植入物连接和韧带完整性对可转换全肘关节置换术中肱骨负荷的影响。
The effect of implant linking and ligament integrity on humeral loading of a convertible total elbow arthroplasty.
作者信息
Brownhill James R, Pollock J Whitcomb, Ferreira Louis M, Johnson James A, King Graham Jw
机构信息
Department of Mechanical Engineering, The University of Western Ontario, The Roth McFarlane Hand and Upper Limb Centre Bioengineering Laboratory, St Joseph's Health Care - London, London, Ontario, Canada.
Department of Surgery, The University of Western Ontario, The Roth McFarlane Hand and Upper Limb Centre Bioengineering Laboratory, St Joseph's Health Care - London, London, Ontario, Canada.
出版信息
Shoulder Elbow. 2019 Feb;11(1):45-52. doi: 10.1177/1758573217728292. Epub 2017 Aug 31.
BACKGROUND
Both unlinked and linked total elbow arthroplasty (TEA) implants have been employed with no consensus as to the optimal design. The present study aimed to evaluate the effect of collateral ligament integrity and implant linkage on wear-inducing loads in a convertible TEA.
METHODS
Eight fresh frozen upper extremities were tested in an elbow motion simulator. A convertible TEA with an instrumented humeral stem was inserted using computer navigation. Elbow kinematics and humeral loading were recorded with the TEA both linked and unlinked. The collateral ligaments were then sectioned and testing was repeated.
RESULTS
In the dependent position, there was no effect of implant linkage or ligament sectioning on humeral loading. Humeral loading was significantly greater following sectioning of the collateral ligaments but not after linking the TEA with the arm in the valgus position. Humeral loading was significantly greater after linking the TEA but not after sectioning of the collateral ligaments and with the arm in the varus position.
CONCLUSIONS
Collateral ligament integrity reduces wear-inducing loads for both an unlinked and linked TEA. Linkage of a convertible TEA increases humeral loading, which may have detrimental effects on implant longevity.
背景
非连接型和连接型全肘关节置换术（TEA）植入物均已被应用，但对于最佳设计尚无共识。本研究旨在评估在可转换TEA中，侧副韧带完整性和植入物连接对磨损诱导负荷的影响。
方法
在肘关节运动模拟器中对8个新鲜冷冻的上肢进行测试。使用计算机导航插入带有仪器化肱骨干的可转换TEA。记录TEA连接和未连接时的肘关节运动学和肱骨负荷。然后切断侧副韧带并重复测试。
结果
在依赖位，植入物连接或韧带切断对肱骨负荷没有影响。切断侧副韧带后肱骨负荷显著增加，但在将TEA与处于外翻位的手臂连接后肱骨负荷没有增加。连接TEA后肱骨负荷显著增加，但在切断侧副韧带且手臂处于内翻位时肱骨负荷没有增加。
结论
侧副韧带完整性可降低非连接型和连接型TEA的磨损诱导负荷。可转换TEA的连接会增加肱骨负荷，这可能对植入物的使用寿命产生不利影响。
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