连接型人工膝关节假体运动和负重模式的演变和进展  

Evolution and trend of motion and loading modes in hinge knee prosthesis

作　　者：高小康 张净宇 刘金伟 田东牧 胡永成[1,2] 徐卫国[1,2] Gao Xiaokang;ZhangJingyu;Liu Jinwei;Tian Dongmu;Hu Yongcheng;Xu Weiguo(Tianjin Hospital,Tianjin 300202,China;Clinical School/College of Orthopedics,Tianjin Medical University,Tianjin 300202,China;North China Medical Health Group Fengfeng General Hospital,Handan 056000,China;Shandong Weigao Orthopaedic Device Co.,Ltd.,Weihai 264200,China)

机构地区：[1]天津市天津医院,300202 [2]天津医科大学骨科临床学院,300202 [3]华北医疗健康集团峰峰总医院,邯郸056000 [4]山东威高骨科材料股份有限公司,威海264200

出　　处：《中华关节外科杂志(电子版)》2024年第4期505-516,共12页Chinese Journal of Joint Surgery(Electronic Edition)

基　　金：天津市卫生健康委员会科技项目重点学科专项(TJWJ2024XK015)

摘　　要：人工假体的普及,翻修患者的逐年增加和骨肿瘤保肢手术的成功应用,导致应用和潜在应用连接型膝关节假体的患者数量增加。连接型膝关节假体是关节内外韧带稳定机制失效的重建手段,目前经历了从屈曲铰链的单轴运动、旋转铰链的双轴运动、球轴铰链的多轴运动三代演变。连接型膝关节假体运动模式经历由屈曲铰链单轴运动,到旋转铰链双轴运动,再到球轴铰链多轴运动。负重模式从完全由铰链负重,到髁负重比例增大和完全髁负重。假体的限制和约束逐步减小,生物力学分布更合理,减少了应力集中,降低了磨损、松动和断裂几率,假体的生存率提高,并发症降低。然而和非限制性假体相比,连接型假体术后的远期效果差。本文总结归纳连接型人工膝关节假体在运动和负重模式的演变规律,为假体研究和设计提供借鉴和思路。The popularity of prostheses,the annual increase in revision patients and the successful application of limb salvage surgery for bone tumors have led to an increase in the number of patients with the application and potential application of hinge knee prostheses.Hinge knee prosthesis is a means to reconstruct the failure of the stability mechanism of the internal and external ligaments of the joint.It has undergone three generations of evolution from the uniaxial movement of fixed hinge,the biaxial movement of rotating hinge,and multi-axial movement of spherical axis.The motion mode of the hinge knee prosthesis goes through uniaxial movement of fixed hinge,biaxial movement of rotating hinge,and multi-axial movement of spherical axis hinge.Loading modes range from full hinge load,to increased condylar load ratio and then full condylar load.The limitations and constraints of the prosthesis gradually decrease,the biomechanical distribution becomes more reasonable,stress concentration is reduced,the probability of wear,loosening,and fracture is declined,the survival rate of the prosthesis is improved,and complications are lowered.However,compared with primary total knee arthroplasty prostheses,hinge prostheses have poorer long-term outcomes.This article summarized the evolution of hinge knee prostheses in motion and loading modes,and to provide references and ideas for prosthetic research and design.

关 键 词：人工膝关节假体 运动 负重 关节不稳定性 生物力学现象 应力 物理 假体失效 假体设计 存活率 

分 类 号：R687.4[医药卫生—骨科学]