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  

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[1] MAO Yong(Panyu Hospital of Chinese Medicine,Guangzhou 511400,Guangdong,China)

机构地区：[1]广州市番禺区中医院,广东广州511400

出　　处：《中医正骨》2020年第6期7-11,共5页The Journal of Traditional Chinese Orthopedics and Traumatology

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1/3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)cm^2,(19.26±1.32)cm^2,(18.96±0.92)cm^2,F=1.311,P=0.093]、外侧接触面积[(13.91±1.81)cm^2,(14.47±0.92)cm^2,(14.77±0.81)cm^2,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。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 ma

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 

分 类 号：R687.4[医药卫生—骨科学]