Catani F, Benedetti M G, De Felice R, Buzzi R, Giannini S, Aglietti P
Gait Analysis Laboratory, Department of Orthopaedic Surgery, Istituto Ortopedico Rizzoli, University of Bologna, Via Di Barbiano 1/10, Bologna 40136, Italy.
Clin Biomech (Bristol). 2003 Jun;18(5):410-8. doi: 10.1016/s0268-0033(03)00044-5.
The purpose of this investigation is to determine the functional performance of the mobile bearing total knee replacement prosthesis as compared to the fixed bearing type total knee replacement prosthesis.
Kinematics, kinetics, and electromyography data were gained from 10 patients with mobile bearing and 10 patients with a fixed bearing posterior stabilized Insall Burstein II total knee replacement during ascending and descending stairs. A control group of 10 normal subjects, matched by sex and age, was also analysed.
No significant biomechanical differences in patients with different total knee replacement designs have been reported from level-walking studies. Slightly better performance of posterior retaining with respect to cruciate sacrificing total knee replacement designs have been claimed from stair climbing studies. Only one study has been conducted regarding mobile versus fixed bearing total knee replacement assessed by gait analysis. This study did not show any biomechanical differences between the two groups.
Motion analysis was used to quantify the knee kinematics, kinetics, and electromyography (right and left longissimus dorsi, gluteus medius, rectus femoris, biceps femoris, semitendinosus, gastrocnemius and tibialis anterior muscles) during stair ascent and descent.
The mobile bearing group demonstrated a reduced knee extensor moment during stair climbing and descending, and a reduced knee adductor moment during stair climbing. When ascending stairs, most of the mobile bearing patients show a peak knee flexion and a peak knee flexion moment at the late stance phase during the double support period. This kinematic and kinetic pattern is absent in normal subject. Both mobile bearing and fixed bearing groups showed abnormal electromyography patterns in both descending and ascending.
During stair climbing, the mobile bearing design demonstrates a different kinematic pattern to the fixed bearing total knee replacement. Lower limb compensatory mechanisms seemed to be adopted particularly by the mobile bearing patients during ascending stairs.
Total knee replacement patient with mobile bearing design can feel excessive femoro-tibial motion during daily living activities such as stair climbing and descending. Proprioceptive control of this tibio-femoral translation is needed as demonstrated by the lower limb compensatory mechanism. This data suggest that antero-posterior constraint structures (ligamentous or mechanical) are important to obtain reproducible knee kinematics.
本研究旨在确定活动轴承全膝关节置换假体与固定轴承型全膝关节置换假体相比的功能表现。
从10例使用活动轴承的患者和10例使用固定轴承后稳定型Insall Burstein II全膝关节置换的患者在上下楼梯过程中获取运动学、动力学和肌电图数据。还分析了10名年龄和性别匹配的正常受试者组成的对照组。
平步行走研究未报告不同全膝关节置换设计患者之间存在显著生物力学差异。爬楼梯研究表明，后稳定型全膝关节置换设计相对于十字韧带牺牲型全膝关节置换设计表现略优。仅有一项关于活动轴承与固定轴承全膝关节置换的研究通过步态分析进行评估。该研究未显示两组之间存在任何生物力学差异。
采用运动分析来量化上下楼梯过程中的膝关节运动学、动力学和肌电图（左右背阔肌、臀中肌、股直肌、股二头肌、半腱肌、腓肠肌和胫骨前肌）。
活动轴承组在上下楼梯时膝关节伸肌力矩降低，在爬楼梯时膝关节内收肌力矩降低。上楼梯时，大多数活动轴承患者在双支撑期的后期站立阶段出现膝关节屈曲峰值和膝关节屈曲力矩峰值。正常受试者不存在这种运动学和动力学模式。活动轴承组和固定轴承组在上下楼梯时均显示出异常的肌电图模式。
爬楼梯时，活动轴承设计显示出与固定轴承全膝关节置换不同的运动学模式。活动轴承患者在上楼梯时似乎尤其采用了下肢代偿机制。
采用活动轴承设计的全膝关节置换患者在诸如上下楼梯等日常生活活动中可能会感到股胫关节运动过度。如下肢代偿机制所示，需要对这种胫股平移进行本体感觉控制。这些数据表明，前后约束结构（韧带或机械结构）对于获得可重复的膝关节运动学很重要。
