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旋转平台全膝关节假体中活动部件的旋转受限。

Limited rotation of the mobile-bearing in a rotating platform total knee prosthesis.

作者信息

Garling E H, Kaptein B L, Nelissen R G H H, Valstar E R

机构信息

Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands; Department of Radiology, Division of Image Processing, Leiden University Medical Center, Leiden, The Netherlands.

出版信息

J Biomech. 2007;40 Suppl 1:S25-30. doi: 10.1016/j.jbiomech.2007.02.013. Epub 2007 Apr 12.

Abstract

The hypothesis of this study was that the polyethylene bearing in a rotating platform total knee prosthesis shows axial rotation during a step-up motion, thereby facilitating the theoretical advantages of mobile-bearing knee prostheses. We examined 10 patients with rheumatoid arthritis who had a rotating platform total knee arthroplasty (NexGen LPS mobile, Zimmer Inc. Warsaw, USA). Fluoroscopic data was collected during a step-up motion six months postoperatively. A 3D-2D model fitting technique was used to reconstruct the in vivo 3D kinematics. The femoral component showed more axial rotation than the polyethylene mobile-bearing insert compared to the tibia during extension. In eight knees, the femoral component rotated internally with respect to the tibia during extension. In the other two knees the femoral component rotated externally with respect to the tibia. In all 10 patients, the femur showed more axial rotation than the mobile-bearing insert indicating the femoral component was sliding on the polyethylene of the rotating platform during the step-up motion. Possible explanations are a too limited conformity between femoral component and insert, the anterior located pivot location of the investigated rotating platform design, polyethylene on metal impingement and fibrous tissue formation between the mobile-bearing insert and the tibial plateau.

摘要

本研究的假设是,旋转平台全膝关节假体中的聚乙烯轴承在向上迈步动作期间会出现轴向旋转,从而发挥活动轴承膝关节假体的理论优势。我们检查了10例患有类风湿性关节炎且接受了旋转平台全膝关节置换术(NexGen LPS活动型,美国华沙齐默公司)的患者。在术后6个月的向上迈步动作期间收集了透视数据。采用三维-二维模型拟合技术重建体内三维运动学。与胫骨相比,在伸展过程中股骨部件比聚乙烯活动轴承衬垫表现出更多的轴向旋转。在8个膝关节中,股骨部件在伸展过程中相对于胫骨进行了内旋。在另外两个膝关节中,股骨部件相对于胫骨进行了外旋。在所有10例患者中,股骨比活动轴承衬垫表现出更多的轴向旋转,这表明在向上迈步动作期间股骨部件在旋转平台的聚乙烯上滑动。可能的解释包括股骨部件与衬垫之间的贴合度过于有限、所研究的旋转平台设计的枢轴位置靠前、金属与聚乙烯之间的撞击以及活动轴承衬垫与胫骨平台之间的纤维组织形成。

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