基于有限元分析的膝关节半月板损伤力学研究

doi:10.3877/cma.j.issn.1674-134X.2026.01.006

目的

使用有限元分析的方法研究半月板Ramp损伤后的力学特征，为临床治疗提供参考。

方法

选取一名健康成年男性志愿者，通过结合计算机断层扫描和磁共振图像，建立了包含完整韧带、损伤长度<2 cm，（1.73±0.21）cm的稳定型膝关节半月板Ramp损伤有限元模型，此模型涵盖了Thaunat分类中的4种损伤类型（Ⅱ~Ⅴ型）。模型验证后以半月板Ramp损伤处的应力和位移为研究指标，分析不同屈膝角度（0°、30°、60°、90°）下膝关节的生物力学变化。

结果

本研究发现，随着屈曲角度增加，与Ⅱ型和Ⅲ型半月板Ramp损伤相比，Ⅳ型和Ⅴ型Ramp损伤的有限元模型中半月板撕裂处位移和应力变化更为显著。当膝关节屈曲60°时，Ⅳ型和Ⅴ型半月板Ramp损伤处的最大应力值为完整半月板的3.4和4.1倍，损伤处位移是完整半月板的4.1和5.0倍。膝关节屈曲90°时，Ⅳ型和Ⅴ型半月板Ramp损伤处的最大应力和位移值，分别为完整半月板的2.3和2.9倍，以及3.4和3.8倍。可见此两类分型的半月板损伤Ramp损伤中，60°的屈曲条件下半月板受压最严重。除60°和90°屈曲和内旋外，Ⅳ和Ⅴ型半月板Ramp损伤模型与完整半月板无明显差异。

结论

在膝关节稳定且撕裂长度小于2 cm的前提下，Ⅱ型和Ⅲ型半月板Ramp损伤可以采用非手术治疗，Ⅳ型和Ⅴ型半月板Ramp损伤可以考虑手术修复。

关键词: 膝关节, 半月板, 有限元分析

Objective

To study the mechanical characteristics of the meniscus after ramp injury using the method of finite element analysis and provide a reference for clinical management.

Methods

A detailed finite element model of the knee joint bone, cartilage, meniscus, and major ligaments (patellar ligament, anterior cruciate ligament, posterior cruciate ligament, medial collateral ligament, and lateral collateral ligament) was constructed by combining computed tomography and magnetic resonance imaging, of based on which a knee model of meniscal ramp injuries was constructed built, covering the four types of injuries in the Thaunat classification (type Ⅱ to type Ⅴ). A vertical load (650 N) and an anterior load (134 N) were applied to simulate the force patterns at different knee flexion angles (0°, 30°, 60°, 90°) to evaluate the stresses and displacements at the meniscal ramp injury.

Results

The angle of flexion increased, the changes in displacement and stress at the meniscal tear were more significant in the finite element models of type Ⅳ and V ramp injuries compared to type Ⅱand Ⅲ meniscal ramp injuries. When the knee flexed at 60°, the maximum stress at the type Ⅳ and Ⅴ meniscal ramp injuries was approximately 3.5 to 4.2 times higher than that of the intact meniscus, and the displacements at the injuries were nearly four to five times higher than those of the intact meniscus. When the knee flexed at 90°, the maximum stress and displacements at the ramp injury were approximately 2.4 to 2.9 and 3.5 to 3.9 times higher than those of the intact meniscus for type Ⅳ and type Ⅴ menisci, respectively. The meniscus was most stressed in the 60° flexion condition in these two subtypes of ramp injury. Except for 60° and 90° of flexion and internal rotation, no remarkable difference existed between the Ⅳ and Ⅴ meniscal ramp injury models and the intact meniscus.

Conclusion

When the knee is stable and the tear length is less than two centimetres, type Ⅱand Ⅲ meniscal ramp injuries can be treated non-operatively, while surgical repair may be chosen for type Ⅳ and Ⅴ meniscal ramp injuries .

Key words: Knee joint, Meniscus, Finite element analysis

图1 完整膝关节的三维示意图。图A为左侧面视图；图B为前视图（正面）；图C为后视图（背面）；图D为右侧面视图

Figure 1 Three-dimensional schematic diagram of the intact knee joint. A is left lateral view; B is anterior view; C is posterior view; D is right lateral view.

图2 膝关节的Ramp损伤分型三维示意图。图A为Ⅱ型，部分上撕裂；图B为Ⅲ型，部分下撕裂；图C为Ⅳ型，完全撕裂；图D为Ⅴ型，双撕裂

Figure 2 Three-dimensional schematic diagrams of the Ramp lesion classifications of the knee. A is partial superior tear as type Ⅱ; B is partial inferior tear as type Ⅲ; C is complete tear as type Ⅳ; D is double tear as type Ⅴ

图3 加载后的膝关节三维示意图。图A为膝关节模型网格化；图B为膝关节模型负载荷

Figure 3 Three-dimensional schematic of the loaded knee joint finite element model. A is mesh generation of the knee joint model; B is the knee joint model under applied load

图4 膝关节各结构的材料属性

Figure 4 Material properties of various knee joint structures

图5 膝关节的模型验证示意图。图A为ACL（前交叉韧带）应力示意图；图B为胫骨前向移位示意图；图C为完整半月板应力示意图；图D为完整半月板移位示意图

Figure 5 Schematic of knee joint model validation. A is schematic of stress distribution in ACL (anterior cruciate ligament); B is schematic of anterior displacement of the tibia; C is schematic of stress distribution in the intact meniscus; D is schematic of displacement in the intact meniscus

图6 组合载荷下膝关节屈曲0°时半月板Ramp损伤处接触应力和位移注：组合载荷为1 150N的压缩、股骨后部134 N和4 Nm内收力矩；上一排为应力（von Mises应力）示意图，下一排为位移矢量示意图

Figure 6 Contact stress and displacement at the meniscus ramp lesion site at zero degree of knee flexion under combined loading.Note: the knee model was subjected to a combined load of 1 150 N compression, 134 N posterior femoral force, and 4 Nm adduction force moment; the upper row is schematic diagram of the equivalent stress (von Mises stress) distribution; the lower row is schematic diagram of the total displacement vector field

图7 组合载荷下膝关节屈曲30°时半月板Ramp损伤处接触应力和位移注：组合载荷为900 N的压缩、股骨后部134 N和4 Nm内收力矩；上一排为应力（von Mises应力）示意图，下一排为位移矢量示意图

Figure 7 Contact stress and displacement at the meniscus ramp lesion site under combined loading at 30° of knee flexionNote: the knee model was subjected to a combined load of 900 N compression, 134 N posterior femoral force, and 4 Nm adduction force moment；the upper row is schematic diagram of the equivalent stress (von Mises stress) distribution; the lower row is chematic diagram of the total displacement vector field

图8 组合载荷下膝关节屈曲60°时半月板Ramp损伤处接触应力和位移注：组合载荷为600 N的压缩、股骨后部134 N和4 Nm内收力矩；上一排为应力（von Mises应力）示意图，下一排为位移矢量示意图

Figure 8 Contact stress and displacement at the meniscus ramp lesion site under combined loading at 60° of knee flexionNote: the knee model was subjected to a combined load of 600 N compression, 134 N posterior femoral force, and 4 Nm adduction moment；the upper row is schematic diagram of the equivalent stress (von Mises stress) distribution; the lower row is schematic diagram of the total displacement vector field

图9 组合载荷下膝关节屈曲90°时半月板Ramp损伤处接触应力和位移注：组合载荷为300 N的压缩、股骨后部134 N和4 Nm内收力矩；上一排为应力（von Mises应力）示意图，下一排为位移矢量示意图

Figure 9 Contact stress and displacement at the meniscus ramp lesion site under combined loading at 90°of knee flexionNote: the knee model was subjected to a combined load of 300 N compression, 134 N posterior femoral force, and 4 Nm adduction moment；the upper row is schematic diagram of the equivalent stress (von Mises stress) distribution; the lower row is schematic diagram of the total displacement vector field

图10 不同载荷和屈曲角度对半月板Ramp损伤处最大接触应力的影响

Figure 10 Effects of different loads and flexion angles on the maximum contact stress at the meniscal ramp lesion site

图11 不同载荷和屈曲角度对半月板Ramp损伤处最大位移的影响

Figure 11 Effect of different loads and flexion angles on the maximum displacement at the the meniscal ramp lesion site

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Biomechanical investigation of meniscus injuries using finite element modeling

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Biomechanical investigation of meniscus injuries using finite element modeling