人体膝关节股胫关节运动特性分析

doi:10.13418/j.issn.1001-165x.2017.01.013

摘要/Abstract

摘要：

目的　分析人体正常膝关节和人工膝关节高屈曲活动下股胫关节的运动，为膝关节运动特性研究、假体设计提供参考。方法　选取健康志愿者，利用CT和MRI扫描数据建立正常全膝关节三维有限元模型以及TKA术后有限元模型，采取三束股四头肌肌力非同步变力加载，模拟人体下蹲运动，以分析股胫关节的相对运动特性，并检索相关研究结果以便对比分析。结果　获得正常膝关节以及TKA术后人体下蹲过程中股骨相对胫骨的三维相对运动数据，结果表明，TKA术前、后股胫关节相对运动的总体趋势相近，同时在前后位移、远近位移、内外位移、内收外展和内外旋等最大值方面存在差异；同时通过对比分析TKA前后股胫关节相对运动以及相关文献数据，发现结果存在不同程度差异。结论　究其原因,正常膝关节相对运动差异主要在于股胫关节各个运动方向上和不同屈曲度时约束程度的改变；人工膝关节相对运动差异主要来源于膝关节型面和结构的改变；同时与坐标系的定义、在体和离体的差异、负荷加载的差异相关。本研究针对人体正常膝关节和TKA术后膝关节股胫关节运动进行有限元仿真分析，对膝关节运动特性研究具有一定的参考价值。

关键词: 膝关节, 股胫关节, 非同步变力加载, 相对运动, 全膝关节置换

Abstract:

Objective 　Analyzing the femorotibial (FT) joint kinematics of natural and artificial knees under high flexion behaviors provides a reference for the study of kinematic characteristics of knees and the prosthesis design.　Method　On the basis of the CT and MRI scanning data of healthy volunteers， dynamic finite element models (FEMs) of the human knee joint and total knee arthroplasty (TKA) were established. Through the loaded three-dimensional quadriceps asynchronous variable forces to simulation of the squatting exercise, our study analyzed the relative kinematic characteristics of FT articulation. Data in the relevant literature were retrieved and compared with our study for analyses. Result Three-dimensional kinematicsdata of the femur relative to the tibia of human’s natural and TKA knees were obtained during the squatting.The results showed that the overall trends of the relative kinematics of the femorotibial articulation before and after TKA were similar. However, the maximums of the kinetic aspects in the anterior or posterior translation,proximal or distal translation, medial or lateral translation, adduction or abduction rotation,and internal or external rotation were different. Our study found varying degrees of differences in the results through analyzing the relative kinematics of intact and TKA knees’ FT articulation and the existing relevant literature data.　Conclusions 　The main differences for nature knee relative kinematics are the changes in the level of restraints on the directions and the shifted flexion degrees of the knees’ FT joints.The differences for the TKA knee derive mainly from the knee-surface and structural changes; andboth of these differences are related to the definition of the coordinate system, in vitro or in vivo, and the various loads. This study has performed finite element simulation analyses for the kinematics of intact and TKA knees’ FT articulations , offering certain valuable references on the study of the knee kinematics.

Key words: Knee, Femorotibial articulations, Asynchronous variable forces, Relative kinematics, Total knee arthroplasty

王建平,梁军,张雁儒,符龙,王猛,张盼盼. 人体膝关节股胫关节运动特性分析[J]. 中国临床解剖学杂志, 2017, 35(1): 62-68.

WANG Jian-ping, LIANG Jun, ZHANG Yan-ru, FU Long, WANG Meng, ZHANG Pan-pan. The high flexion kinematic characteristics research of Human tibiofemoral joint[J]. Chinese Journal Of Clinical Anatomy, 2017, 35(1): 62-68.

参考文献

[1] 魏鸿文, 郑诚功. 膝关节高屈曲假体的研究进展[J]. 中华关节外科杂志 (电子版), 2009, 3(4): 70-72.
[2] Caruntu DI, Hefzy MS. 3-D anatomically based dynamic modeling of the human knee to include tibio-femoral and patello-femoral joints [J]. J Biomech Eng, 2004, 126(1): 44-53.
[3] Jia X, Zhang M, Lee WC. Load transfer mechanics between trans-tibial prosthetic socket and residual limb-dynamic effects[J]. J Biomech, 2004, 37(9): 1371-1377.
[4] Komistek RD, Kane TR, Mahfouz M, et al. Knee mechanics: a review of past and present techniques to determine in vivo loads[J]. J Biomech, 2005, 38(2): 215-228.
[5] Shirazi-Adl A, Mesfar W. Effect of tibial tubercle elevation on biomechanics of the entire knee joint under muscle loads[J]. Clin Biomech(Bristol, Avon), 2007, 22(3): 344-351.
[6] Fitzpatrick CK, Baldwin MA, Laz PJ, et al. Development of a statistical shape model of the patellofemoral joint for investigating relationships between shape and function[J]. J Biomech, 2011, 44(13): 2446-2452.
[7] 王建平. 膝关节力学建模与屈曲运动生物力学特性研究[D]. 上海: 上海交通大学, 2010.
[8] 王建平，吴海山，王成焘. 人体膝关节动态有限元模型及其在TKR中的应用[J]. 医用生物力学, 2009, 24(5): 333-337.
[9] Wang J, Tao K, Li H, et al. Modelling and analysis on biomechanical dynamic characteristics of knee flexion kinematics under squating [J]. Scientific World Journal, 2014,(2014): 321080-321080.
[10] 王建平, 张琳琳, 王成焘. 人体膝髌股关节相对运动分析[J]. 上海交通大学学报, 2009, 43(7): 1043-1046.
[11]王建平, 韩雪莲，季文婷，等. 人体膝股胫关节相对运动的三维图像配准分析[J]. 生物医学工程学, 2009, 26(6): 1336-1340.
[12]Pena E, Calvo B, Martinez MA, et al. A three-dimensional finite element analysis of the combined behavior of ligaments and menisci in the healthy human knee joint[J]. J Biomech, 2006, 39(9): 1686-1701.
[13]Godest AC, Beaugonin M, Haug E, et al. Simulation of a knee joint replacement during a gait cycle using explicit finite element analysis[J]. J Biomech, 2002, 35(2): 267-275.
[14]Halloran JP, Petrella AJ, Rullkoetter PJ. Explicit finite element modeling of total knee replacement mechanics[J]. J Biomech, 2005, 38(2): 323-331.
[15]Grood ES, Suntay WJ. A joint coordinate system for the clinical description of three-dimensional kinematicss: application to the knee[J]. J Biomech, 1983,105(2):136-144.
[16]Sharma A, Leszko F, Komistek RD, et al. In vivo patellofemoral forces in high flexion total knee arthroplasty[J]. J Biomech, 2008, 41(3): 642-648.
[17]Powers CM, Lilley JC, Lee TQ. The effects of axial and multi-plane loading of the extensor mechanism on the patellofemoral joint[J]. Clin Biomech（Bristol, Avon）, 1998, 13(8): 616-624.
[18]Kozanek M, Hosseini A, Liu F, et al. Tibiofemoral kinematics and condylar kinematics during the stance phase of gait[J]. J Biomech, 2009, 42(12): 1877-1884.
[19]Chen CH, Li JS, Hosseini A, et al. Tibiofemoral kinematics of the knee during the stance phase of gait after acl deficiency[R]. Proceedings of the ASME 2011 Summer Bioengineering Conference SBC2011, 2011, June 22–25.
[20]Mizuno Y, Kumagai M, Mattessich SM, et al. Q-angle influences tibiofemoral and patellofemoral kinematics [J]. J Orthop Res, 2001, 19(5): 834-840.
[21]Moglo KE, Shirazi-Adl A. Cruciate coupling and screw-home mechanism in passive knee joint during extension–?exion[J]. J Biomech, 2009, 38(5): 1075-1083.
[22]Pianigiani S, Chevalier Y, Labey L, et al. Tibio-femoral kinematics in different total knee arthroplasty designs during a loaded squat: A numerical sensitivity study[J]. J Biomech, 2012, 45 (13): 2315-2323.
[23]Merican AM, Amis AA. Iliotibial band tension affects patellofemoral and tibiofemoral kinematics[J]. J Biomech, 2009, 42(10): 1539-1546.
[24]Hagemeister N，Yahia L，Duval N, et al. In vivo reproducibility of a new non-invasive diagnostic tool for three-dimensional knee evaluation [J]. Knee, 1999, 6(3):175-181.
[25]Harris ML, Morberg P, Bruce WJ, et al. An improved method for measuring tibiofemoral contact wereas in total knee arthroplasty: a comparison of K-scan sensor and Fuji film[J]. J Biomech, 1999, 32(9): 951-958.
[26] Sharma A, Leszko F, Komistek RD, et al. In vivo patellofemoral forces in high flexion total knee arthroplasty[J]. J Biomech, 2008, 41(3): 642-648.
[27]Keays SL, Sayers M, Mellifont DB, et al. Tibial displacement and rotation during seated knee extension and wall squatting: A comparative study of tibiofemoral kinematics between chronic unilateral anterior cruciate ligament de?cient and healthy knees[J]. Knee, 2013, 20 (5): 346-353.
[28]Yildirim G, Walker PS, Sussman-Fort J, et al. The contact locations in the knee during high flexion[J]. Knee, 2007, 14(5): 379-384.
[29] Kettelkamp DB, Jacobs AW. Tibiofemoral contact area-determination and implications[J]. J Bone Joint Surg, 1972, 54(2): 349-356.