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Article(id=1244321218640331606, tenantId=1146029695717560320, journalId=1244284848500682798, issueId=1244321215637209904, articleNumber=null, orderNo=null, doi=10.16156/j.1004-7220.2025.05.007, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1737216000000, receivedDateStr=2025-01-19, revisedDate=1740585600000, revisedDateStr=2025-02-27, acceptedDate=null, acceptedDateStr=null, onlineDate=1774598896894, onlineDateStr=2026-03-27, pubDate=1759248000000, pubDateStr=2025-10-01, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1774598896894, onlineIssueDateStr=2026-03-27, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1774598896894, creator=13701087609, updateTime=1774598896894, updator=13701087609, issue=Issue{id=1244321215637209904, tenantId=1146029695717560320, journalId=1244284848500682798, year='2025', volume='40', issue='5', pageStart='1079', pageEnd='1366', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=1, specialIssue=null, createTime=1774598896178, creator=13701087609, updateTime=1774599509568, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1244323788452639476, tenantId=1146029695717560320, journalId=1244284848500682798, issueId=1244321215637209904, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1244323788452639477, tenantId=1146029695717560320, journalId=1244284848500682798, issueId=1244321215637209904, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=1136, endPage=1143, ext={EN=ArticleExt(id=1244321220448076649, articleId=1244321218640331606, tenantId=1146029695717560320, journalId=1244284848500682798, language=EN, title=Effects of Medial Collateral Ligament Release on Knee Joint Squatting Motion after Total Knee Arthroplasty, columnId=1244321216404767539, journalTitle=Journal of Medical Biomechanics, columnName=Original Articles, runingTitle=null, highlight=null, articleAbstract=
Objective

To study the effect of medial collateral ligament (MCL) release on the squatting motion followling total knee arthroplasty (TKA) and provide reference data for ligament release during knee replacement surgery.

Methods

Based on CT and MRI images of a volunteer, a three-dimensional (3D) geometric anatomical model of the natural knee joint including bone tissues and major soft tissues was established. A finite element model of the artificial knee joint was established by simulating TKA surgery. The squatting motion after 30% release of the upper end, lower end, and both ends of the MCL was simulated, and motion characteristic data of the knee joint at flexion/extension angles from 0° to 135° were obtained.

Results

The effects of ligament release at different locations on knee squatting motion varied. After releasing the lower end, the medial translation, posterior translation, superior translation, and adduction of the femur relative to the tibia increased by 13.74%, 3.83%, 9.74%, and 2.37%, respectively, while the external rotation decreased by 36.8%. After releasing the upper end, the medial translation and posterior translation increased by 10.65% and 10%, respectively, while the superior translation, adduction, and external rotation decreased by 4.52%, 33.89%, and 67.1%, respectively. After releasing both ends, the medial translation, posterior translation, and superior translation increased by 14.77%, 9.39%, and 22.56%, respectively, while the adduction and external rotation decreased by 15.62% and 47.3%, respectively.

Conclusions

After MCL released, the medial translation, anterior translation, superior translation, and abduction of the femur relative to the tibia increased, while the external rotation decreased. Releasing the lower end had the least effect on these femoral movements, showing an obvious advantage.

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目的

研究内侧副韧带（medial collateral ligament，MCL）松解对全膝关节置换（total knee arthroplasty，TKA）术后下蹲运动的影响，为膝关节置换术中韧带松解提供参考数据。

方法

基于志愿者CT和MRI图像，建立包括骨组织以及主要软组织的自然膝关节三维几何解剖模型。模拟TKA手术建立人工膝关节有限元模型，分别模拟MCL上端、下端和两端松解30%后下蹲运动，并提取膝关节屈曲0°~135°运动特征数据。

结果

不同部位松解对膝关节下蹲运动的影响不同。下端松解后，股骨相对胫骨的内移、后移、上移和内收分别增大13.74%、3.83%、9.74%、2.37%，外旋减小36.8%；上端松解使内移、后移分别增大10.65%、10%，上移、内收和外旋分别减小4.52%、33.89%、67.1%；两端松解后，内移、后移和上移分别增大14.77%、9.39%、22.56%，内收和外旋分别减小15.62%、47.3%。

结论

MCL松解后，股骨相对胫骨的内移、前移、上移、外展增大，外旋减小。下端松解对股骨的这些运动影响最小，优势明显。

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王建平，教授，博士生导师，E-mail：
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作者贡献声明：

肖忠旭、曲海军、李强、张晓辉负责研究实施、数据处理以及论文撰写；杜国凯、巴战生负责技术指导与论文修改；王金武、王建平负责仿真分析与论文指导。

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Relative motion between femur and tibia before and after TKA release

, figureFileSmall=null, figureFileBig=null, tableContent=
松解方式内外移/mm上下移/mm前后移/mm内外旋/（°）内收外展/（°）
未松解-2.91+5.75-11.70-12.51+7.17
上端松解+3.22+5.49-12.87-4.12+4.74
下端松解+2.51+5.97-12.84-7.92+7.34
两端松解+3.34+6.29-14.34-6.59+6.05
), ArticleFig(id=1244321234092147419, tenantId=1146029695717560320, journalId=1244284848500682798, articleId=1244321218640331606, language=CN, label=表1, caption=

TKA松解前后股骨和胫骨的相对运动

, figureFileSmall=null, figureFileBig=null, tableContent=
松解方式内外移/mm上下移/mm前后移/mm内外旋/（°）内收外展/（°）
未松解-2.91+5.75-11.70-12.51+7.17
上端松解+3.22+5.49-12.87-4.12+4.74
下端松解+2.51+5.97-12.84-7.92+7.34
两端松解+3.34+6.29-14.34-6.59+6.05
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内侧副韧带松解对全膝关节置换后膝关节下蹲运动的影响
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曲海军 1 , 肖忠旭 1 , 杜国凯 2 , 巴战生 2 , 李强 3 , 王金武 4 , 张晓辉 1 , 王建平 1
医用生物力学 | 论著 2025,40(5): 1136-1143
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医用生物力学 | 论著 2025, 40(5): 1136-1143
内侧副韧带松解对全膝关节置换后膝关节下蹲运动的影响
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曲海军1, 肖忠旭1, 杜国凯2, 巴战生2, 李强3, 王金武4, 张晓辉1, 王建平1
作者信息
  • 1.河南理工大学　机械与动力工程学院，郑州　454000
  • 2.肃南县人民医院　内科，甘肃　张掖　734400
  • 3.河南优德医疗设备股份有限公司，河南　开封　475500
  • 4.上海交通大学医学院附属第九人民医院　骨科，上海　200011

通讯作者:

王建平，教授，博士生导师，E-mail：
Effects of Medial Collateral Ligament Release on Knee Joint Squatting Motion after Total Knee Arthroplasty
Haijun QU1, Zhongxu XIAO1, Guokai DU2, Zhansheng BA2, Qiang LI3, Jinwu WANG4, Xiaohui ZHANG1, Jianping WANG1
Affiliations
  • 1.School of Mechanical and Power Engineering, Henan Polytechnic University, Jiaozuo 454000, China
  • 2.Department of Internal Medicine, Sunan County People's Hospital, Zhangye 734400, Gansu, China
  • 3.Henan Youde Medical Equipment Co., Ltd., Kaifeng 475500, Henan, China
  • 4.Department of Orthopedics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
出版时间: 2025-10-01 doi: 10.16156/j.1004-7220.2025.05.007
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摘要
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目的

研究内侧副韧带（medial collateral ligament，MCL）松解对全膝关节置换（total knee arthroplasty，TKA）术后下蹲运动的影响，为膝关节置换术中韧带松解提供参考数据。

方法

基于志愿者CT和MRI图像，建立包括骨组织以及主要软组织的自然膝关节三维几何解剖模型。模拟TKA手术建立人工膝关节有限元模型，分别模拟MCL上端、下端和两端松解30%后下蹲运动，并提取膝关节屈曲0°~135°运动特征数据。

结果

不同部位松解对膝关节下蹲运动的影响不同。下端松解后，股骨相对胫骨的内移、后移、上移和内收分别增大13.74%、3.83%、9.74%、2.37%，外旋减小36.8%；上端松解使内移、后移分别增大10.65%、10%，上移、内收和外旋分别减小4.52%、33.89%、67.1%；两端松解后，内移、后移和上移分别增大14.77%、9.39%、22.56%，内收和外旋分别减小15.62%、47.3%。

结论

MCL松解后，股骨相对胫骨的内移、前移、上移、外展增大，外旋减小。下端松解对股骨的这些运动影响最小，优势明显。

膝关节置换  /  内侧副韧带  /  胫股关节  /  下蹲运动  /  有限元分析
Objective

To study the effect of medial collateral ligament (MCL) release on the squatting motion followling total knee arthroplasty (TKA) and provide reference data for ligament release during knee replacement surgery.

Methods

Based on CT and MRI images of a volunteer, a three-dimensional (3D) geometric anatomical model of the natural knee joint including bone tissues and major soft tissues was established. A finite element model of the artificial knee joint was established by simulating TKA surgery. The squatting motion after 30% release of the upper end, lower end, and both ends of the MCL was simulated, and motion characteristic data of the knee joint at flexion/extension angles from 0° to 135° were obtained.

Results

The effects of ligament release at different locations on knee squatting motion varied. After releasing the lower end, the medial translation, posterior translation, superior translation, and adduction of the femur relative to the tibia increased by 13.74%, 3.83%, 9.74%, and 2.37%, respectively, while the external rotation decreased by 36.8%. After releasing the upper end, the medial translation and posterior translation increased by 10.65% and 10%, respectively, while the superior translation, adduction, and external rotation decreased by 4.52%, 33.89%, and 67.1%, respectively. After releasing both ends, the medial translation, posterior translation, and superior translation increased by 14.77%, 9.39%, and 22.56%, respectively, while the adduction and external rotation decreased by 15.62% and 47.3%, respectively.

Conclusions

After MCL released, the medial translation, anterior translation, superior translation, and abduction of the femur relative to the tibia increased, while the external rotation decreased. Releasing the lower end had the least effect on these femoral movements, showing an obvious advantage.

total knee arthroplasty  /  medial collateral ligament  /  tibiofemoral joint  /  squatting motion  /  finite element analysis
曲海军, 肖忠旭, 杜国凯, 巴战生, 李强, 王金武, 张晓辉, 王建平. 内侧副韧带松解对全膝关节置换后膝关节下蹲运动的影响. 医用生物力学, 2025 , 40 (5) : 1136 -1143 . DOI: 10.16156/j.1004-7220.2025.05.007
Haijun QU, Zhongxu XIAO, Guokai DU, Zhansheng BA, Qiang LI, Jinwu WANG, Xiaohui ZHANG, Jianping WANG. Effects of Medial Collateral Ligament Release on Knee Joint Squatting Motion after Total Knee Arthroplasty[J]. Journal of Medical Biomechanics, 2025 , 40 (5) : 1136 -1143 . DOI: 10.16156/j.1004-7220.2025.05.007
正文
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膝关节置换术作为治疗骨关节炎的最有效方法之一，目前在全世界范围得到广泛应用[1-4]。然而，胫股关节不稳定是导致术后早期翻修的常见原因[5-6]。研究胫股关节不稳定的影响因素及内侧副韧带（medial collateral ligament，MCL）松解后胫股关节的运动特性，对于评估患者在下蹲过程中膝关节稳定性具有重要临床指导意义。
近年来，越来越多的研究关注全膝关节置换（total knee arthroplasty，TKA）术后软组织平衡与关节运动学之间的内在联系[7]。MCL是膝关节内侧的主要生物力学约束[8]。研究表明，内侧副韧带张力的适度调整会影响下蹲等运动中膝关节胫股接触力[9-10]。因此，合理调整MCL张力对维持膝关节稳定和预防关节损伤十分重要。在膝关节置换术中，软组织平衡是手术成功的关键因素之一[11]。无论韧带保留或切除，都需要获得软组织平衡，以实现最佳的手术效果并提高患者满意度。在部分内翻膝患者中，为了纠正力线并获得内外侧间隙的平衡，需要对MCL进行松解。MCL的松解方法包括拉网样松解、体部松解、止点周围松解[12-13]。研究表明，采用拉网样松解技术对MCL后部和深层MCL后部进行松解可扩大内侧间隙，提示不同解剖层次的松解可能产生差异化的生物力学效果[14-15]。网样松解、体部松解方法比较常用，止点周围松解则根据解剖位置细分为远端止点松解（Chung等[16]对浅层MCL远端附着物进行松解）和近端止点松解（Lee等[17]对MCL股骨起始点松解用于纠正TKA中严重内翻畸形）。虽然MCL松解对治疗TKA患者取得了较好的疗效，但同时也存在诸多风险，例如过度松解会破坏膝关节稳定性，因此，需要进一步研究MCL松解位置、松解量对膝关节运动特性的影响，以安全实现软组织平衡，获得较好的运动特性。
本文以30%松解为例，并将30%的松解量定义为几何外形的30%，针对MCL不同部位，建立TKA术后MCL上端、下端和两端同时松解30%的膝关节有限元模型，分析MCL不同位置松解对人工胫股关节深蹲运动特性的影响，为理解膝关节病理和膝关节假体设计提供参考。
1　材料与方法
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1.1　有限元模型立
对1名健康男性（身高1.73 m，体重60 kg）膝关节中心上下各10 cm范围进行计算机断层（computed tomography，CT）扫描，设置扫描的峰值电压为120 kV，电流为150 mA，扫描层距1 mm，得到膝关节骨组织图像。随后对同一名健康志愿者进行磁共振成像（magnetic resonance imaging，MRI）扫描，得到膝关节软组织图像。基于健康志愿者CT和MRI图像，建立包括骨组织以及主要软组织在内的自然膝关节三维几何解剖模型[见图1（a）]。采用比较典型PFC假体（Sigma PFC，Depuy Orthopaedics公司，美国）模拟TKA术，依据膝关节置换术的操作规范在计算机中模拟截骨，按照“股骨和胫骨假体适当外置，髌骨假体适当内置”原则，把假体模型装配到三维几何解剖模型上[见图1（b）]。装配后通过在软件中测量90°时屈膝间隙，以及0°时伸展间隙，综合评估假体在整个运动范围内的稳定性。对所建立的TKA后的膝关节三维模型进行有限元网格划分，划分的单元类型为六面体[见图1（c）]，单元总数为31 767个，节点总数为31 032个。
使用Hypermesh 11.0模拟MCL股骨和胫骨部分的松解，结果显示，MCL上端股骨前后整体松解前、后粘结长度分别为18.52、12.41 mm；MCL下端胫骨前后整体松解前、后粘结长度分别为16.75、13.79 mm。图2所示为MCL松解30%前后的有限元模型，该模型在王建平等人的研究基础上建立，并已通过体外尸体实验验证了其有效性[18]，模型中自然膝关节胫股关节的数据参考文献[18]的实验结果。通过对比自然膝关节MCL松解前后的运动变化，为膝关节软组织平衡和假体设计提供参考。基于本文初步成果，计划后续开展相关病人的韧带松解研究。
1.2　模型参数设置
对股四头肌顶端施加500 N力，方向平行于股骨干，指向股四头肌起点。同时，在股骨大转子处施加垂直于地面300 N力，即50%BW（50%body weight）。边界条件设定为：将胫骨远端踝中心下方10 mm处固定（U1=U2=U3=UR1=UR2=UR3=0），设为点A，保留胫骨远端踝中心相对A点的3个自由度（UR1、UR2、UR3）。通过上述力和边界条件的设置，可模拟人体膝关节做下蹲运动。为了评估下蹲时胫股关节运动，建立相应运动坐标系[19]。TKA中用到胫骨托假体、股骨假体，以及胫骨和髌骨超高分子聚乙烯假体，前两种定义为线弹性[20-22]，后者为非线性弹性[23-24]。在TKA术后有限元模型中，对股骨、高分子聚乙烯假体、胫骨及其他软组织定义7个表面接触副[19]。
2　结果
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将人工膝关节和MCL松解后的有限元模型导入ABAQUS 6.14进行分析，仿真结果如图3所示。经PFC假体置换后的膝关节下蹲运动可屈曲至135°，本文主要分析0°~135°范围内不同屈曲角度下的运动特征数据。
当屈曲大于100°时，松解后股骨相对胫骨向内侧平移，135°时达到最大，上端、下端和两端松解后股骨最大内侧移位分别为3.22、2.51、3.34 mm，较未松解的最大外移量（2.91 mm），上端和两端松解外移量分别增加了10.65%、14.77%，下端松解外移量减少了13.74%[见图4（a）]。屈曲0°~95°，未松解时股骨上移量大于松解后，此后下端和两端松解的上移量大于未松解模型；屈曲135°时，上移量达到最大值，下端、两端松解上移量分别为5.97、6.29 mm，分别比未松解上移量（5.75 mm）增加3.83%和9.39%。上端松解的上移量为5.49 mm，比未松解减小了4.52%[见图4（b）]。松解后股骨相对胫骨前平移增大，其中两端松解的前移量最大。随后股骨相对胫骨向后平移，屈曲至135°时后移达到最大，上端、下端以及两端松解的最大后移量分别为12.87、12.84、14.34 mm，比未松解的后移量（11.70 mm）分别增大了10%、9.74%、22.56%[见图4（c）]。屈曲初期，股骨相对胫骨内旋，随后持续外旋，外旋角先增大后减小。上端松解在屈曲20°时最大外旋角为4.12°，下端松解在屈曲78°时为外旋角7.92°，两端松解在屈曲35°时外旋角为6.59°，相比未松解模型最大外旋角（12.51°）分别减少67.1%、36.8%、47.3%。随着屈曲角度增加，外旋角逐渐减小且均小于未松解模型[见图4（d）]。松解前后股骨相对胫骨表现出相同的运动趋势，股骨相对胫骨先外展，在屈曲42.4°时，两端松解的外展量最大，未松解的外展量均小于松解模型。此后，股骨相对胫骨持续内收，在屈曲135°时达到最大。下端松解的最大内收角为7.34°，比未松解模型内收角（7.17°）增大2.37%；上端和两端松解的最大内收角分别为4.74°和6.05°，比未松解模型分别减少33.89%和15.62%[见图4（e）]。表1展示了松解前后股骨和胫骨的相对运动数值。
3　讨论
收起
本文通过仿真分析了MCL松解对人工膝关节深蹲运动的影响。结果显示，MCL上端松解、下端松解、两端松解对胫股关节的运动特性影响不同。将本文MCL松解后与其他研究者及自然膝关节的运动特性进行对比，为进一步探讨MCL松解在下蹲运动中的作用提供依据。
3.1　TKA后MCL松解对膝关节下蹲运动的影响
3.1.1　股骨相对胫骨的平移运动
高屈曲时，松解后的内外移大于未松解时的内外移。Maderbacher等[25]研究显示，TKA后屈曲0°~10°时股骨相对胫骨的外移逐渐增大，在10°~50°外移逐渐减小，50°~90°外移趋于平稳，与自然膝关节接近[18]，在整个屈曲过程均外移。Rhoads等[26]研究也表明，TKA后股骨完全伸直时外移4~5 mm，随着屈曲继续，股骨相对胫骨开始内移，屈曲135°时达到2.77 mm，与下端松解在高屈曲时的内外移趋于一致。Akbari等[27]对比了受试者TKA前后运动学，发现TKA后股骨由最初外移转向内移，屈曲100°时内移达到最大1.14 mm，变化趋势比较平缓，与松解后变化较接近。自然膝关节在下蹲时产生较小的内移，屈曲135°时外移达到最大1.7 mm。从仿真结果以及前人研究结果来看，当屈曲角度小于90°时，MCL松解对胫股关节内外移有一定影响，而在高屈曲时，MCL松解后股骨相对胫骨出现较大内移，因此最值得注意的是松解造成高屈曲时的内移现象，需严格控制松解量进而控制高屈曲时的内移[见图5（a）]。
Akalan等[28]仿真结果显示，TKA后屈曲0°~ 50°时股骨相对胫骨不断上移，最大达到8.2 mm，随后上移逐渐减小，屈曲80°后上移小于自然膝关节[18]，且仍有下降趋势。Maderbacher等[25]研究显示，TKA后屈曲0°~40°时股骨上移大于自然膝关节，此后上移量小于自然膝关节。不同的手术造成TKA后上下移存在差异较大，若手术造成较大的上移量，通过松解MCL等可以减小上移量[见图5（b）]。
TKA对股骨前后移有着较大的影响。Maderbacher等[25]研究发现，在膝关节完全伸展时，股骨会发生轻微后移，随后股骨的前移量逐渐增大，推测原因是TKA后在膝关节屈曲期间股骨回滚减少，股骨的前移增大，故股骨的回滚相当重要（文献[25-26]中结果相似）。而Shimizu等[29]研究发现，TKA后股骨相对胫骨始终后移，屈曲130°时达到最大后移量6.8 mm，变化比较平缓，表明假体在控制胫股关节前后移位方面具有较好性能。MCL松解会在屈曲30°~100°时增大前移量，对高屈曲影响不大，故MCL是否松解对前后移影响不大[见图5（c）]。
3.1.2　股骨相对胫骨的旋转运动
TKA会导致股骨外旋值减小。Rhoads等[26]和Lützner等[30]研究表明，在膝关节屈曲的大部分过程中，术后股骨相对胫骨持续外旋，最大外旋角分别为10.94°和7.99°，数值较大。而Wang等[31]研究发现，TKA后股骨相对胫骨外旋先增大，后有减缓趋势，但是变化比较平缓。总体而言，松解后股骨的外旋相对未松解的减小。同时，在整个膝关节屈曲过程中，下端松解对股骨外旋的影响较小。因此，在需要松解韧带时选择下端松解的膝关节内外旋较为合理[见图6（a）]。
MCL松解后，股骨相对胫骨在屈曲0°~80°时外展角增大，在高屈曲阶段内收角减小。Akalan等[28]和Wilson等[32]研究发现，在膝关节屈曲期间，股骨相对胫骨持续外展，最大外展量分别为3.3°、2.5°，随后外展逐渐减小，呈现内收趋势。Heyse等[33]研究表明，TKA后股骨相对胫骨外展不断增大，最大外展角为2.6°，小于自然膝关节的最大外展角，松解后外展也增大，且在高屈曲时下端松解的内收与自然膝关节接近[18]。由此可见，MCL松解改善了内收外展状况，尤其是在屈曲角度小于80°阶段，两端松解的内收外展最接近自然膝关节[见图6（b）]。
3.2　规范松解MCL改善膝关节下蹲运动
国内外学者针对MCL松解提出了多种方法。吴厦等[13]研究发现，MCL浅层贴骨剥离可以带来1.5~2.0 mm内侧松解度，并且不会影响术后膝关节活动度。Motififard等[12]采用拉网样松解可逐步松解韧带长度，这些方法在一定程度上改善了软组织平衡。本文基于上述松解方法的研究，分析MCL不同部位松解对膝关节的影响。MCL的不同部位松解带来的稳定性和康复效果不尽相同。Chung等[16]和Lee等[17]分别对MCL下端、上端松解，为本文提供了重要基础。无论是上端或下端松解，均可增大内侧间隙，减轻膝关节内部压力[34-35]。本文研究MCL的上端、下端及两端同时松解对膝关节的影响，结果显示，虽然3种松解方式有很多共同点，但也存在各自优点。在膝关节高屈曲过程中，3种松解都会造成股骨内移，但是下端松解造成的内移量较小；屈曲0°~80°，3种松解方式都会造成股骨前移，下端松解造成的前移量最小；3种松解都会减小股骨外旋，下端松解影响最小；与自然膝关节对比，TKA手术使得股骨有内收，韧带松解使得股骨外展，高屈曲时下端松解的内收与自然膝关节接近，但是在屈曲角度小于80°阶段，两端松解后内收外展最接近自然膝关节。总体而言，MCL选择下端松解益处较多。
本研究的局限性如下：仅分析了MCL松解30%的模型，未对其余松解程度分析，也未研究关节囊、腓肠肌对膝关节活动的影响，不能较全面分析韧带松解后膝关节的稳定性。未来研究将纳入这些因素，使模型更符合人体生理，同时着眼于规范化的松解技术，探讨不同松解程度并确定最佳松解方式，从而提升下蹲运动的效果和患者的生活质量。基于本研究使用的模型，将进一步研究其他韧带的松解与重建等相关问题。同时，将结合双平面X线成像技术研究MCL松解对TKA后膝关节下蹲运动的影响，以便更好复现膝关节的六自由度耦合运动。
4　结论
收起
TKA手术通常会改变膝关节的运动特性，经常通过MCL松解改善手术空间和平衡软组织。本文通过有限元仿真分析了MCL松解对人工膝关节下蹲运动特性的影响。结果表明，MCL不同部位（上端、下端、两端）松解30%对膝关节下蹲运动产生的影响不同。MCL松解后，股骨相对胫骨的内移、前移、上移和外展增大，外旋减小。下端松解对股骨内移、前移、上移和外展和外旋的影响最小，下端松解优势明显。本文结果可为膝关节软组织平衡、膝关节假体设计等提供参考。
基金
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  • 中国残疾人联合会残疾人辅助器具专项项目(2024CDPFAT-15)
  • 肃南县科技局人才引进培育专项(SN2023RC04)
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2025年第40卷第5期
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doi: 10.16156/j.1004-7220.2025.05.007
  • 接收时间：2025-01-19
  • 首发时间：2026-03-27
  • 出版时间：2025-10-01
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  • 收稿日期：2025-01-19
  • 修回日期：2025-02-27
基金
中国残疾人联合会残疾人辅助器具专项项目(2024CDPFAT-15)
肃南县科技局人才引进培育专项(SN2023RC04)
作者信息
    1.河南理工大学　机械与动力工程学院，郑州　454000
    2.肃南县人民医院　内科，甘肃　张掖　734400
    3.河南优德医疗设备股份有限公司，河南　开封　475500
    4.上海交通大学医学院附属第九人民医院　骨科，上海　200011

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