后稳定型全膝关节假体的骨肌多体动力学研究  

Musculoskeletal multibody dynamics investigation of posterior-stabilized total knee prosthesis

作　　者：陈瑱贤 张志峰[2] 高永昌 张静 郭磊 靳忠民 CHEN Zhenxian;ZHANG Zhifeng;GAO Yongchang;ZHANG Jing;GUO Lei;JIN Zhongmin(School of Construction Machinery,Chang'an University,Xi’an 710064,P.R.China;Department of Arthroplasty Surgery,the Second Affiliated Hospital of Inner Mongolia Medical University,Hohhot 010030,P.R.China;School of Mechanical Engineering,Southwest Jiaotong University,Chengdu 610031,P.R.China)

机构地区：[1]长安大学工程机械学院,西安710064 [2]内蒙古医科大学第二附属医院关节外科,呼和浩特010030 [3]西南交通大学机械工程学院,成都610031

出　　处：《生物医学工程学杂志》2022年第4期651-659,共9页Journal of Biomedical Engineering

基　　金：国家自然科学基金(11902048,52035012);陕西省自然科学基金(2022JQ-529,2022JM-254);内蒙古自治区自然科学基金(2020MS08144);长安大学中央高校基本科研业务费专项资金(300102252106)。

摘　　要：后稳定型全膝关节假体已经被广泛应用于骨科临床治疗膝骨关节炎,但是胫骨衬垫立柱的磨损、断裂以及假体松动等失效问题依然困扰着患者和医生。了解患者体内膝关节假体的生物力学特性有利于降低术后的假体翻修率和患者不满意度。本文针对6种不同后稳定型全膝关节假体分别建立了全膝关节置换的骨肌多体动力学模型,在模拟走路、右转和下蹲3种生理活动下,对比研究了6种后稳定型全膝关节假体的生物力学差异。结果表明,在走路、右转和下蹲活动中PFC Sigma和Scorpio NGR两种假体的立柱所受接触力较大,增加了立柱断裂和磨损破坏以及假体早期松动的风险。Gemini SL的螺旋型立柱设计更有利于膝关节的内外旋转运动,同时避免了立柱边沿接触磨损。后稳定型全膝关节假体矢状面较低的关节面匹配度设计和较晚的立柱-凸轮相遇接触设计将导致较大的前后平移运动。本文为临床指导医生选择、改进假体设计和降低假体失效提供了理论支撑。Posterior-stabilized total knee prostheses have been widely used in orthopedic clinical treatment of knee osteoarthritis,but the patients and surgeons are still troubled by the complications,for example severe wear and fracture of the post,as well as prosthetic loosening.Understanding the in vivo biomechanics of knee prostheses will aid in the decrease of postoperative prosthetic revision and patient dissatisfaction.Therefore,six different designs of posteriorstabilized total knee prostheses were used to establish the musculoskeletal multibody dynamics models of total knee arthroplasty respectively,and the biomechanical differences of six posterior-stabilized total knee prostheses were investigated under three simulated physiological activities:walking,right turn and squatting.The results showed that the post contact forces of PFC Sigma and Scorpio NGR prostheses were larger during walking,turning right,and squatting,which may increase the risk of the fracture and wear as well as the early loosening.The post design of Gemini SL prosthesis was more conductive to the knee internal-external rotation and avoided the edge contact and wear.The lower conformity design in sagittal plane and the later post-cam engagement resulted in the larger anterior-posterior translation.This study provides a theoretical support for guiding surgeon selection,improving posterior-stabilized prosthetic design and reducing the prosthetic failure.

关 键 词：全膝关节置换 后稳定型全膝关节假体 立柱-凸轮机构 骨肌多体动力学 接触力 关节运动 

分 类 号：R687.4[医药卫生—骨科学]