活动平台全膝关节假体和单髁膝关节假体置换术后的步态对比分析  

Comparison of gait analysis between mobile-bearing total knee arthroplasty and unicompartmental knee arthroplasty

作　　者：刘志宏[1,2] 张炅[2] 何川[1,2] 王毅[1,2] 冯建民[2] 王尚城[3] 黄萍[1] 邓廉夫[1] 郑乃权 

机构地区：[1]上海市伤骨科研究所,200025 [2]上海交通大学医学院附属瑞金医院骨科,200025 [3]美国北卡罗莱纳大学生物医学工程中心,夏洛特28223

出　　处：《中华关节外科杂志（电子版）》2017年第1期17-22,共6页Chinese Journal of Joint Surgery(Electronic Edition)

基　　金：上海市卫计委科研项目(20134211)

摘　　要：目的比较活动平台全膝关节假体和单髁膝关节假体置换术后,患者膝关节在平地行走中的运动学及动力学特点。方法选择上海交通大学医学院附属瑞金医院骨科自2011年7月至2014年10月间进行的活动平台全膝关节置换术(29例)和单髁膝关节假体置换术(22例)的患者,并选择18例健康志愿者作为健康对照组。采用10镜头红外运动捕捉系统记录体表53枚反光标记物的运动轨迹,并采用测力板记录地面反作用力。通过这些运动轨迹和地面反作用力我们计算膝关节在平地行走中的三维运动(移动和转动)和关节受到的力和力矩。然后应用SPSS 19.0软件的单因素ANOVA对这些运动学和动力学参数进行比较。结果单髁置换术后股骨前移程度优于活动平台置换(F=6.5,P<0.05)。采用活动平台置换股骨内旋程度小于单髁置换(F=5,P<0.05)。采用单髁置换后,站立相膝关节伸直时的伸直扭矩(F=28.6,P<0.01)及站立中期的外翻扭矩(F=6,P<0.05)均显著大于正常人群,但活动平台减少扭矩的优势仅在站立初期阶段明显(F=9,P<0.05)。结论单髁置换后膝关节在正常平地行走中更接近正常的运动学和动力学表现,结合其较明显的临床优势,可推荐用于治疗单间室膝骨关节炎患者。Objective To compare the kinematic and kinetic characteristics during level walking between the patients received mobile-bearing total knee arthroplasty（MB-TKA） and unicompartmental knee arthroplasty（UKA）.Methods Twenty-nine and 22 patients received MB-TKA and UKA respectively from July 2011 to October 2014 in Ruijin Hospital,Shanghai Jiao Tong University.Eighteen healthy volunteers were recruited in the control group.A 10-camera infrared motion capture system was applied to track the motions of 53 reflection markers on body surface,and the ground reaction forces were recorded with two force plates.Three-dimensional（3D） motion and force/torque of the knee joint were determined from the motion data and ground reaction forces.Differences in 3D joint motion and force/torque were compared using one-way ANOVA（SPSS）.Results UKA presented better anterior and medial translation than MB-TKA（F = 6.5,P 〈0.05）.Excessive femoral internal rotation was avoided after MBTKA which was better from UKA（F = 5,P〈 0.05）.The extension（F = 6,P〈 0.05） and valgus torques（F = 6,P〈 0.05） during the standing phase in the UKA patients were greater than the healthy volunteers.The advantages of MB-TKA in reducing axial rotation torque was only statistically significant during the early stance（F = 9,P 〈0.05）.Conclusion UKA shows better kinematic and kinetic results during level walking,and it can be recommended to treat unicompartmental knee arthritis when the clinical advantages are also considered.

关 键 词：关节成形术 置换 膝 膝关节 人工 步态 

分 类 号：R687.4[医药卫生—骨科学]