Taylor William R, Heller Markus O, Bergmann Georg, Duda Georg N
Research Laboratory, Trauma and Reconstructive Surgery, Charité, Humboldt-University of Berlin, Campus Virchow-Clinic, Augustenburger Platz 1, D-13353 Berlin, Germany.
J Orthop Res. 2004 May;22(3):625-32. doi: 10.1016/j.orthres.2003.09.003.
Surgical intervention of the knee joint routinely endeavors to recreate a physiologically normal joint loading environment. The loading conditions resulting from osteotomies, fracture treatment, ligament replacements, and arthroplasties of the knee are considered to have an impact on the long term clinical outcome; however, knowledge regarding in vivo loading conditions is limited. Using a previously validated musculoskeletal lower limb model, we predicted the tibio-femoral joint contact forces that occur in the human knee during the common daily activities of walking and stair climbing. The average resultant peak force during walking was 3.1 times body weight (BW) across four total hip arthroplasty patients. Inter-individual variations proved larger than the variation of forces for each patient repeating the same task. Forces through the knee were considerably larger during stair climbing than during walking: the average resultant peak force during stair climbing was 5.4 BW although peaks of up to 6.2 BW were calculated for one particular patient. Average anteroposterior peak shear components of 0.6 BW were determined during walking and 1.3 BW during stair climbing. These results confirm both the joint contact forces reported in the literature and the importance of muscular activity in creating high forces across the joint. The magnitudes of these forces, specifically in shear, have implications for all forms of surgical intervention in the knee. The data demonstrate that high contact and shear forces are generated during weight bearing combined with knee flexion angles greater than approximately 15 degrees. Clinically, the conditions that produce these larger contact forces should be avoided during post-operative rehabilitation.
膝关节的手术干预通常致力于重建生理上正常的关节负荷环境。截骨术、骨折治疗、韧带置换以及膝关节置换术所产生的负荷情况被认为会对长期临床结果产生影响；然而，关于体内负荷情况的了解却很有限。我们使用一个先前经过验证的下肢肌肉骨骼模型，预测了人类膝关节在日常行走和爬楼梯活动中出现的胫股关节接触力。在四名全髋关节置换患者中，行走过程中平均合成峰值力为体重（BW）的3.1倍。个体间差异证明比每个患者重复相同任务时的力的差异更大。爬楼梯时通过膝关节的力比行走时大得多：爬楼梯时平均合成峰值力为5.4BW，尽管为一名特定患者计算出的峰值高达6.2BW。行走时前后平均峰值剪切力分量为0.6BW，爬楼梯时为1.3BW。这些结果既证实了文献中报道的关节接触力，也证实了肌肉活动在产生跨关节高力方面的重要性。这些力的大小，特别是剪切力，对膝关节的所有手术干预形式都有影响。数据表明，在负重且膝关节屈曲角度大于约15度时会产生高接触力和剪切力。临床上，术后康复期间应避免产生这些更大接触力的情况。
