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预测全膝关节置换术后托盘不对位对骨损伤和植入物下沉风险的影响。

Predicting the effect of tray malalignment on risk for bone damage and implant subsidence after total knee arthroplasty.

机构信息

Shiley Center for Orthopaedic Research and Education at Scripps Clinic, 11025 North Torrey Pines Road, Suite 140, La Jolla, California 92037, USA.

出版信息

J Orthop Res. 2011 Mar;29(3):347-53. doi: 10.1002/jor.21221. Epub 2010 Sep 29.

Abstract

Tibial tray malalignment has been associated with increased subsidence and failure. We constructed a finite element model of knee arthroplasty to determine the biomechanical factors involved in increasing the risk of subsidence with malalignment. Four fresh-frozen human knees were implanted with a tibial tray and subjected to forces representative of walking for up to 100,000 cycles. Cyclic displacement was measured between the tray and proximal tibia. The vertical load was shifted medially to generate a load distribution ratio of 55:45 (medial/lateral) to represent neutral alignment or 75:25 to represent varus alignment. Subjected specific geometry and material properties were obtained from qCT scans of tibia to construct a finite element model. The tray was subjected to a single load cycle representing experimental conditions. Tray displacement computed by the model matched that measured experimentally. Forces representing varus tray alignment generated greater strains in the proximal tibia and a greater volume of bone was subjected to strains higher than the fatigue threshold. Local compressive strains directly correlated with experimental subsidence and failure. Our results indicate that failure after tray malalignment is likely due to fatigue damage to the proximal tibia rather than shear across the implant-bone interface or failure of the cement mantle.

摘要

胫骨托板对线不良与沉降增加和失败有关。我们构建了膝关节置换的有限元模型,以确定与对线不良增加沉降风险相关的生物力学因素。将四个新鲜冷冻的人膝关节植入胫骨托板,并施加代表行走的力,最长可达 100,000 个循环。测量托板和胫骨近端之间的循环位移。将垂直载荷向内侧转移,以产生 55:45(内侧/外侧)的载荷分布比来代表中立对线,或 75:25 来代表内翻对线。根据胫骨的 qCT 扫描获得特定的几何形状和材料特性来构建有限元模型。托板承受单个代表实验条件的循环载荷。模型计算的托板位移与实验测量的位移匹配。代表内翻托板对线的力在胫骨近端产生更大的应变,并且更大体积的骨受到高于疲劳阈值的应变。局部压缩应变与实验沉降和失败直接相关。我们的结果表明,托板对线不良后的失败可能是由于胫骨近端的疲劳损伤所致,而不是植入物-骨界面的剪切或水泥帽的失效。

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