) were applied to these models to analyze and compare the changes of the stress distribution of cartilages/meniscus/ligaments and the tension characteristic of ligaments before and after the ACL reconstruction. The results show that: (1) The stresses on cartilages and meniscus after ACL single bundle/double bundle reconstruction change with the flexion angles, and especially the stress distributions on the cartilages change significantly at some angle. (2) Single-bundle reconstruction can lead to the obvious increment of the equivalent stresses on cartilages and meniscus, and the maximum increment is to 40%. However, the corresponding values after double bundle reconstruction at different flexion angles are closer than that after single-bundle reconstruction. (3) Although ACL single-bundle reconstruction will reduce the equivalent stress on PCL, stress on medial/lateral collateral ligament will significantly increase at high-flexion angle. The maximum stress on MCL changes obviously with the flexion angles after double-bundle reconstruction, but the maximum stress on LCL and PCL show the corresponding trend to normal joint. (4) The average tension of MCL is higher than that of the other two after single or double bundle reconstruction. Besides, the tension characteristic of ligaments after the double-bundle reconstruction is closer to the normal joint than that after single-bundle. In short, considering the stress and tension of cartilages, meniscus and ligaments after ACL reconstruction, the tibio-femoral joint mechanical contact characteristic after ACL double-bundle reconstruction is closer to the normal joint than that after single-bundle reconstruction. And whether ACL single-bundle or double bundle reconstruction, the change of stress distribution and the increase of peak stress on cartilages, meniscus and ligaments would induce chronic degeneration of joints and be the main reason for the disease knee.
- biomechanics /
- finite element /
- ACL reconstruction /
- ligament /
- meniscus /
- stress

HTML全文

参考文献(16)

Shelbourne KD, Heinrich J. The long-term evaluation of lateral meniscus tears left in situ at the time of anterior cruciate ligament reconstruction. Arthroscopy, 2004, 20(4): 346-351

Li G, Suggs J, Gill T. The effect of anterior cruciate ligament injury on knee joint function under a simulated muscle load: a three-dimensional computational simulation. Annals of Biomedical Engineering, 2002, 30(5): 713-720

Yao J, Snibbe J, Maloney M, et al. Stresses and strains in the medial meniscus of an ACL deficient knee under anterior loading: a finite element analysis with image-based experimental validation. Journal of Biomedical Engineering, 2006, 128(1): 135-141

Au G, James R, Adrian B, et al. A three-dimensional finite element stress analysis for tunnel placement and buttons in anterior cruciate ligament reconstructions. Journal of Biomechanics, 2005, 38: 827-832

Pena E, Martinez M A, Calvo B, et al. A finite element simulation of the effect of graft stiffness and graft tensioning in ACL reconstruction. Clinical Biomechanics, 2005, 20: 636-644

Muneta T, Koga H, Mochizuki T. A prospective randomized study of 42-strand semitendinosus tendon anterior cruciate ligament reconstruction comparing single-bundle and double-bundle techniques. Arthroscopy, 2007, 23(6): 618-628

黄荣瑛, 徐强, 许勇刚等. ACL单束/双束重建对胫股关节应力分布影响. 工程力学, 2010, 28(8): 240-247 (Huang Rongying, Xu Qiang, Xu Yonggang, et al. Effects of the anterior cruciate ligament reconstructions on the stress distribution of the tibio-femoral joint. Engineering Mechanics, 2010, 28(8): 240-247 (in Chinese))

Armstrong C, Lai W. An analysis of the unconfined compression of articular cartilage. Journal of Biomechanical Engineering, 1984, 106: 165-173

Weiss J. Finite element implementation of incompressible, transversely isotropic hyperelasticity. Computer Methods and Applications in Mechanical Engineering, 1996, 135: 107-128

王亦璁. 膝关节外科的基础和临床. 北京: 人民卫生出版社, 1999 (Wang Yicong. Basis and Clinical of Knee Joint Surgery. Beijing: People Sanitation Press, 1999 (in Chinese))

Tammy L, Haut D, Hull ML, et al. A finite element modal of the human knee joint for the study of tibia-femoral contact. Journal of Biomechanical Engineering, 2002, 124: 273-279

徐强,黄荣瑛,许勇刚等. ACL 移植物初始力对胫股关节接触性能影响. 工程力学, 2012, 29(2): 205-211 (Xu Qiang, Huang Rongying, Xu Yonggang, et al. Effects of the initial force of grafts on the contact characteristic of the tibio-femoral joint after ACL reconstruction. Engineering Mechanics, 2010, 29 (2): 205-211 (in Chinese))

Moglo K E, Shirazi A. Cruciate coupling and screw-home mechanism in passive knee joint during extension-flexion. Journal of Biomechanics, 2005, 38: 1075-1083

Simmons R, Howell S, Hull M. Effect of angle of the femoral and tibial tunnels in the coronal plane and incremental excision of the posterior cruciate ligament on tension of an anterior cruciate ligament graft: an in vitro study. J Bone Joint Surg, 2003, 85(6): 1018-1029

Changfu Wu, Sabrina Noorani, Fabio Vercillo, et al. Tension patterns of the anteromedial and posterolateral grafts in a double-bundle anterior cruciate ligament reconstruction. J Orthop Res, 2009, 27(7): 879-884

Harner CD, Giffin R, et al. Evaluation and treatment of recurrent instability after anterior cruciate ligament reconstruction. J Bone Joint Surg, 2000, 82: 1652-1663