【摘要】 目的应用有限分析的方法,研究冈上肌部分损伤对肌腱应力的影响。方法选取1名成年男性志愿者,采用64排螺旋CT对志愿者肩部行薄层扫描,CT图像以DICOM格式导入Mimics 16.0中,分割出肩胛骨、肱骨近端、冈上肌,然后以点云文件格式导入Geomagic studio2012,拟合模型的NURBS曲面,在Hypermesh 13.0有限元模型。将冈上肌腱性部分由前向后分为3个区域,每个区域设计出损伤深度依次为20%(A组)、40%(B组)、60%(C组)肌腱损伤的有限元模型,并与正常无冈上肌损伤模型为对照,通过改变盂肱关节的相对位置,建立外展0°、30°、60°、90°四个肩关节模型,将模型导入Abaqus 6.14。沿冈上肌纵轴添加400N的拉力,在肱骨远端添加约束。结果a)在肩关节外展过程中,冈上肌中区受到的应力最大,其次为前区和后区。b)在四个观察组中,伴随着肩关节外展角度的增大,冈上肌载荷产生的肌腱应力以外展30°最大,与其他外展角度相比差异有统计学意义(P<0.05)。外展90°的肌腱应力仍明显大于外展0°时的应力,差异有统计学意义(P<0.05)。c)在前区及后区损伤的三组中,C组中肌腱应力明显大于A组和B组(P<0.01),A组和B组之间差异无统计学意义(P>0.05)。d)在中区损伤的三组中,B组和C组的肌腱应力明显大于A组(P<0.01),B组和C组之间差异无统计学意义(P>0.05)。结论冈上肌中部的应力要明显高于前后区。在冈上肌中部损伤深度40%,前后区损伤深度60%,会导致损伤周围肌腱的应力集中,容易延伸为全层损伤,应积极进行手术重建。更多还原

【Abstract】 Objective To study the effect of partial-thickness tear of the supraspinatus tendon by finite element analysis.Methods The shoulder of volunteer was scanned by CT.The CT images were imported into Mimics 16.0,and segmented scapula,proximal humerus,supraspinatus muscle,and thenthe models were imported into Geomagic studio 2012 to fit the NURBS surface of the models.The supraspinatus tendon was divided into 3 regions.According to the damage depth,3 model were build(A group 20%,B group 40%,C group 60%).All models were meshed in Hypermesh 13.0,and normal supraspinatus muscle injury model was uesed as control.Through changing the relative position of glenoid humeral joint,the above models were fixed at different abduction degree(0°、30°、60°、90°).Then all models were exported to Abaqus 6.14.Results a)During the abduction of the shoulder,the middle region of the supraspinatus was the most stressed,followed by the anterior and posterior regions.b)With the increase of shoulder abduction angle,the stress produced by supraspinatus muscle was maximal at abduction of 30°,which was significantly different from other abduction angles(P<0.05).The stress of tendon in 90° abduction angles was still significantly greater than that of 0° angles,and there was a significant difference(P<0.05).c)In the three groups of anterior and posterior region injury,the tendon stress in group C was significantly greater than that in group A and group B(P<0.01),and there was no significant difference between group A and B group(P>0.05).d)In the three groups of middle area injuries,the tendon stress in group B and group C was significantly greater than that in group A(P<0.01),and there was no significant difference between group B and group C(P>0.05).Conclusion The stress in the middle supraspinatus is significantly higher than that in the anterior and posterior regions.The depth of injury is 40% at the middle part of supraspinatus,and 60% at the anterior and posterior parts,that can cause the stress concentration around the injured tendons and extend to full thickness injury,that should be actively reconstructed.更多还原