摘要
目的:在人工膝关节置换术中,膝假体尤其是解剖型假体大多是模仿人膝关节几何外型尺寸(尤其是股骨髁部分),并参考假体植入后的运动及稳定性等设计,因此,研究膝关节几何外形尺寸对人工膝关节设计有重要意义。资料来源:应用计算机检索Pubmed数据库1990-01/2005-04有关膝关节几何外形尺寸测量的文章,检索词“kneejoint,geometry measure-ment,prosthesis design,TKA”,限定文章语言种类为English,研究对象为人类。同时计算机检索中国期刊全文数据库、万方数据1994-01/2005-04期间的相关文章,检索词“膝关节外形尺寸测量、人工膝关节假体设计”,限定文章语言种类为中文。资料选择:对资料进行初审,选取符合研究要求的有关文章,查找全文。纳入标准:①有关膝关节几何外形尺寸测量的研究。②有关人工膝关节假体设计的研究。排除标准:重复研究。资料提炼:共收集到135篇有关膝关节假体设计及膝关节外形尺寸测量的文章,排除重复或类似的同一研究,17篇符合研究要求。资料综合:①国内膝关节假体尺寸研究:有研究对正常人膝关节进行三维CT扫描,按身高不同分为3组,每组各获得6个正常左右膝关节数据,合每组数据建立典型的膝关节三维解剖模型;对120例240个正综常人膝关节CT扫描后所输出的数据进行三维重建,并行相关参数的测量和分析,初步建立国内正常人膝关节模型和国人正常膝关节相关指标参考值;对数字化虚拟中国男性一号的膝关节断面切片图像,提供膝关节的有限元生物力学仿真分析。②国外膝关节假体尺寸研究:通过对尸体骨CT扫描,应用计算机辅助设计三维重建测量分析后,指出在人工膝关节置换术中,不仅要恢复肢体正常的力线,而且假体的几何形状要与个人人体相匹配,从而使假体能与周围保留的软组织协调运动。③膝关节假体尺寸研究展望:提供更多尺寸、或不同尺寸比率来得到最大的截骨覆盖面,重建膝关节。结论:人工膝关节设计方面不但需要大量人体解剖学研究资料,还需要测量股骨远端、胫骨近端和髌骨实体的几何学、形态学相关的数据及病态膝关节截骨后的相关数据,才能设计出符合人解剖结构的人工假体,而且型号从小至大,应俱全,供给假体的型号愈多,择余地愈大,一选手术效果亦愈理想。
OBJECTIVE： During total knee prosthesis replacement, most knee prosthesis are imitate the dimension of human knee geometry feature （especially the part of femoral condyles）, reference on the motion and stability after prosthesis replacement. So the dimension of human knee geometry feature is significantly important on prosthesis design. DATA SOURCES： By using the keywords of ＂knee joint, geometry measurement, prosthesis design, TKA＂, the Pubmed database was searched to identify articles about the geometry measurement of knee joint with the subjects of human being published in English between January 1990 and April 2005. At the same time, the same keywords Chinese were used to search Chinese relevant articles published between January 1990 and April 2005 in Chinese journal full-text database and Wanfang database. STUDY SELECTION： All article were selected firstly, and those relevant to the dimensions geometry feature of total knee prosthesis and the study on the design of knee prosthesis were selected. Exclusive criteria： the repeated study and reviews. DATA EXTRACTION： A total 135 articles on the dimensions geometry feature of total knee prosthesis and the study on the design of knee prosthesis were collected, and the repeated and analogous identical study and review article were excluded, finally 17 articles accorded with the study. DATA SYNTHESIS： ①Study on the dimension of knee prosthesis in China： Existing studies are based on three-dimensional CT scan of the normal knees; All the cases were divided into three groups according to the body height of each individual with each group consisting of 6 individuals. Data of the 6 normal knees were integrated to create a typical three- dimensional anatomical model. To find the three-dimensional （3D） solid model and the parameter database of the healthy Chinese knee of the knee joint. The CT imaging data of 120 normal adult volunteers 240 knees were obtained -and analyzed. The fundamental relevant reference data were got. The normal knee model was reconstructed and measured. To provide a three-dimensional （3D） model of the knee joint of digitized Virtual Chinese Male No. 1 for finite element simulation. ②Study on the dimension of knee prosthesis abroad： According to the analysis through CAD （Computer Aid Design） software based on the knees of cadaveric bone by using three dimensional CT scan and, the 3-D solid model were reconstructed and measured. The results indicates that not only the normal bearing line of the limbs should be recovered during the TKA but also the geometry shape of the prosthesis should match each patient in order to make the prosthesis maintain the coordinated motion with the remained soft issue. ③The prospect on the study of the dimension of knee prosthesis：to provide more kinds of dimension or the ratio of different dimension as to get the biggest osteotomied surface to reconstruct the knee joints. CONCLUSION： The design of knee prosthesis need not only much of anatomical data, the relevant geometry and morphology data of distal femoral, proximal tibia and patella but also the data of after osteotomy of abnormal knee joint, so the knee prosthesis could fit anatomical body of human being. Anatomical knee prosthesis should have all kinds of dimensions. The more dimensions we design the more chance we choose, so the effect of operation will get better.
出处
《中国临床康复》
CSCD
北大核心
2006年第1期141-143,共3页
Chinese Journal of Clinical Rehabilitation
