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该文通过SONATA MAESTRO 1.5T采集0°/25°/60°/80°四个屈曲角下的正常膝关节的MRI图像,构建四个屈曲角位姿的正常/内侧副韧带缺损的整体胫股关节3D模型,通过对这八组模型施加不同的外翻力矩进行有限元仿真,来分析内侧副韧带缺损时关节软组织及韧带的力学特性。仿真结果表明:1)膝关节外翻时,内侧副韧带缺损会引起交叉韧带的张力显著增大,前交叉韧带和后交叉韧带替代了内侧副韧带的外翻限制作用,成为抵抗外翻的主要稳定结构,其中前交叉韧带相比后交叉韧带能提供更大的外翻阻力。随着屈曲角度的增加,交叉韧带抵抗外翻的负荷均显著增大。在高屈曲角位姿时,交叉韧带尤其是前交叉韧带,极易伴随内侧副韧带断裂而产生联合损伤;2)内侧副韧带缺损降低了膝关节的直向稳定性,特别对股骨内侧髁与内侧胫骨关节面的直向稳定性的损失最为明显。膝关节的外侧关节软骨和半月板在外翻时比正常关节承受更高的负荷,同时外侧半月板传递力的能力明显下降;3)内侧副韧带损伤后,股骨软骨在小屈曲角位姿(25°屈曲角)等效应力值变化最大,而胫骨软骨和半月板在小屈曲角位姿(25°屈曲角)和高屈曲角位姿(80°屈曲角)最大等效应力值变化最为明显,外翻时最大等效应力变化最大的屈曲角位姿将更易导致关节软骨与韧带损伤。
In this paper, MRI images of normal knee joint at four degrees of flexion at 0 ° / 25 ° / 60 ° / 80 ° were collected by SONATA MAESTRO 1.5T to construct the whole tibiofemoral The joint 3D model was used to analyze the mechanical properties of the articular soft tissue and ligaments of the medial collateral ligament defect by applying different eversion moments to the eight groups of models for the finite element simulation. The simulation results show that: 1) When the knee joint valgus, the medial collateral ligament defect will cause a significant increase in the tension of the cruciate ligament, anterior cruciate ligament and posterior cruciate ligament replacement of the medial collateral ligament eversion limit, a major resistance to valgus The stabilizing structure, in which the anterior cruciate ligament provides greater eversion resistance than the posterior cruciate ligament. With the increase of flexion angle, the load of cruciate ligament against valgus increased significantly. In the high flexion position posture, the cruciate ligament, especially the anterior cruciate ligament, easily accompanied by medial collateral ligament rupture and joint damage; 2) medial collateral ligament defects reduce the direct stability of the knee, especially for the medial femoral condyle and The loss of straight stability of the medial tibial articular surface is most pronounced. Lateral articular cartilage and meniscus of the knee under higher load than the normal joint valgus, while the lateral meniscus ability to transmit force decreased significantly; 3) after the injury of the medial collateral ligament, femoral cartilage in the small flexion angle posture (25 ° flexion angle) had the greatest change in the equivalent stress value, while the maximum equivalent stress value of the tibial cartilage and meniscus in the small flexion angle (25 ° flexion) and the high flexion angle (80 ° flexion) Valgus flexion angle pose maximum changes in maximum equivalent stress will be more easily lead to articular cartilage and ligament injury.