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北京大学学报（医学版） ›› 2019, Vol. 51 ›› Issue (3): 586-590. doi: 10.19723/j.issn.1671-167X.2019.03.031

• 技术方法 • 上一篇    下一篇

前交叉韧带生物力学止点重建的解剖学与有限元分析

张家豪,任爽,邵嘉艺,牛星跃,胡晓青,敖英芳△()   

  1. 北京大学第三医院运动医学研究所,北京市运动医学关节伤病重点实验室, 北京 100191
  • 收稿日期:2019-03-13 出版日期:2019-05-14 发布日期:2019-06-26
  • 作者简介:敖英芳,教授,主任医师,博士生导师,北京大学运动医学研究所所长,北京大学第三医院崇礼院区院长。曾任北京大学党委副书记、北京大学医学部党委书记、北京大学第三医院副院长。
    中华医学会第二十五届理事会常务理事,中国体育科学学会副理事长,中华医学会运动医疗分会前任主任委员,中华医学会骨科分会委员、全国关节镜学组组长,中国体育科学学会运动医学分会副主任委员,中国医师协会内镜医师分会副会长,亚洲关节镜学会前任主席,亚洲关节软骨修复学会创始人之一,国际关节软骨修复学会-中国部(ICRS-CHINA)创始人兼主席。《中国微创外科杂志》《中国骨伤杂志》《中国运动医学杂志》副主编。
  • 基金资助:
    北京大学临床科学家计划专项(BMU2019LCKXJ008)-中央高校基本科研业务费和北京大学第三医院院临床重点项目(BYSY2018005)

Anatomical and finite element analysis of anterior cruciate ligament reconstruction within biomechanical insertion

Jia-hao ZHANG,Shuang REN,Jia-yi SHAO,Xing-yue NIU,Xiao-qing HU,Ying-fang AO△()   

  1. Beijing Key Laboratory of Sports Injuries, Beijing 100191, China
  • Received:2019-03-13 Online:2019-05-14 Published:2019-06-26
  • Supported by:
    Supported by the Fundamental Research funds for the Central Universities: Peking University Clinical Scientist Program(BMU2019LCKXJ008), and Grant from the Major Clinical Project of Peking University Third Hospital(BYSY2018005)

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摘要： 目的 解剖研究大体观察膝关节前交叉韧带(anterior cruciate ligament, ACL)胫骨止点的形态,并利用有限元分析软件分析ACL的力学止点分布,为临床ACL重建提供新理念。方法 选取10例新鲜成人膝关节标本,男6例,女4例,采取标准髌旁内侧入路打开关节腔,暴露并解剖剔除ACL,观察并记录ACL胫骨止点形态,测量胫骨止点前后径和左右径。利用三维重建软件MIMICS及有限元分析软件ANSYS建立膝关节模型,模拟临床体格检查Lachman试验和pivot-shift试验,观察ACL在胫骨和股骨端止点的受力分布情况。结果 ACL胫骨致密止点大体观呈扁长的弧形,其前后径为(13.8±2.0) mm,体部左右径为(5.3±0.6) mm,前缘左右径为(11.5±1.2) mm。有限元分析显示,股骨端应力较高区域为住院医师嵴(residents’ ridge)附近一类椭圆形区域,胫骨端应力较高部分延内侧髁间嵴(medial intercondylar ridge)狭长分布,与解剖观察相符,从理论上验证了ACL止点的生物力学分布特点。结论 解剖研究及有限元分析均证实ACL胫骨止点为一扁长的弧形,理想的ACL重建技术应依据其生物力学特点进行重建, 基于解剖学研究和生物力学分析本课题组提出前交叉韧带生物力学止点重建理念,并建立手术模型。

关键词: 前交叉韧带重建, 胫骨止点, 解剖, 有限元, 生物力学

Abstract: Objective: To provide new concepts of anterior cruciate ligament (ACL) reconstruction by anatomical gross observation of ACL tibial insertion and finite element analysis of distribution of ACL mechanical insertion.Methods: In the anatomical study, ten fresh adult cadaveric knees were dissected, including 6 males and 4 females, all knees were generally observed through standard medial parapatellar approaches, paying attention to the close anatomical relationship of tibial insertion and anterior horn of lateral meniscus, and ACL was exposed and gradually removed from the inside. The shape of tibial insertion of ACL was observed and recorded, and anterior-posterior diameters and left-right diameters of tibial insertion were measured with vernier caliper. For the study of finite element analysis, three-dimensional thin-layer magnetic resonance imaging of normal knee joint was used to establish knee joint model. Three-dimensional reconstruction software MIMICS and finite element analysis software ANSYS were used to establish knee joint model, subsequently, clinical physical examination Lachman test and pivot-shift test were simulated to observe the force distribution of ACL tibial insertion and femoral insertion. Results: The ACL tibial mechanical insertion was rather flat and long similar as an arc shape without a clear separation between anterior medial bundle (AMB) and posterolateral bundle (PLB) in gross observation. The dense fibers lies belonged to the medial intercondylar ridge and ended up anterior with the osseous landmark of anterior ridge. Its average anterior-posterior diameter was (13.8±2.0) mm, the average left-right diameter of midsubstance was (5.3±0.6) mm, and the average left-right diameter of anterior margin was (11.5±1.2) mm. The finite element analysis showed that distribution on the femoral side was oval shape mainly below the residents’ ridge, while the tibial side was rather flat mainly along the medial intercondylar ridge, which was consistent with the anatomical observation. The biomechanical characteristics of ACL attachments were verified theoretically.Conclusion: Anatomical study and finite element analysis have confirmed the flat arc shape of ACL tibial insertion. The ideal reconstruction technique of ACL should be based on its biomechanical insertion. Based on anatomical study and biomechanical analysis, we have proposed the idea of ACL biomechanical insertion reconstruction (BIR) and established a surgical model with oval femoral tunnel and rounded-rectangle tibial tunnel.

Key words: ACL reconstruction, Tibial insertion, Anatomy, Finite element analysis, Biomechanical

中图分类号: 

  • R329.4

图1

标本测量"

图2

Lachman试验时股骨(A)和胫骨(B)端的von Mises应力分布"

图3

Pivot-shift试验时股骨(A)和胫骨(B)端的von Mises应力分布"

图4

骨道口截面示意图"

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ISSN 1671-167X
CN 11-4691/R
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