摘要
目的探讨不同胫骨柄长度的膝关节翻修胫骨侧骨缺损定制化假体的力学性能。方法建立形态匹配的骨缺损翻修术后有限元模型,按骨缺损程度为三个梯度(缺损深度分别为15、30、45 mm),分别使用80、120、150 mm三种长度的3D打印钽金属填充物重建。常规静态和动态(步行步态)加载,分析胫骨受力及假体界面累积滑移峰值,评估三种不同胫骨柄长度对定制胫骨缺损修复体稳定性及胫骨内应力状态分布。结果动态加载形态匹配的修复体模型累积滑移峰值为17.94~21.31 mm,较静态加载的10.26~11.69 mm增大68.0%~84.3%。动态加载的胫骨应力峰值为170.41~200.14 MPa,大于静态加载的132.94~143.88 MPa,增加28.0%~49.2%。修复体模型整体滑移值从胫骨截骨面开始逐渐变小,静态加载累积峰值滑移值为10.26~11.69 mm、动态加载为17.94~21.31 mm。胫骨前外侧及内后侧的骨组织应力从上到下逐渐升高,各个截面的最大应力值均在胫骨后内侧(最大值为200.14 MPa)。胫骨外侧骨组织应力最高值受胫骨柄的影响导致出现的位置不同,是受到应力遮挡影响最大的区域(最大值为170.65 MPa)。结论对形态匹配的钽金属定制化修复体的稳定性评估,符合生理的步态动态加载研究较静态加载更为可靠;胫骨柄长度选择要综合修复体模型累积滑移量与胫骨应力分布因素而定。
Objective To evaluate the mechanical performance of customized metal prosthesis with tibia stems of varying lengths for tibial bone defects reconstruction.Methods Morphologically matched postoperative finite element models of bone defect revision were developed,with three gradients(15 mm,30 mm,and 45 mm)according to the degree of bone defect and were reconstructed with 3D printed tantalum metal prosthesis using three tibial stem lengths(80 mm,120 mm,and 150 mm),respectively.Conventional static and dynamic(walking gait)loading was performed to analyze the peak tibial stress distribution and accumulated sliding distance at the prosthetic interface,and to assess the effects of the three tibial stems of different lengths on the stability of the customized tibial defect restorations and the internal tibial stress state.Results The peak accumulated sliding distance of the dynamically loaded morphologically matched restorations ranged from 17.94 to 21.31 mm with static loading,which were 68%to 84.3%higher than those of 10.26 to 11.69 mm with static loading.The peak tibial stresses in the dynamically loaded model were greater than those in the statically loaded model,with an increase of 28%-49.2%,including 132.94-143.88 MPa in the statically loaded model and 170.41-200.14 MPa in the dynamically loaded model.The overall accumulated sliding distance of the tibia prosthetic model gradually decreased from the tibial osteotomy surface,and the accumulated peak sliding distances ranged from 10.26 to 11.69 mm for static loading,and from 17.94 to 21.31 mm for dynamic loading.The bone tissue stresses in the anterolateral and medial-posterior tibia increased gradually from top to bottom,and the maximum stress value in each section was in the posterior medial tibia(the maximum value was 200.14 MPa).The highest bone tissue stress in the lateral tibia was affected by the tibial stem length,which resulted in a different location,and it was the area most affected by stress shielding(maximum value of 170.65 MPa).Conclusion For stability
作者
张维杰
高永昌
安智成
陈世斌
姚舒馨
马建兵
Zhang Weijie;Gao Yongchang;An Zhicheng;Chen Shibin;Yao Shuxin;Ma Jianbing(Department of Joint Surgery,Honghui Hospital,Health Science Center,Xi'an Jiaotong University,Xi'an 710054,China;School of Construction Machinery,Chang'an University,Xi'an 710064,China)
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2024年第4期260-269,共10页
Chinese Journal of Orthopaedics
基金
国家自然科学基金青年项目(81601937)
陕西省重点研发计划(2021SF-187)
陕西省自然科学基金(2021JM-569)
陕西省科技创新团队计划(2023-CX-TD-73)。
关键词
再手术
骨重建
假体设计
有限元分析
Reoperation
Bone remodeling
Prosthesis design
Finite element analysis
