【摘要】：膝關(guān)節(jié)作為人體最大且構(gòu)造最復(fù)雜的關(guān)節(jié),極易受到損傷。一般采用全膝置換術(shù)對(duì)晚期的膝關(guān)節(jié)疾病進(jìn)行治療。而關(guān)節(jié)置換術(shù)并非一勞永逸,很多患者術(shù)后都會(huì)出現(xiàn)關(guān)節(jié)失效等問題。目前,很多學(xué)者從運(yùn)動(dòng)生物力學(xué)的角度對(duì)骨關(guān)節(jié)炎發(fā)病機(jī)理、人工關(guān)節(jié)失效等問題進(jìn)行了大量研究,但還未取得突破性成果。尤其,相對(duì)于歐美國(guó)家,我國(guó)的運(yùn)動(dòng)生物力學(xué)研究起步較晚,很多方面都不夠完善。因此,針對(duì)國(guó)人的運(yùn)動(dòng)生物力學(xué)研究意義重大。有關(guān)運(yùn)動(dòng)生物力學(xué)的研究中,針對(duì)人體步態(tài)的研究開展最為廣泛。正常人體步態(tài)具有周期性和穩(wěn)定性,能夠描述人體基本運(yùn)動(dòng)特征。本文采用三維運(yùn)動(dòng)捕捉、有限元分析、肌肉驅(qū)動(dòng)模擬等先進(jìn)的技術(shù)手段,對(duì)健康人體和接受TKA的患者進(jìn)行了步態(tài)分析和仿真研究。本章所得結(jié)論揭示了健康人體下肢關(guān)節(jié)的運(yùn)動(dòng)規(guī)律和TKA對(duì)人體下肢關(guān)節(jié)運(yùn)動(dòng)的影響,對(duì)人工膝關(guān)節(jié)的設(shè)計(jì)以及TKA術(shù)后康復(fù)等都有指導(dǎo)作用。采用三維運(yùn)動(dòng)捕捉系統(tǒng),對(duì)健康青年人和老年人在行走和慢跑時(shí)的時(shí)空參數(shù)和運(yùn)動(dòng)學(xué)參數(shù)進(jìn)行研究。結(jié)果顯示與青年人相比,老年人的速度和步長(zhǎng)都較小,而步頻相差不大。青年人和老年人之間存在的步態(tài)時(shí)空參數(shù)的年齡差異主要是老年人步長(zhǎng)減小引起的。在行走和慢跑時(shí),下肢關(guān)節(jié)的運(yùn)動(dòng)學(xué)參數(shù)也存在年齡差異。青年人和老年人下肢關(guān)節(jié)的運(yùn)動(dòng)范圍差異與人體運(yùn)動(dòng)速度有關(guān)。采用三維運(yùn)動(dòng)捕捉系統(tǒng)和測(cè)力系統(tǒng),對(duì)膝關(guān)節(jié)損傷的老年女性和健康老年女性在行走時(shí)的下肢關(guān)節(jié)運(yùn)動(dòng)學(xué)和動(dòng)力學(xué)參數(shù)進(jìn)行研究。結(jié)果顯示,與健康受試者相比,TKA前患者的速度和步長(zhǎng)較小,雙支撐期明顯變長(zhǎng)。同時(shí),患者更傾向于使用健康側(cè)下肢膝關(guān)節(jié),雙側(cè)髖關(guān)節(jié)和踝關(guān)節(jié)的運(yùn)動(dòng)會(huì)發(fā)生一定的代償性變化。TKA后,患者的時(shí)空參數(shù)基本恢復(fù)到正常水平。而與健康受試者相比,患者下肢關(guān)節(jié)運(yùn)動(dòng)角度仍然存在較大差異,但關(guān)節(jié)運(yùn)動(dòng)力矩有較大改善。采用醫(yī)學(xué)影像掃描和有限元分析技術(shù),研究直立狀態(tài)和腳跟著地相、單肢中立相、腳尖離地相四個(gè)瞬態(tài)時(shí),人體膝關(guān)節(jié)的股骨軟骨、脛骨軟骨的接觸應(yīng)力分布情況,和人工膝關(guān)節(jié)的股骨假體、脛骨墊片和髕骨假體的接觸應(yīng)力分布情況。研究結(jié)果顯示,人體膝關(guān)節(jié)中,股骨軟骨最易產(chǎn)生磨損和病變,并且脛骨內(nèi)側(cè)軟骨比外側(cè)軟骨易發(fā)生磨損。人工膝關(guān)節(jié)中,脛骨墊片和股骨假體上應(yīng)力峰值較大,為容易產(chǎn)生關(guān)節(jié)失效的部位。采用Open Sim軟件建立一名接受TKA患者的肌肉骨骼模型,分析四種步速下,患者手術(shù)側(cè)和健康側(cè)下肢主要肌肉的肌力和活動(dòng)度的變化以及下肢主要肌肉分別引起的質(zhì)心加速度。研究結(jié)果顯示,隨著步速下降,患者下肢各肌肉的肌力基本呈現(xiàn)逐漸減小的趨勢(shì)�；颊呤中g(shù)側(cè)和健康側(cè)肌肉力和肌肉活性基本一致,而雙側(cè)下肢肌肉對(duì)身體質(zhì)心的作用完全相反。
[Abstract]:As the largest and most complicated joint of human body, knee joint is easy to be damaged. General use of total knee replacement for the treatment of late knee disease. Joint replacement is not once and for all, many patients will have joint failure and other problems. At present, many scholars have done a lot of research on the pathogenesis of osteoarthritis and artificial joint failure from the point of view of sports biomechanics, but no breakthrough results have been achieved. In particular, the study of sports biomechanics in China is relatively late compared with Europe and America, and many aspects are not perfect. Therefore, the study of sports biomechanics for Chinese is of great significance. In the research of sports biomechanics, the research on human gait is the most extensive. The gait of normal human body has periodicity and stability, and can describe the basic motion characteristics of human body. In this paper, gait analysis and simulation of healthy human body and patients receiving TKA were carried out by using advanced techniques such as 3D motion capture, finite element analysis and muscle drive simulation. The conclusions in this chapter reveal the movement law of lower extremity joint and the influence of TKA on lower extremity joint movement. It can guide the design of artificial knee joint and rehabilitation after TKA. The time and space parameters and kinematics parameters of walking and jogging of healthy young people and old people were studied by three dimensional motion capture system. The results showed that the speed and step length of the old people were smaller than that of the young people, but the step frequency was not different. The difference in gait space-time parameters between the young and the elderly is mainly caused by the decrease of the gait size. During walking and jogging, the kinematic parameters of lower extremity joints were also different in age. The range of lower extremity joint movement in young and old people is related to the movement speed of human body. The kinematic and dynamic parameters of lower extremity joints of elderly and healthy elderly women with knee joint injury were studied by means of three-dimensional motion capture system and force measuring system. The results showed that the speed and step length of the patients before TKA were smaller and the double support period was longer than that of the healthy subjects. At the same time, patients tend to use the healthy lower extremity knee joint, bilateral hip and ankle motion will have a certain compensatory change. TKA, the patient's space-time parameters are basically back to normal level. Compared with the healthy subjects, the lower extremity motion angle of the patients is still different, but the joint motion torque is improved greatly. Using medical imaging scanning and finite element analysis techniques, the contact stress distribution of femoral cartilage and tibial cartilage of human knee joint was studied under four transient conditions: vertical state and heel landing phase, neutral phase of single limb and apical phase. The contact stress distribution of femoral prosthesis, tibial pad and patellar prosthesis. The results show that femoral cartilage is the most prone to wear and lesion in human knee, and medial tibial cartilage is more prone to wear than lateral cartilage. In the artificial knee joint, the peak stress of tibial gasket and femur prosthesis is high, which is prone to joint failure. A musculoskeletal model of a patient receiving TKA was established by using Open Sim software. The changes of muscle strength and movement of the main muscles of the lower extremities and the acceleration of the center of mass caused by the main muscles of the lower extremities were analyzed under four walking speeds. The results showed that the muscle strength of lower extremity muscles decreased gradually with the decrease of walking speed. The muscle strength and muscle activity of the surgical side and the healthy side were basically the same, but the effect of bilateral lower extremity muscles on the body centroid was completely opposite.
【學(xué)位授予單位】：中國(guó)礦業(yè)大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R687.4;R318.1

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