Tan Xiaoyan,Tang Kai,Hou Huacheng,et al.Analysis of the biomechanical impact on the patellofemoral joint of lateral patellofemoral ligament release in medial patellofemoral ligament reconstruction for patellar dislocation based on three-dimensional finite element software[J].Journal of Clinical Pediatric Surgery,2025,(05):473-479.[doi:10.3760/cma.j.cn101785-202501056-014]
基于三维有限元软件分析的外侧髌股韧带松解术对髌骨脱位内侧髌股韧带手术中髌股关节生物力学的影响研究
- Title:
- Analysis of the biomechanical impact on the patellofemoral joint of lateral patellofemoral ligament release in medial patellofemoral ligament reconstruction for patellar dislocation based on three-dimensional finite element software
- Keywords:
- Patellar Dislocation; Three-dimensional Reconstruction; Finite Element Analysis; Knee Joint; Surgical Procedures; Operative; Biomechanical Phenomena; Child
- 摘要:
- 目的 通过三维有限元软件分析外侧髌股韧带松解术对髌骨脱位内侧髌股韧带(medial patellofemoral ligament,MPEL)手术中髌股关节生物力学的影响。方法 采用南京医科大学附属儿童医院1例13岁健康男性志愿者的CT和MRI影像资料创建并验证正常膝关节有限元模型(Normal模型),修改该模型模拟髌骨脱位手术过程,分别建立外侧髌股韧带松解(lateral patellofemoral ligament release,LPFL-S)、内侧髌股韧带重建(medial patellofemoral ligament release,MPFL-R)、内侧髌股韧带重建联合外侧髌股韧带松解的有限元模型,并采用有限元软件分析3种手术方式中髌股关节的接触应力、髌骨外侧移位位移及髌骨倾斜角情况。结果 4种模型在 0°~90°屈膝活动下对应的髌股关节接触应力、髌骨外侧移位生物力学特性表现均不相同。Normal模型髌股关节接触应力峰值7.82 MPa;MPFL-R模型为6.64 MPa,较Normal模型减少15.1%;而LPFL-S模型、MPFL-R联合LPFL-S模型分别为3.46 MPa、2.94 MPa,较Normal组分别减少55.8%、62.4%;髌骨外侧位移的峰值Normal模型为4.16 mm,MPFL-R模型为4.57 mm,较Normal模型增加9.9%,而LPFL-S模型、MPFL-R联合LPFL-S模型分别为4.67 mm、5.79 mm,较Normal模型分别增加12.3%、39.2%;对于髌骨倾斜角而言,Normal模型峰值为12.85°,MPFL-R模型为13.87°,较Normal模型增加7.9%,而LPFL-S模型、MPFL-R联合LPFL-S模型分别为16.19°、22.98°,较Normal模型分别增加26.0%、78.8%。结论 MPFL重建术后髌股关节接触应力、髌骨外侧移位位移及髌骨倾斜角力学参数接近正常膝关节状态;LPFL松解术可降低髌股关节接触应力,但会增加一定的髌骨外侧位移和髌骨倾斜角,尤其是MPFL重建联合LPFL松解手术会大幅增加髌骨外侧位移和髌骨倾斜角,增加髌骨外侧不稳定的风险。
- Abstract:
- Objective To analyze the biomechanical impact on the patellofemoral joint of lateral patellofemoral ligament release in medial patellofemoral ligament (MPFL) reconstruction for patellar dislocation using three-dimensional finite element software. Methods A normal finite element model of the knee (Normal model) was created and validated using computed tomography (CT) and magnetic resonance imaging (MRI) images from healthy adolescents.This model was modified to simulate the surgical process for patellar dislocation.Four finite element models were established:the normal model,a model of lateral patellofemoral ligament release (LPFL-S),a model of medial patellofemoral ligament reconstruction (MPFL-R),and a model combining MPFL-R with LPFL release.Finite element analysis was employed to assess patellofemoral joint contact stress,patellar lateral displacement,and patellar tilt angle for the three surgical approaches. Results Under knee flexion from 0° to 90°,the four models exhibited distinct biomechanical characteristics regarding patellofemoral joint contact stress and patellar lateral displacement.The Normal model showed a peak patellofemoral contact stress of 7.82 MPa.The MPFL-R model demonstrated a peak stress of 6.64 MPa,a reduction of 15.1% compared with the Normal model.In contrast,the LPFL-S model and the MPFL-R combined with LPFL-S model had peak stresses of 3.46 MPa and 2.94 MPa,respectively,representing reductions of 55.8% and 62.4%,compared with the Normal model.The peak patellar lateral displacement in the Normal model was 4.16 mm,while the MPFL-R model showed an increase to 4.57 mm (an increase of 9.9% compared with the Normal model); the LPFL-S model and the MPFL-R combined with LPFL-S model had peak displacements of 4.67 mm and 5.79 mm,respectively,which correspond to increases of 12.3% and 39.2%,compared with the Normal model.Regarding the patellar tilt angle,the Normal model had a peak value of 12.85°,the MPFL-R model increased to 13.87° (a 7.9% increase),and the LPFL-S model and the MPFL-R combined with LPFL-S model had peak angles of 16.19° and 22.98°,representing increases of 26.0% and 78.8%,compared with the Normal model. Conclusions MPFL reconstruction restores the mechanical parameters of patellofemoral joint contact stress,patellar lateral displacement,and patellar tilt angle to levels close to those of a normal knee.However,LPFL release reduces patellofemoral joint contact stress while increasing patellar lateral displacement and tilt angle.Notably,combining MPFL reconstruction with LPFL release significantly increases patellar lateral displacement and tilt angle,raising the risk of patellar lateral instability.
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备注/Memo
收稿日期:2025-1-20。
基金项目:江苏省卫生健康发展研究中心开放课题(JSHD2022065); 南京市卫生科技发展专项资金项目(YKK23168)
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