全膝关节置换术中股骨假体屈曲对髌股关节生物力学影响的实验研究Experimental study on biomechanical effects of femoral prosthesis flexion on patellofemoral joint in total knee arthroplasty
翁伟峰;潘福根;刘宁;钱齐荣;
摘要(Abstract):
[目的]探讨全膝置换术中股骨假体矢状位上屈曲对髌股关节生物力学的影响,为临床指导人工膝关节置换的手术技术提供实验依据,以减少术后髌股关节的并发症。[方法]取正常国人新鲜冷冻尸体的5个膝关节作为研究对象,模拟膝关节自站立位屈膝下蹲的动作,设计制作膝关节实验架,与生物力学测试仪共同搭建实验平台。人工膝关节采用DePuy PFC假体全膝系统,手术由同一位有经验的术者实施以控制实验误差,置换髌骨。比较股骨假体相对于按下肢力线位、前屈5°、10°及后屈5°、10°、15°位置时的髌股关节的生物力学指标。选择屈膝30°、60°、90°、120°为观察角度,采用美国Tecscan公司生产的感测片测定髌股关节接触压峰值,最后软件处理得到数字化的结果。[结果]除了在膝关节屈曲30°、60°、90°,股骨假体前屈5°时,髌股关节内侧间隙接触压峰值与下肢力线位相比较无显著性差异(P>0.05),其余各种屈膝角度下,股骨假体不同屈曲角度所致髌股关节内外侧间隙接触压峰值与下肢力线位比较有显著性差异(P<0.05)。股骨假体后屈角度越大,峰值的升高越明显。[结论]全膝关节置换术中,股骨假体在矢状位上争取按下肢力线位置入,以降低术后并发症的发生。
关键词(KeyWords): 关节成形术;置换;膝;股骨假体屈曲;髌股关节;生物力学
基金项目(Foundation): 青浦区科学技术发展基金项目(青科发2010-45)
作者(Author): 翁伟峰;潘福根;刘宁;钱齐荣;
Email:
DOI:
参考文献(References):
- [1]Fehring TK,Murphy JA,Hayes TD,et al.Factors influencing wearand osteolysis in press-fit condylar modular total knee replace-ments[J].Clin Orthop,2004,428:40-50.
- [2]Dixon MC,Brown RR,Parsch D,et al.Modular fixed-bearing to-tal knee arthroplasty with retention of the posterior cruciate liga-ment.A study of patients followed for a minimum of fifteen years[J].J Bone Joint Surg Am,2005,87:598-603.
- [3]尚延春,陈海龙,王战朝.全膝关节置换术后伸膝装置并发症分析[J].中国矫形外科杂志,2007,11:869-971.
- [4]Yip DK,Zhu YH,Chui KY,et al.Distal rotational alignment of theChinese femur and its relevance in total knee arthroplasty[J].J Ar-throplasty,2004,19:213-219.
- [5]陶坤,吴海山,储小兵,等.国人胫骨平台内翻角的测量及其临床意义[J].中国矫形外科杂志,2006,6:434-436.
- [6]Csintalan RP,Schulz MM,Jonathan W,et al.Gender differences inpatellofemoral joint biomechanics[J].Clin Orthop,2002,9:260-269.
- [7]Bengs BC,Scott RD.The effect of patella thickness on intraoperativeknee flexion and patella tracking in total knee arthroplasty[J].JArthroplasty,2006,5:650-655.
- [8]朱志刚,金大地,罗吉伟,等.股骨远端解剖形态性别差异与假体形态设计的关系[J].中国临床解剖学杂志,2008,4:386-388.
- [9]Whiteside LA,Mihalko WM.Surgical procedure for flexion contrac-ture and recrvatum in total knee arthroplasty[J].Clin Orthop,2002,404:189-195.
- [10]O’Rourke MR,Callaghan JJ,Goetz DD,et al.Osteolysis associatedwith a cemented modular posterior-cruciate-substituting totalknee design:five to eight years follow-up[J].J Bone Joint SurgAm,2002,84:1362-1371.