膝关节假体安装方式对股骨远端应力屏蔽的影响
李凯1，周建华2，王跃2，周鑫1
（1.四川大学 制造科学与工程学院，四川 成都 610065；2.四川省人民医院 骨科，四川 成都 610072）
摘要：针对全膝关节置换术后植入假体对周围骨产生应力屏蔽的问题，选用十字固定假体为实验组，无固定方式假体为参照组，借助有限元的分析方法，在屈曲位前倾5°、内翻5°和外翻5°三种错位角度下进行假体植入，模拟仿真手术结果。结果表明，十字固定假体内外髁种植短茎的设计能够很好的将载荷应力传导至松质骨内部，减少应力屏蔽的影响。无论是内翻还是外翻情况下装配假体，应力分布均出现极不均匀的现象，不利于保证装配假体的长期有效性。屈曲位装配假体不仅可以保证内外侧髁的应力分布在总体趋势上和原生骨保持一致，而且在一定程度上减少应力屏蔽的影响。因为术后即刻应力应变分布与骨重塑的长期临床结果之间存在正相关关系，研究得出的预测结果对假体设计和临床决策有一定的参考价值。
关键词：全膝关节置换术；应力屏蔽；有限元分析
中图分类号：O34 文献标志码：A doi：10.3969/j.issn.1006-0316.2019.04.002
文章编号：1006－0316 (2019) 04－0009－07
Effect of Knee Prosthesis Installation on Stress Shielding of Distal Femur
LI KAI1，ZHOU Jianhua2，WANG Yue2，ZHOU Xin1
( 1.School of Manufacturing Science and Engineering, Sichuan University, Chengdu 610065, China; 2.Department of Orthopedics, Sichuan Provincial People's Hospital, Chengdu 610072, China )
Abstract：In order to solve the problem of stress shielding of the surrounding bone after total knee arthroplasty, the cross fixed prosthesis was selected as the experimental group and the non-fixed prosthesis as the reference group. With the help of the finite element analysis method, the prosthesis tilted forward 5° in the flexion position. The prosthesis was implanted at 5° varus and 5° valgus, and the results were simulated. The results showed that the short stem of external condyle implant in vivo and external condyle could be well transmitted to the inner part of cancellous bone and the effect of stress shielding could be reduced. The stress distribution of the assembly prosthesis is very uneven, which is not conducive to the long-term effectiveness of the assembly prosthesis. The buckling prosthesis can not only ensure that the stress distribution of the internal and external condyle is consistent with that of the original bone, but also reduce the effect of stress shielding to some extent. Because there is a positive correlation between the immediate stress and strain distribution and the long-term clinical results of bone remodeling, the predicted results are valuable for the design of prosthesis and clinical decision.
Key words：total knee arthroplasty；stress shielding；finite element analysis
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收稿日期：2018－11－16
基金项目：国家重点研发计划（2016YFC1100600）；国家自然科学基金（61540006）
作者简介：李凯（1992－），男，河南郑州人，硕士研究生，主要研究方向为人工假体的力学分析和设计；周建华（1987－），男，四川资阳人，硕士研究生，主要研究方向为人工关节置换术；王跃（1958－），男，重庆人，主任医师、教授，主要研究方向为膝关节、髋关节各种疾病的诊治和关节置换手术；周鑫（1993－），男，江西九江人，硕士研究生，主要研究方向为人工假体的力学分析和设计。
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