盘状半月板对软骨退变影响及不同术式软骨应力变化研究
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摘要
第一章盘状半月板对膝关节软骨退变影响的临床研究
目的：
探讨盘状半月板对膝关节软骨退变的影响特点。
方法：
通过对57例61膝国人盘状半月板进行临床研究,按照盘状半月板类型、撕裂与否、患者年龄对病例进行分组,观察统计软骨退变发生部位、严重程度,明确膝关节软骨退变发生率和盘状半月板类型、损伤情况及年龄的关系。
结果：
完全型盘状半月板和不完全型盘状半月板对软骨退变影响无明显差异；破裂盘状半月板和完整盘状半月板对软骨退变影响无明显差异；关节软骨退变发生率与患者年龄高度相关,40岁之前盘状半月板对关节软骨退变影响作用明显。
结论：
对于无症状或有症状未发生损伤的盘状半月板,提示应尽量早期进行手术处理,以期恢复正常的关节生物力学,避免或延缓软骨退变的发生。
第二章人膝关节三维有限元模型的建立及生物力学分析
目的：
建立正常人膝关节三维有限元模型,并验证模型的有效性,为下一步研究提供数字化平台,并分析正常膝关节软骨生物力学特点。
方法：
选取一名健康志愿者,采用CT及MRI对其膝关节进行连续扫描,以DICOM格式文件存储所得扫描图像。将扫描图像导入三维仿真建模软件Mimics,利用Mimics软件生成健康人膝关节三维仿真模型,模型包括骨性结构、软骨和韧带,将原始模型导入Mimics自带的Magics软件中进行网格划分和模型优化,将优化后的模型导入有限元分析软件ANSYS中,在ANSYS中对模型网格赋予特定的材料属性。人膝关节三维有限元模型建立后,对模型进行生物力学测试,将获取数据与既往已有研究文献中的数据进行对比,分析膝关节模型的有效性；施加边界条件,获得正常半月板膝关节生物力学特点。
结果：
本研究模型和其他研究模型对比进行验证,应力大小趋势与文献报道一致：在屈膝0°、轴向施加1150N压力情况下,内侧半月板应力峰值约为3.12MP,外侧峰值约为2.39MP,并且相对应的股骨内髁应力大于股骨外髁,胫骨平台内侧应力大于平台外侧；应力有前后两个集中点,应力峰值均在靠后部位。通过以上模型的验证,证实模型的可靠性,能够用于下一步的盘状半月板生物力学研究。
结论：
1.基于MRI、CT扫描的DICOM格式文件,采用Mimics与ANSYS软件,成功构建了人膝关节三维有限元模型,模型中包括股骨下段、髌骨、胫腓骨上段、各关节面软骨及周围主要韧带。
2.有限元模型模拟计算得到的关节内部各部分应力与以往文献报道数据吻合程度高,证实了模型具有良好的有效性,为进一步研究提供了可靠的数字化平台。
3.膝关节直立状态时,应力主要分布于关节内侧靠后。
第三章膝关节盘状半月板及各手术方式生物力学有限元分析
目的：
采用上一章所建立的正常膝关节有限元模型,建立盘状半月板膝关节模型,并模拟盘状半月板各种手术方式,探讨盘状半月板及手术方式对膝关节的生物力学影响。
方法：
1.利用E-feature Recontruction3D将外侧半月板增厚拉宽,平铺覆盖外侧胫骨平台,分别构建完全型及不完全型盘状半月板；施加边界条件,获取盘状半月板生物力学数据。
2.在上述盘状半月板模型上,模拟盘状半月板全切及盘状半月板成形术；施加边界条件,获取各手术方式后膝关节生物力学数据。
结果：
1.盘状半月板及各术式后股骨外髁应力均较正常膝关节有明显增大,随着外侧半月板体积的的缩小,半月板应力峰值增加速度高于软骨应力峰值增加速度。
2.半月板成形术后膝关节相对半月板全切术后有着较小的软骨接触面积和半月板应力,发生退行性骨关节炎的风险较小。
结论：
1.盘状半月板膝关节股骨外髁较其他部位更易发生软骨退变。
2.盘状半月板成形术从生物力学角度要优于半月板全切术。
Chapter1:Clinical effect analysis of discoid meniscus on cartilage degeneration
Objective:To investigate epidemiology of discoid meniscus, researching the effect of discoid meniscus on cartilage degeneration.
Methods:Collecting adequate cases of discoid meniscus, recording the tear condition, pattern of meniscus and the degeneration progression of cartilage, ages of patients included.
Results:The degeneration progression of cartilage is related to course of disease, and there is no difference of cartilage degeneration progression between tore and intact discoid meniscus, complete and in complete discoid meniscus.
Conclusion:It's better to get arthroscopy operation for patient with complete or asymptomatic discoid meniscus.
Chapter two:The finite element biomechanical analysis of healthy human knee
Objective:To create finite element model of human knee and get the the biomechanical feature of healthy adults.
Methods:Chose a healthy volunteer, using CT and MRI to get the images of DICOM form. Used the Mimics and ANSYS software to form3-diamensional geometric model and finite element model; then got the biomechanical feature of healthy adults with boundary condition.
Results:This finite element model was checked with other studies, with coincident of peak contact pressure (3.12MPa on medial meniscus,2.39MPa on lateral meniscus); and the distribution feature was also similar.
Conclusion:Based on DICOM document with CT and MRI scanning, used software of Mimics and ANSYS, we constructed a finite element model of knee joint, including bone, cartilage and main ligaments; the model was proved dependable by comparing with published data. Otherwise, the pressure mainly located at posterior medial part of knee with full extend.
Chapter three:The finite element biomechanical analysis of discoid meniscus and meniscectomy
Objective:To create finite element model of discoid meniscus and varies of meniscectomy based on model of Chapter two; approaching the biomechanical features of them.
Methods:Enlarging and thickening the lateral meniscus by software of E-feature Recontruction3D to get model of discoid meniscus; stegnosis to4mm to mimesis partial meniscectomy and took off to mimesis total meniscectomy.
Results:The lateral condyles of femur has greater pressure in discoid meniscus; and knee with partial meniscectomy has smaller cartilage contact area and less pressure on meniscus, which has lower risk of osteoarthritis compared with total meniscectomy.
Conclusion:The lateral condyles cartilage of femur has greater risk of degeneration than other parts of knee with lateral discoid meniscus; and partial meniscectomy is better than total meniscectomy on biomechanical side.
目的：
探讨盘状半月板对膝关节软骨退变的影响特点。
方法：
通过对57例61膝国人盘状半月板进行临床研究,按照盘状半月板类型、撕裂与否、患者年龄对病例进行分组,观察统计软骨退变发生部位、严重程度,明确膝关节软骨退变发生率和盘状半月板类型、损伤情况及年龄的关系。
结果：
完全型盘状半月板和不完全型盘状半月板对软骨退变影响无明显差异；破裂盘状半月板和完整盘状半月板对软骨退变影响无明显差异；关节软骨退变发生率与患者年龄高度相关,40岁之前盘状半月板对关节软骨退变影响作用明显。
结论：
对于无症状或有症状未发生损伤的盘状半月板,提示应尽量早期进行手术处理,以期恢复正常的关节生物力学,避免或延缓软骨退变的发生。
第二章人膝关节三维有限元模型的建立及生物力学分析
目的：
建立正常人膝关节三维有限元模型,并验证模型的有效性,为下一步研究提供数字化平台,并分析正常膝关节软骨生物力学特点。
方法：
选取一名健康志愿者,采用CT及MRI对其膝关节进行连续扫描,以DICOM格式文件存储所得扫描图像。将扫描图像导入三维仿真建模软件Mimics,利用Mimics软件生成健康人膝关节三维仿真模型,模型包括骨性结构、软骨和韧带,将原始模型导入Mimics自带的Magics软件中进行网格划分和模型优化,将优化后的模型导入有限元分析软件ANSYS中,在ANSYS中对模型网格赋予特定的材料属性。人膝关节三维有限元模型建立后,对模型进行生物力学测试,将获取数据与既往已有研究文献中的数据进行对比,分析膝关节模型的有效性；施加边界条件,获得正常半月板膝关节生物力学特点。
结果：
本研究模型和其他研究模型对比进行验证,应力大小趋势与文献报道一致：在屈膝0°、轴向施加1150N压力情况下,内侧半月板应力峰值约为3.12MP,外侧峰值约为2.39MP,并且相对应的股骨内髁应力大于股骨外髁,胫骨平台内侧应力大于平台外侧；应力有前后两个集中点,应力峰值均在靠后部位。通过以上模型的验证,证实模型的可靠性,能够用于下一步的盘状半月板生物力学研究。
结论：
1.基于MRI、CT扫描的DICOM格式文件,采用Mimics与ANSYS软件,成功构建了人膝关节三维有限元模型,模型中包括股骨下段、髌骨、胫腓骨上段、各关节面软骨及周围主要韧带。
2.有限元模型模拟计算得到的关节内部各部分应力与以往文献报道数据吻合程度高,证实了模型具有良好的有效性,为进一步研究提供了可靠的数字化平台。
3.膝关节直立状态时,应力主要分布于关节内侧靠后。
第三章膝关节盘状半月板及各手术方式生物力学有限元分析
目的：
采用上一章所建立的正常膝关节有限元模型,建立盘状半月板膝关节模型,并模拟盘状半月板各种手术方式,探讨盘状半月板及手术方式对膝关节的生物力学影响。
方法：
1.利用E-feature Recontruction3D将外侧半月板增厚拉宽,平铺覆盖外侧胫骨平台,分别构建完全型及不完全型盘状半月板；施加边界条件,获取盘状半月板生物力学数据。
2.在上述盘状半月板模型上,模拟盘状半月板全切及盘状半月板成形术；施加边界条件,获取各手术方式后膝关节生物力学数据。
结果：
1.盘状半月板及各术式后股骨外髁应力均较正常膝关节有明显增大,随着外侧半月板体积的的缩小,半月板应力峰值增加速度高于软骨应力峰值增加速度。
2.半月板成形术后膝关节相对半月板全切术后有着较小的软骨接触面积和半月板应力,发生退行性骨关节炎的风险较小。
结论：
1.盘状半月板膝关节股骨外髁较其他部位更易发生软骨退变。
2.盘状半月板成形术从生物力学角度要优于半月板全切术。
Chapter1:Clinical effect analysis of discoid meniscus on cartilage degeneration
Objective:To investigate epidemiology of discoid meniscus, researching the effect of discoid meniscus on cartilage degeneration.
Methods:Collecting adequate cases of discoid meniscus, recording the tear condition, pattern of meniscus and the degeneration progression of cartilage, ages of patients included.
Results:The degeneration progression of cartilage is related to course of disease, and there is no difference of cartilage degeneration progression between tore and intact discoid meniscus, complete and in complete discoid meniscus.
Conclusion:It's better to get arthroscopy operation for patient with complete or asymptomatic discoid meniscus.
Chapter two:The finite element biomechanical analysis of healthy human knee
Objective:To create finite element model of human knee and get the the biomechanical feature of healthy adults.
Methods:Chose a healthy volunteer, using CT and MRI to get the images of DICOM form. Used the Mimics and ANSYS software to form3-diamensional geometric model and finite element model; then got the biomechanical feature of healthy adults with boundary condition.
Results:This finite element model was checked with other studies, with coincident of peak contact pressure (3.12MPa on medial meniscus,2.39MPa on lateral meniscus); and the distribution feature was also similar.
Conclusion:Based on DICOM document with CT and MRI scanning, used software of Mimics and ANSYS, we constructed a finite element model of knee joint, including bone, cartilage and main ligaments; the model was proved dependable by comparing with published data. Otherwise, the pressure mainly located at posterior medial part of knee with full extend.
Chapter three:The finite element biomechanical analysis of discoid meniscus and meniscectomy
Objective:To create finite element model of discoid meniscus and varies of meniscectomy based on model of Chapter two; approaching the biomechanical features of them.
Methods:Enlarging and thickening the lateral meniscus by software of E-feature Recontruction3D to get model of discoid meniscus; stegnosis to4mm to mimesis partial meniscectomy and took off to mimesis total meniscectomy.
Results:The lateral condyles of femur has greater pressure in discoid meniscus; and knee with partial meniscectomy has smaller cartilage contact area and less pressure on meniscus, which has lower risk of osteoarthritis compared with total meniscectomy.
Conclusion:The lateral condyles cartilage of femur has greater risk of degeneration than other parts of knee with lateral discoid meniscus; and partial meniscectomy is better than total meniscectomy on biomechanical side.
引文
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[1]Rb Y. The external semilunar cartilage as a complete disc. In:Cleland J, Makey JY, Young RB, eds. Memoirs and Memoranda in Anatomy. [J]. London:Williams and Morgade,(1889; 179.).
[2]Jones R W. Specimen of Internal Semilunar Cartilage as a Complete Disc[J]. Proc R SocMed,1930,23(11):1588-1589.
[3]Kaplan E B. Discoid lateral meniscus of the knee joint; nature, mechanism, and operative treatment[J]. J Bone Joint Surg Am,1957,39-A(1):77-87.
[4]Clark C R, Ogden J A. Development of the menisci of the human knee joint. Morphological changes and their potential role in childhood meniscal injury[J]. J Bone Joint Surg Am,1983,65(4):538-547.
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