Pegg E C, Baré J, Gill H S, Pandit H G, O'Connor J J, Murray D W, Price A J
Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
Melbourne Orthopaedic Group, 33 The Avenue, Windsor, VIC 3181, Australia.
Knee. 2015 Dec;22(6):646-52. doi: 10.1016/j.knee.2015.09.017. Epub 2015 Oct 27.
Quantification of the in vivo position of the medial condyle throughout flexion is important for knee replacement design, and understanding knee pathology. The influence of consciousness, muscle action, and activity type on condyle translation was examined in patients who had undergone medial unicompartmental knee replacement (UKR) using lateral video fluoroscopy.
The position of the centre of the femoral component relative to the tibial component was measured for nine patients under different conditions. The following activities were assessed; passive flexion and extension when anaesthetised, passive flexion and extension when conscious, and active flexion, extension and step-up.
The position of the centre of the femoral component relative to the tibial component was highly patient dependent. The greatest average translation range (14.9 mm) was observed in anaesthetised patients, and the condyle was significantly more anterior near to extension. Furthermore, when conscious but being moved passively, the femoral condyle translated a greater range (8.9 mm) than when moving actively (5.2mm). When ascending stairs, the femoral condyle was more posterior at 20-30° of flexion than during flexion/extension.
The similarity between these results and published data suggest that knee kinematics following mobile-bearing UKR is relatively normal. The results show that in the normal knee and after UKR, knee kinematics is variable and is influenced by the patient, consciousness, muscle action, and activity type.
It is therefore essential that all these factors are considered during knee replacement design, if the aim is to achieve more normal knee kinematics.
量化股骨内侧髁在整个屈曲过程中的体内位置对于膝关节置换设计和理解膝关节病理学至关重要。使用外侧视频荧光透视法，对接受内侧单髁膝关节置换（UKR）的患者，研究了意识、肌肉活动和活动类型对髁平移的影响。
测量了9名患者在不同条件下股骨组件中心相对于胫骨组件的位置。评估了以下活动：麻醉状态下的被动屈伸、清醒状态下的被动屈伸、主动屈伸和上台阶。
股骨组件中心相对于胫骨组件的位置高度依赖于患者。在麻醉患者中观察到最大平均平移范围（14.9毫米），并且髁在接近伸展时明显更靠前。此外，在清醒但被动移动时，股骨髁的平移范围（8.9毫米）比主动移动时（5.2毫米）更大。上楼梯时，股骨髁在屈曲20 - 30°时比屈伸过程中更靠后。
这些结果与已发表数据的相似性表明，活动平台UKR后的膝关节运动学相对正常。结果表明，在正常膝关节和UKR后，膝关节运动学是可变的，并且受患者、意识、肌肉活动和活动类型的影响。
因此，如果目标是实现更正常的膝关节运动学，那么在膝关节置换设计过程中必须考虑所有这些因素。
