假体偏置角对骨肿瘤全膝关节置换患者下肢生物力学的影响  

Effect of prosthetic offset angle on lower limb biomechanics in patients with bone tumor-type knee arthroplasty

作　　者：王航辉 宋依芯[4] 韩为华 张敏利 朱正飞[5] 朱文侠 WANG Hanghui;SONG Yixin;HAN Weihua;ZHANG Minli;ZHU Zhengfei;ZHU Wenxia(Xi'an International Medical Center Hospital,Shaanxi Xi'an 710100,China;Medical College of Xi'an International University,Shaanxi Xi'an 710077,China;Medical College of Yan'an University,Shaanxi Yan'an 716000,China;Honghui Hospital,Xi'an Jiaotong University,Shaanxi Xi'an 710054,China;School of Mechanical Engineering,Xi'an Jiaotong University,Shaanxi Xi'an 710054,China)

机构地区：[1]西安国际医学中心医院,陕西西安710100 [2]西安外事学院医学院,陕西西安710077 [3]延安大学医学院,陕西延安716000 [4]西安交通大学附属红会医院,陕西西安710054 [5]西安交通大学机械工程学院,陕西西安710054

出　　处：《现代肿瘤医学》2023年第20期3849-3854,共6页Journal of Modern Oncology

基　　金：中国博士后项目(编号:2016M600804);陕西省博士后项目(编号:2016BSHEDZZ92);陕西省重点研发计划(编号:2023-YBSF-402,2023-YBSF-250);延安大学横向科研项目(编号:YAU202212342);西安国际医学中心医院面上项目(编号:2022MS06)。

摘　　要：目的:通过阶梯性改变骨肿瘤全膝关节假体在冠状面和矢状面内的偏置角度,探索骨肿瘤全膝关节假体的偏置角度对患者下肢关节的生物力学影响,以期定量骨肿瘤全膝关节假体在矢状面和冠状面偏置角度的安装许可范围。方法:2010年09月至2020年03月在空军军医大学附属西京医院接受骨肿瘤全膝关节置换手术的24例患者(术后6个月)。构建个体化人工膝关节基于力的动力学模型(force-dependent kinematics,FDK)模型;在Anybody软件中调整患者个体化骨肌模型的膝关节假体组件的FCAVA偏角和FSMAA偏角,步态分析,并得到不同偏角对应的关节载荷与关节力曲线。极差比用于衡量假体组件偏置对关节力的影响程度。结果:假体组件的平均FCAVA为(-0.22±0.97)°,平均FSMAA为(0.23±1.46)°。当假体在冠状面内偏置角度超过2°时,置换侧下肢髋、膝关节力最大增幅可达25%和164%。对于标准关节力曲线而言,健康侧髋、膝关节力峰值分别为4.87 BW、6.07 BW;置换侧髋、膝关节力峰值分别为4.30 BW、5.40 BW。假体在冠状面内的安装许可偏置范围为±2°。假体在矢状面内的偏置角度对下肢关节的生物力学影响不显著。结论:骨肿瘤全膝假体在冠状面内的偏置角度对置换侧的生物力学影响比较明显,建议外科医生在术中假体安装时应尽量保证其偏置角度的许可范围为±2°。Objective:By stepwise changing the offset angle of the total knee prosthesis for malignant bone tumors around the knee joint in the coronal and sagittal planes,we explored the biomechanical impact of the offset angle of the total knee prosthesis for bone tumors on the lower limb joints of patients,with a view to quantifying the installation permission range of the total knee prosthesis for bone tumors in the sagittal and coronal planes.Methods:From September 2010 to March 2020,24 patients with bone tumors underwent total knee replacement surgery in Xijing Hospital Affiliated to Air Force Medical University(6 months after surgery).Constructe a multibody dynamic FDK model for bone and muscle of individual artificial knee joint.Adjust the femoral coronal anatomical valgus angle(FCAVA)offset angle and femoral sagittal mechanical anatomical angle(FSMAA)offset angle of the knee prosthesis component of the patient's individualized skeletal muscle model in the Anybody software,gait analysis and obtain the joint load and joint force curves corresponding to different deflection angles.Range ratio was used to measure the influence of component offset on joint force.Results:The average FCAVA and FSMAA of the prosthesis components were(-0.22±0.97)°,(0.23±1.46)°respectively.When the offset angle of the prosthesis in the coronal plane exceeded 2°,the maximum increase of the hip and knee joint force of the lower limb on the replacement side can reach 25% and 164%.For the standard joint force curve,the peak values of hip and knee joint forces on the healthy side were 4.87 BW and 6.07 BW respectively.The peak force of hip and knee joint on the replacement side was 4.30 BW and 5.40 BW respectively.The allowable offset range of prosthesis installation in the coronal plane was ±2°.The offset angle of the prosthesis in the sagittal plane had no significant effect on the biomechanics of the lower limb joints. Conclusion: The offset angle of the total knee prosthesis of bone tumor in the coronal plane has an obvious impact on the

关 键 词：假体偏置 骨肿瘤全膝关节置换 生物力学 

分 类 号：R738.1[医药卫生—肿瘤]