国人内侧旋转中心膝关节假体的设计和运动学分析
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摘要
第一部分适合国人股骨远端截面及股骨外旋角度的膝关节假体设计
目的:根据国人股骨远端截骨面及根据国人的股骨远端截面和股骨远端外旋角度放置的研究,根据国人解剖特点进行修改设计。
方法:回顾研究国人股骨远端截骨面及根据国人的股骨远端截面和股骨远端外旋角度放置的数据,提出以国人解剖基础设计的膝关节假体股骨组件,利用Imageware软件(Unigraphics solutions公司,美国),根据膝关节假体原型,和国人解剖特点进行修改设计。
结果:设计的股骨假体包括优化股骨前后径和左右径的比值,在相同前后径的条件下增大左右径,按测量的中值扩大1.207倍;股骨外旋角度的优化,增大股骨外旋角度为5°,采用Build-in的方式,增加股骨外后髁的厚度来优化股骨外旋角度。
结论:优化膝关节股骨原型假体的前后径/左右径比值,在相同的前后径情况下,将左右径扩大到原来的1.207倍。选用build-in的方式增加股骨外后髁厚度,使外旋为5°。
第二部分适合国人胫骨截面胫骨托假体设计及胫骨托茎的优化
目的:根据国人胫骨近端截骨面解剖研究,以国人解剖基础设计的膝关节假体胫骨托。
方法:根据国人胫骨近端截骨面解剖研究,以及不同胫骨托茎的固定特点和内侧旋转中心假体的要求,提出以国人解剖基础设计的膝关节假体胫骨托和胫骨茎的设计,利用Imageware软件(Unigraphics solutions公司,美国),根据假体原型,进行设计。
结果:国人胫骨近端截骨面前后径/左右径比值较现有进口假体大,我们选取中值0.716,在相同胫骨左右径条件下,增大前后径1.07倍;交叉型茎能更好的分散负荷,内侧骨质吸收更为常见,为此在内侧增加一个翼。
结论:优化胫骨假体原型前后径扩大1.07倍,胫骨茎内侧增加一个翼。
第三部分胫股关节内侧旋转中心屈伸运动的优化设计
目的:通过对自然膝的运动学研究,设计出模仿自然膝运动内侧旋转中心屈曲运动的假体。利用Imageware软件(Unigraphics solutions公司,美国),在软件上反求出胫骨衬垫的形状。。
方法:利用Imageware软件(Unigraphics solutions公司,美国),胫骨被初始为平面,在正上方成型。在屈曲0°,股骨部件嵌入胫骨表面6mm,应用逻辑剪影产生胫骨凹陷。股骨部件屈曲,向后移位,并且以内侧为中心旋转,进行另外一个逻辑剪影。重复这个过程从0°到135°,在期间股骨线性移位12mm,旋转20°。当它向后移位时,股骨髁始终在胫骨凹陷的底部,潜在能量最小的位置也随屈曲向后移位。
结果:对自然膝运动研究显示在屈曲过程中,股骨中心向后移位伴随通过内侧胫骨平台的垂直轴进行的内旋,屈曲伴随胫骨内旋,膝关节在侧位几乎是铰链运动。模仿自然膝的运动,采用软件逻辑剪影技术反求出胫骨垫片的形状。
结论:模仿自然膝的运动,采用软件逻辑剪影技术反求出胫骨垫片的形状,通过胫骨垫片的形状。无论那一部分软组织被保留或被切除,根据特殊的设计,运动特征应与正常膝关节相似。
第四部分国人内侧旋转中心膝关节假体在全膝关节置换术后运动学分析
目的:在建立的自然膝数字模拟模型,进行初步的运动学验证。
方法:与交通大学机械和动力学研究所合作建立自然膝数字模拟模型;在自然膝模型上,模拟常规膝关节置换手术,安装设计的膝关节假体,进行相关运动学进行研究。分别测量股骨胫骨的相对运动和接触面的位置。
结果:股骨屈曲和运动时间的关系和胫骨内旋和运动时间的关系比较可以看出,随着股骨的屈曲,胫骨逐渐内旋,屈曲到120°,达到内旋20°,达到了设计要求的随屈曲角度增加,胫骨逐渐内旋的要求。从股骨外髁在胫骨垫片的接触面的位置可以看出,股骨外髁随屈曲角度的增加向后滑移,在整个屈曲过程中,未发现有向前的反常运动。
结论:在建立的自然膝数字模拟模型的膝关节置换模拟显示,设计的膝关节假体可以模拟自然膝的运动,未发现反常运动。
PART ONE Design of femoral component based on study on Morphometrical measurements of resected surface and lateral rotated degree of femur of Chinese
Objective:To Design of femoral component based on study on morphometrical measurements of resected surface and external rotation degree of femur of Chinese.
Methods:Review the literatures about the morphometrical measurements of resected surface and external rotation degree of femur of Chinese. Using software Imageware (Unigraphics solutions, USA),the femoral component was designed in the prime type of a dual-radius knee system, based on Chinese anatomical characteristics.
Results: Chinese femoral aspect rate(medial-lateral width/ anterior-posterior length) is larger than that of the Western people. We enlarge medial-lateral width 1.207 times. Femoral external rotation degree is 5°in Chinese, so we increase the external rotation degree by thickening lateral femoral posterior condyle.
Conclusion: Medial-lateral width was enlarged 1.207 times and lateral femoral posterior condyle was thickened by build-in.
Part Two Design of tibial component based on study on Morphometrical measurements of resected surface of tibia of Chinese
Objective : To Design tibial component based on study on morphometrical measurements of resected surface of tibia of Chinese and the mechanical properties of tibial component fixation.
Methods:Review the literatures about the morphometrical measurements of resected surface of tibia of Chinese, and the mechanical properties of tibial component fixation.Using software Imageware (Unigraphics solutions, USA), the tibial component was designed in the prime type based on Chinese anatomical characteristics, and the mechanical properties of tibial component fixation to ensure good stability and provide a homogeneous loading distribution.
Results:The AP/ML ratio of proximal tibial resected surface of Chinese population was larger than those of several commonly imported tibial baseplates of total knee prosthesis. The cylindrical stem produces heterogeneous BMD changes under the tibial platform in knee arthroplasties, and this could be a potential risk factor for asymmetrical subsidence of this component, and large decrease in the medial region.however, the cruciform stem allows a more uniform loading distribution, resulting in a more homogeneous BMD decrease in the three analysed ROIs.
Conclusion:The tibial component was enlarge the anteroposterior dimension 1.07 times, and the stem of the cruciform stem was added a new flange under the medial plane.
Part Three Design of The Medial Pivot knee
Objective:To design a medial pivot knee system to achieve a normal neutral anatomical path of motion with a total knee arthroplasty (TKA) using specific motion-guiding design features.
Methods:The tibia initially was shaped correctly in the overhead view but was flat on its upper surface. At 0°flexion, the femoral component was embedded into the tibial surface by 6 mm, and a boolean subtraction was carried out creating a depression in the tibia. The femoral component was flexed, displaced posteriorly, and rotated about the center, and another boolean subtraction performed. This procedure was repeated at flexion intervals from 0°to 135°, during which the femur was displaced linearly with flexion to a total of 12 mm and was rotated linearly with flexion to a total of 20°.
Results: Describing three-dimensional knee motion by rigid body analysis has shown that during flexion, there is a posterior translation of the center of the femur and an internal tibial rotation. This motion is closely equivalent to only an internal rotation about a vertical axis through the medial tibial plateau. A special insert was generated.
Conclusion: Knee kinematics of nature knee is medial pivot.The tibial bearing surfaces are shaped so that normal knee motion is possible without a cam.
Part Four Kinematics Study on the Medial Pivot Knee of Chinese in Total Knee Arthroplasty
Objective:To develop a three dimensional anatomical configuration model of the human knee , and validated to compute the kinematics of the medial pivot knee of Chinese in total knee arthroplasty. Methods:According to the model building principle from point to line to area to volume of mimics software, a three dimensional anatomical configuration model of the knee joint was reconstructed on the basis of the images of CT and MRI. In addition, quadriceps, ligaments and other soft tissues are defined as non-linear fiber, meanwhile simulating knee extension activity with input variable of quadriceps forces. We used the validated computer simulation of the knee joint to virtually insert the medial pivot knee of Chinese, then, flexed the knee from 0°to 120°。Recorded the angles of flexion of the knee and rotation of the tibia along time; the contact area of lateral femoral condyle with the insert.
Results:When the knee was flexed to 120°, the angle of rotation of the tibia was 20°,and the lateral femoral condyle moved posteriorly.
Conclusion:The medial pivot knee of Chinese can mimesis the nature knee, and the paradoxical movement was not presented.
目的:根据国人股骨远端截骨面及根据国人的股骨远端截面和股骨远端外旋角度放置的研究,根据国人解剖特点进行修改设计。
方法:回顾研究国人股骨远端截骨面及根据国人的股骨远端截面和股骨远端外旋角度放置的数据,提出以国人解剖基础设计的膝关节假体股骨组件,利用Imageware软件(Unigraphics solutions公司,美国),根据膝关节假体原型,和国人解剖特点进行修改设计。
结果:设计的股骨假体包括优化股骨前后径和左右径的比值,在相同前后径的条件下增大左右径,按测量的中值扩大1.207倍;股骨外旋角度的优化,增大股骨外旋角度为5°,采用Build-in的方式,增加股骨外后髁的厚度来优化股骨外旋角度。
结论:优化膝关节股骨原型假体的前后径/左右径比值,在相同的前后径情况下,将左右径扩大到原来的1.207倍。选用build-in的方式增加股骨外后髁厚度,使外旋为5°。
第二部分适合国人胫骨截面胫骨托假体设计及胫骨托茎的优化
目的:根据国人胫骨近端截骨面解剖研究,以国人解剖基础设计的膝关节假体胫骨托。
方法:根据国人胫骨近端截骨面解剖研究,以及不同胫骨托茎的固定特点和内侧旋转中心假体的要求,提出以国人解剖基础设计的膝关节假体胫骨托和胫骨茎的设计,利用Imageware软件(Unigraphics solutions公司,美国),根据假体原型,进行设计。
结果:国人胫骨近端截骨面前后径/左右径比值较现有进口假体大,我们选取中值0.716,在相同胫骨左右径条件下,增大前后径1.07倍;交叉型茎能更好的分散负荷,内侧骨质吸收更为常见,为此在内侧增加一个翼。
结论:优化胫骨假体原型前后径扩大1.07倍,胫骨茎内侧增加一个翼。
第三部分胫股关节内侧旋转中心屈伸运动的优化设计
目的:通过对自然膝的运动学研究,设计出模仿自然膝运动内侧旋转中心屈曲运动的假体。利用Imageware软件(Unigraphics solutions公司,美国),在软件上反求出胫骨衬垫的形状。。
方法:利用Imageware软件(Unigraphics solutions公司,美国),胫骨被初始为平面,在正上方成型。在屈曲0°,股骨部件嵌入胫骨表面6mm,应用逻辑剪影产生胫骨凹陷。股骨部件屈曲,向后移位,并且以内侧为中心旋转,进行另外一个逻辑剪影。重复这个过程从0°到135°,在期间股骨线性移位12mm,旋转20°。当它向后移位时,股骨髁始终在胫骨凹陷的底部,潜在能量最小的位置也随屈曲向后移位。
结果:对自然膝运动研究显示在屈曲过程中,股骨中心向后移位伴随通过内侧胫骨平台的垂直轴进行的内旋,屈曲伴随胫骨内旋,膝关节在侧位几乎是铰链运动。模仿自然膝的运动,采用软件逻辑剪影技术反求出胫骨垫片的形状。
结论:模仿自然膝的运动,采用软件逻辑剪影技术反求出胫骨垫片的形状,通过胫骨垫片的形状。无论那一部分软组织被保留或被切除,根据特殊的设计,运动特征应与正常膝关节相似。
第四部分国人内侧旋转中心膝关节假体在全膝关节置换术后运动学分析
目的:在建立的自然膝数字模拟模型,进行初步的运动学验证。
方法:与交通大学机械和动力学研究所合作建立自然膝数字模拟模型;在自然膝模型上,模拟常规膝关节置换手术,安装设计的膝关节假体,进行相关运动学进行研究。分别测量股骨胫骨的相对运动和接触面的位置。
结果:股骨屈曲和运动时间的关系和胫骨内旋和运动时间的关系比较可以看出,随着股骨的屈曲,胫骨逐渐内旋,屈曲到120°,达到内旋20°,达到了设计要求的随屈曲角度增加,胫骨逐渐内旋的要求。从股骨外髁在胫骨垫片的接触面的位置可以看出,股骨外髁随屈曲角度的增加向后滑移,在整个屈曲过程中,未发现有向前的反常运动。
结论:在建立的自然膝数字模拟模型的膝关节置换模拟显示,设计的膝关节假体可以模拟自然膝的运动,未发现反常运动。
PART ONE Design of femoral component based on study on Morphometrical measurements of resected surface and lateral rotated degree of femur of Chinese
Objective:To Design of femoral component based on study on morphometrical measurements of resected surface and external rotation degree of femur of Chinese.
Methods:Review the literatures about the morphometrical measurements of resected surface and external rotation degree of femur of Chinese. Using software Imageware (Unigraphics solutions, USA),the femoral component was designed in the prime type of a dual-radius knee system, based on Chinese anatomical characteristics.
Results: Chinese femoral aspect rate(medial-lateral width/ anterior-posterior length) is larger than that of the Western people. We enlarge medial-lateral width 1.207 times. Femoral external rotation degree is 5°in Chinese, so we increase the external rotation degree by thickening lateral femoral posterior condyle.
Conclusion: Medial-lateral width was enlarged 1.207 times and lateral femoral posterior condyle was thickened by build-in.
Part Two Design of tibial component based on study on Morphometrical measurements of resected surface of tibia of Chinese
Objective : To Design tibial component based on study on morphometrical measurements of resected surface of tibia of Chinese and the mechanical properties of tibial component fixation.
Methods:Review the literatures about the morphometrical measurements of resected surface of tibia of Chinese, and the mechanical properties of tibial component fixation.Using software Imageware (Unigraphics solutions, USA), the tibial component was designed in the prime type based on Chinese anatomical characteristics, and the mechanical properties of tibial component fixation to ensure good stability and provide a homogeneous loading distribution.
Results:The AP/ML ratio of proximal tibial resected surface of Chinese population was larger than those of several commonly imported tibial baseplates of total knee prosthesis. The cylindrical stem produces heterogeneous BMD changes under the tibial platform in knee arthroplasties, and this could be a potential risk factor for asymmetrical subsidence of this component, and large decrease in the medial region.however, the cruciform stem allows a more uniform loading distribution, resulting in a more homogeneous BMD decrease in the three analysed ROIs.
Conclusion:The tibial component was enlarge the anteroposterior dimension 1.07 times, and the stem of the cruciform stem was added a new flange under the medial plane.
Part Three Design of The Medial Pivot knee
Objective:To design a medial pivot knee system to achieve a normal neutral anatomical path of motion with a total knee arthroplasty (TKA) using specific motion-guiding design features.
Methods:The tibia initially was shaped correctly in the overhead view but was flat on its upper surface. At 0°flexion, the femoral component was embedded into the tibial surface by 6 mm, and a boolean subtraction was carried out creating a depression in the tibia. The femoral component was flexed, displaced posteriorly, and rotated about the center, and another boolean subtraction performed. This procedure was repeated at flexion intervals from 0°to 135°, during which the femur was displaced linearly with flexion to a total of 12 mm and was rotated linearly with flexion to a total of 20°.
Results: Describing three-dimensional knee motion by rigid body analysis has shown that during flexion, there is a posterior translation of the center of the femur and an internal tibial rotation. This motion is closely equivalent to only an internal rotation about a vertical axis through the medial tibial plateau. A special insert was generated.
Conclusion: Knee kinematics of nature knee is medial pivot.The tibial bearing surfaces are shaped so that normal knee motion is possible without a cam.
Part Four Kinematics Study on the Medial Pivot Knee of Chinese in Total Knee Arthroplasty
Objective:To develop a three dimensional anatomical configuration model of the human knee , and validated to compute the kinematics of the medial pivot knee of Chinese in total knee arthroplasty. Methods:According to the model building principle from point to line to area to volume of mimics software, a three dimensional anatomical configuration model of the knee joint was reconstructed on the basis of the images of CT and MRI. In addition, quadriceps, ligaments and other soft tissues are defined as non-linear fiber, meanwhile simulating knee extension activity with input variable of quadriceps forces. We used the validated computer simulation of the knee joint to virtually insert the medial pivot knee of Chinese, then, flexed the knee from 0°to 120°。Recorded the angles of flexion of the knee and rotation of the tibia along time; the contact area of lateral femoral condyle with the insert.
Results:When the knee was flexed to 120°, the angle of rotation of the tibia was 20°,and the lateral femoral condyle moved posteriorly.
Conclusion:The medial pivot knee of Chinese can mimesis the nature knee, and the paradoxical movement was not presented.
引文
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