活动平台单髁膝关节置换术中胫骨假体后倾角度、股骨假体安放位置不同时聚乙烯垫片和胫骨平台应力对比观察  

Comparative stress analysis of polyethylene inserts and tibial plateaus in unicompartmental knee arthroplasty with mobile platform:observations on two tibial component posterior slopes and three femoral component positions

作　　者：王弢 何云利 张乾 何森 冯哲 边华 WANG Tao;HE Yunli;ZHANG Qian;HE Sen;FENG Zhe;BIAN Hua(Department of Osteoarthrosis,Tianjin Beichen Hospital,Tianjin 300070,China)

机构地区：[1]天津市北辰医院骨关节科,天津300070

出　　处：《山东医药》2024年第3期24-28,共5页Shandong Medical Journal

基　　金：天津市北辰区科研项目(SHGY-2020022)。

摘　　要：目的 对比观察活动平台单髁膝关节置换术中胫骨假体于两个后倾角度、股骨假体于三个位置安放时聚乙烯垫片和胫骨平台应力,为假体安放最佳位置提供参考。方法 利用Mimics、Solidwork、Geomagic Studio等软件,建立正常膝关节和活动平台单髁膝关节假体的有限元模型,在Magics软件中模拟单髁置换膝关节手术,将胫骨假体后倾角度设置为0°、7°,股骨假体分别安放在股骨内髁的中心位置、内移5 mm位置、外移5 mm位置,然后在膝关节屈曲0°、30°、60°、90°的情况下,分别观察聚乙烯垫片、胫骨平台的应力值大小和应力分布情况。结果 当胫骨假体后倾为0°和7°时,与股骨假体安放在内移5 mm的位置相比,安放在中心和外移5 mm的位置聚乙烯垫片和胫骨平台的应力值低(P均<0.05),在股骨假体放置在中心位置和外移5 mm的位置时聚乙烯垫片和胫骨平台的应力分布均匀;当胫骨假体后倾角度增加时,聚乙烯垫片以及胫骨平台应力没有明显变化。结论 活动平台单髁膝关节置换术中股骨假体放置在股骨内髁中心和轻度外移的位置,胫骨假体的后倾角度控制在0°~7°时,聚乙烯垫片和胫骨平台的应力值最小,应力分布均匀。Objective To conduct a comparative stress analysis of polyethylene inserts and tibial plateaus during unicompartmental knee arthroplasty with mobile platform,specifically focusing on two posterior slopes of the tibial component and three positions of the femoral component in order to provide a reference for the optimal placement of the prosthesis.Methods Finite element models of normal knee joints and unicompartmental knee arthroplasty with mobile platform were developed using software such as Mimics,Solidwork,and Geomagic Studio.In the Magics software,we simulated the unicompartmental knee replacement surgery,and adjusted the tibial component posterior slope to 0° and 7°.The femoral component was placed at three locations:the center of the medial condyle of femur,shifted 5 mm inward,and shifted 5 mm outward.Stress values and distribution on polyethylene inserts and tibial plateaus were observed at knee flexion angles of 0°,30°,60°,and 90°.Results When the tibial component had posterior slopes of 0° and 7°,compared to placing the femoral component 5 mm inward,positioning it at the center and 5 mm outward resulted in significantly lower stress values on both polyethylene inserts and tibial plateaus(all P<0.05).When the femoral component was placed at the center and 5 mm outward positions,the stress distribution on polyethylene inserts and tibial plateaus was found to be uniform.With an increase in the posterior slope of the tibial component,there was no significant alteration in stress on polyethylene inserts and tibial plateaus.Conclusion In the unicompartmental knee arthroplasty,when the femoral component is placed at the center of the medial condyle of femur or slightly outward,and the posterior slope of the tibial component is controlled at 0°to 7°,the stress value of the polyethylene insert and the tibial plateau is the smallest,and the stress distribution is uniform.

关 键 词：单髁膝关节置换术 单髁膝关节假体 胫骨假体 股骨假体 聚乙烯垫片应力 胫骨平台应力 

分 类 号：R687[医药卫生—骨科学]