[1]毛勇.胫骨平台前缘圆弧顶点作为胫骨假体旋转定位标志对胫股关节接触力学指标的影响[J].中医正骨,2020,32(06):7-11.
　MAO Yong.Effects of using vertex of curved anterior border of tibial plateau as tibial prosthesis rotational positioning mark on contact mechanics indexes of tibiofemoral joint[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2020,32(06):7-11.
点击复制

胫骨平台前缘圆弧顶点作为胫骨假体旋转定位标志对胫股关节接触力学指标的影响()
分享到：

《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第32卷
期数:
2020年06期
页码:
7-11
栏目:
基础研究
出版日期:
2020-06-20

文章信息/Info

Title:
Effects of using vertex of curved anterior border of tibial plateau as tibial prosthesis rotational positioning mark on contact mechanics indexes of tibiofemoral joint
作者:
毛勇
(广州市番禺区中医院,广东广州511400)
Author(s):
MAO Yong
Panyu Hospital of Chinese Medicine,Guangzhou 511400,Guangdong,China
关键词:
关节成形术; 置换; 膝;  胫骨;  定位标记;  生物力学;  可行性研究
Keywords:
arthroplasty; replacement; knee;  tibia;  fiducial markers;  biomechanics;  feasibility studies
摘要:
目的:观察胫骨平台前缘圆弧顶点作为胫骨假体旋转定位标志对胫股关节接触力学指标的影响。方法:将6具成人膝关节尸体标本分为3组,每组2具标本,由同一组具备高级职称的医生使用PS型固定平台假体实施全膝关节置换术(total knee arthroplasty,TKA)。观察组以胫骨平台前缘圆弧顶点作为胫骨假体旋转定位参考,对照1组以胫骨结节中内13作为胫骨假体旋转定位参考,对照2组以自我形合法确定胫骨假体旋转定位对线。术后将膝关节标本固定在WDW4100万能试验机上,测定3组膝关节标本的胫股关节内侧总应力、外侧总应力、内侧接触面积、外侧接触面积、内侧接触应力、外侧接触应力、内侧接触应力峰值及外侧接触应力峰值。结果:6具膝关节标本假体均顺利安装完成,胫骨假体位置无明显差异。3组标本的胫股关节内侧总应力[(1.59±0.15)Pa,(1.65±0.01)Pa,(1.71±0.12)Pa,F=1.838,P=0.172]、外侧总应力[(2.65±0.34)Pa,(2.52±0.13)Pa,(2.41±0.21)Pa,F=1.742,P=0.087]、内侧接触面积[(17.35±1.12)cm2,(19.26±1.32)cm2,(18.96±0.92)cm2,F=1.311,P=0.093]、外侧接触面积[(13.91±1.81)cm2,(14.47±0.92)cm2,(14.77±0.81)cm2,F=1.983,P=0.131]、内侧接触应力[(3.97±1.05)Pa,(3.57±0.05)Pa,(4.07±0.17)Pa,F=1.363,P=0.069]、外侧接触应力[(2.52±0.71)Pa,(2.22±0.03)Pa,(1.98±0.13)Pa,F=1.965,P=0.072]、内侧接触应力峰值[(6.21±0.32)Pa,(6.65±0.07)Pa,(6.37±0.16)Pa,F=1.682,P=0.153]、外侧接触应力峰值[(5.74±0.19)Pa,(5.56±0.09)Pa,(5.38±0.32)Pa,F=1.256,P=0.086]比较,组间差异均无统计学意义。结论:TKA手术中以胫骨平台前缘圆弧顶点作为胫骨假体旋转定位标志,术后胫股关节接触力学特征与以往常用定位方法相当,可作为TKA手术中胫骨假体旋转定位的参考标志。
Abstract:
Objective:To observe the effects of using vertex of curved anterior border of tibial plateau as tibial prosthesis rotational positioning mark on contact mechanics indexes of tibiofemoral joint(TFJ).Methods:Six knee specimens from 3 adult cadavers were selected and divided into observation group,control group 1 and control group 2,2 cases in each group.Total knee arthroplasty(TKA)was performed by the same group of surgeons with senior professional titles by using type PS fixed-bearing prosthesis.The vertex of curved anterior border of tibial plateau and the junction of the medial one third and lateral two thirds of tibial tubercle were used as the reference points for tibial prosthesis rotational positioning in observation group and control group 1 respectively,and tibial prosthesis rotational positioning alignment was confirmed by using self-hypotaxis method in control group 2.The knee specimens were fixed on WDW4100 universal testing machine after the surgery.The medial and lateral total stress,contact area,contact stress and peak contact stress of TFJ of knee specimens were measured and compared between the 3 groups.Results:The prostheses installation were finished successfully in all knee specimens,and there was no significant difference in the position of tibial prostheses.There was no statistical difference in medial and lateral total stress,contact area,contact stress and peak contact stress of TFJ of knee specimens between the 3 groups(1.59+-0.15,1.65+-0.01,1.71+-0.12 Pa,F=1.838,P=0.172; 2.65+-0.34,2.52+-0.13,2.41+-0.21 Pa,F=1.742,P=0.087; 17.35+-1.12,19.26+-1.32,18.96+-0.92 cm(2),F=1.311,P=0.093; 13.91+-1.81,14.47+-0.92,14.77+-0.81 cm(2),F=1.983,P=0.131; 3.97+-1.05,3.57+-0.05,4.07+-0.17 Pa,F=1.363,P=0.069; 2.52+-0.71,2.22+-0.03,1.98+-0.13 Pa,F=1.965,P=0.072; 6.21+-0.32,6.65+-0.07,6.37+-0.16 Pa,F=1.682,P=0.153; 5.74+-0.19,5.56+-0.09,5.38+-0.32 Pa,F=1.256,P=0.086).Conclusion:The method of using vertex of curved anterior border of tibial plateau as tibial prosthesis rotational positioning mark in surgery of TKA is similar to conventional positioning methods in postoperative TFJ contact mechanical characteristics,so the vertex of curved anterior border of tibial plateau can be used as a reference mark for tibial prosthesis rotational positioning during the TKA surgery.

参考文献/References:

[1]张雷,廉凯,彭昊,等.CT确定胫骨前后轴指导全膝关节置换过程中胫骨假体的旋转对线[J].中国组织工程研究,2018,22(3):426-431.
[2]ZAMBIANCHI F,FIACCHI F,LOMBARI V,et al.Changes in total knee arthroplasty design affect in-vivo kinematics in a redesigned total knee system:a fluoroscopy study[J].Clin Biomech(Bristol, Avon),2018,54:92-102.
[3]胡承方,罗从风.国人胫骨近端形态学测量调查[J].中华创伤骨科杂志,2007,9(2):126-130.
[4]友斯伟,沈宇辉,王毅.全膝关节置换与胫骨假体旋转对线[J].国际骨科学杂志,2014,35(1):30-32.
[5]郭马珑,崔宏勋,李峰,等.单髁置换术治疗中重度膝关节单间室骨关节炎[J].中医正骨,2017,29(6):16-19.
[6]刘恒,李卓扬,曹永平,等.胫骨侧徒手截骨的膝关节置换术后力线测量及其影响因素分析[J].北京大学学报(医学版),2018,50(5):850-854.
[7]孙振国,翁伟,李恒,等.3D打印技术辅助全膝关节置换术治疗骨关节炎膝外翻畸形的临床研究[J].中医正骨,2018,30(6):34-39.
[8]JOONG I K,JANG J,KI W L,et al.Anterior tibial curved cortex is a reliable landmark for tibial rotational alignment in total knee arthroplasty[J].BMC Musculoskelet Disord,2017,18(1):252.
[9]李相伟,丁晶,甘煜东.个体化导航模板在Oxford单髁置换术股骨和胫骨假体定位中的应用[J].中华骨科杂志,2018,38(3):172-178.
[10] 周一新,蒋毅,张洪,等.胫骨轴向旋转运动与膝关节屈伸运动耦合的研究[J].中华骨科杂志,2004,24(12):747-750.
[11] 杨波,黄爱兵,宋长辉,等.骨性关节炎胫骨近端解剖形态性别差异及临床意义[J].中国矫形外科杂志,2017,25(23):2173-2176.
[12] 吴厦,蔡谞,刘璞,等.膝关节置换术术中与术后胫骨平台假体后倾角差异分析[J].解放军医学院学报,2015,36(3):255-257.
[13] MOST E.Development of a 6-DOF robotic test system for studying the biomechanics of total knee replacement[D].Boston:Massachusetts Institute of Technology,2000.
[14] GAUTHIER P.Tibio-femoral joint contact mechanics:an in-vitro simulation with a 6 DOF static knee simulator[D].Ottawa:University of Ottawa,2016.
[15] HERREGODTS S,BAETS P D,VICTOR J,et al.Use of Tekscan pressure sensors for measuring contact pressures in the human knee joint[J].Sustainable Construction and Design,2015,6(2):1-7.
[16] BEDI A,CHEN T,SANTNER T,et al.Changes in dynamic medial tibiofemoral contact mechanics and kinematics after injury of the anterior cruciate ligament:a cadaveric model[J].Journal of Engineering in Medicine,2013,227(9):1027-1037.
[17] 柴巍巍,尚延春,孙永强,等.全膝关节置换术治疗伸直型膝关节僵硬[J].中医正骨,2017,29(6):56-58.
[18] 陈煜东,魏瑄,刘宏建.单髁置换术治疗老年膝关节内侧间室骨关节炎[J].中医正骨,2018,30(6):67-69.
[19] 朱东,董心,刘百奇,等.膝内翻引起胫骨平台内侧骨质增生的模拟[J].中国生物医学工程学报,2005,24(4):391-396.

相似文献/References:

[1]邢金明.切开复位锁定钢板内固定术和人工半肩关节置换术 治疗老年肱骨近端复杂骨折的对比研究[J].中医正骨,2015,27(08):11.
　XING Jinming.A retrospective trial of open reduction and locking plate internal fixation versus artificial shoulder hemiarthroplasty for complicated proximal humeral fractures in old patients[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(06):11.
[2]赵云昌.人工股骨头置换治疗老年粉碎性股骨转子间骨折[J].中医正骨,2015,27(08):31.
[3]张明强.生物型加长柄半髋关节置换术治疗 高龄不稳定股骨转子间骨折疗效观察[J].中医正骨,2015,27(02):56.
[4]蔡云仙.围手术期耳穴按压联合平衡针疗法 在全膝关节置换术后镇痛中的应用[J].中医正骨,2015,27(06):41.
[5]喻长纯,杨明路,王战朝.不同手术方式治疗胫骨平台骨折畸形愈合的体会[J].中医正骨,2015,27(03):37.
[6]魏瑄,宋树春,王金良.术前精确测量和评估在全髋关节置换治疗 成人发育性髋关节发育不良继发骨关节炎中的价值[J].中医正骨,2015,27(01):30.
[7]鲍荣华,陈晓东,王国平,等.Wagner Cone生物型假体置换结合经股骨转子下横形截骨 治疗CroweⅣ型成人发育性髋关节发育不良[J].中医正骨,2015,27(01):33.
[8]喻长纯,杨明路,王战朝.同期髌骨脱位矫正术联合全膝关节置换术治疗 晚期膝骨关节炎合并习惯性髌骨脱位[J].中医正骨,2015,27(01):41.
[9]武理国,沈军,傅国海,等.人工肱骨头置换治疗老年肱骨近端复杂骨折[J].中医正骨,2013,25(10):70.
[10]李国梁,韩广普,闫国强,等.红花化瘀汤薰蒸联合理筋手法 在膝骨关节炎全膝关节置换术后康复中的应用[J].中医正骨,2013,25(12):31.
　Li Guoliang*,Han Guangpu,Yan Guoqiang,et al.Clinical application of HONGHUAHUAYU decoctions steaming combined with sinew adjusting manipulation in the postoperative rehabilitation of total knee arthroplasty in patients with knee osteoarthritis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2013,25(06):31.
[11]樊庆阳,任凯晶.定制3D打印切模辅助全膝关节置换术治疗 膝骨关节炎合并股骨干骨折畸形愈合[J].中医正骨,2015,27(11):37.
[12]李翰林,童培建.利福平联合用药配合保留假体清创治疗 人工关节置换术后早期感染及低毒性感染[J].中医正骨,2015,27(09):56.
[13]刘晓雅,孙永强,刘国杰.主动快速康复锻炼对全膝关节置换术后关节活动度的影响[J].中医正骨,2015,27(09):73.
[14]张维平,康两期,陈卫,等.全髋关节置换术围手术期隐性失血的研究进展[J].中医正骨,2015,27(08):61.
[15]宋兵华,孙俊英,倪增良,等.全膝关节置换术前CT测量股骨后髁角的临床意义[J].中医正骨,2015,27(07):38.
[16]王金良,孙京涛,李玲,等.骨水泥联合螺钉修复全膝关节置换术中 胫骨平台内侧骨缺损[J].中医正骨,2015,27(12):55.
[17]徐伟锋,叶健,吴连国.强骨饮对骨质疏松性股骨颈骨折患者全髋关节置换术后 血清骨代谢生化指标和骨密度的影响[J].中医正骨,2015,27(02):12.
　XU Weifeng,YE Jian,WU Lianguo.Effect of Qianggu Yin(强骨饮,QGY)on serum bone metabolism indexes and bone density after total hip arthroplasty in patients with osteoporotic femoral neck fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(06):12.
[18]张荣,王健.人工全膝关节置换术的围手术期心理护理[J].中医正骨,2015,27(05):77.
[19]齐志远,陈秀民,王在斌,等.桃红四物加黄芪汤预防人工髋膝关节置换术后 下肢深静脉血栓形成[J].中医正骨,2015,27(03):71.
[20]陆吴超,季卫锋,马镇川.关节镜下清创后持续灌洗联合中药口服治疗 全膝关节置换术后急性期感染[J].中医正骨,2015,27(01):51.

备注/Memo

备注/Memo:
(收稿日期:2019-06-07本文编辑:李晓乐)
更新日期/Last Update: 2020-10-10