Dye S F
Department of Orthopaedic Surgery, University of California, San Francisco, CA, USA.
Clin Orthop Relat Res. 1996 Apr(325):10-8. doi: 10.1097/00003086-199604000-00003.
The knee can be characterized as a complex set of asymmetrical moving parts acting together as a living biologic transmission. The purpose of this system is to accept, transfer, and dissipate loads generated at the ends of the long mechanical lever arms of the femur and tibia. In this analogy, the various ligaments represent sensate adaptive linkages, the articular cartilages represent bearings, and the menisci, mobile sensate bearings within the transmission. The muscles represent both living engines providing motive forces, and brakes and dampening systems under complex neurologic control mechanisms. The range of load that can be applied across an individual joint in a given period without supraphysiologic overload or structural failure can be termed the envelope of function. This range of homeostatic loading can be graphed with increasing applied loads on the vertical axis and the frequency of loading on the horizontal axis. At least 4 categories of factors together determine the envelope of function for a given joint including anatomic, kinematic, physiologic, and treatment factors. This theory of joint function can result in a more rational clinical approach to treating patients with knee injuries and other orthopaedic conditions. Orthopaedic therapy should be designed to maximize the envelope of function of musculoskeletal systems with the least degree of risk.
膝关节可被视为一组复杂的不对称活动部件，共同构成一个有生命的生物传动系统。该系统的目的是承受、传递和消散在股骨和胫骨长机械杠杆臂末端产生的负荷。在此类比中，各种韧带代表有感觉的适应性连接，关节软骨代表轴承，半月板则是传动系统内可移动的有感觉的轴承。肌肉既代表提供动力的有生命的发动机，也代表在复杂神经控制机制下的制动器和减震系统。在给定时间段内，单个关节在不发生超生理过载或结构破坏的情况下所能承受的负荷范围可称为功能范围。这种稳态负荷范围可以用纵轴上增加的施加负荷和横轴上的负荷频率来绘制图表。至少四类因素共同决定了给定关节的功能范围，包括解剖学、运动学、生理学和治疗因素。这种关节功能理论可以为治疗膝关节损伤和其他骨科疾病的患者带来更合理的临床方法。骨科治疗应旨在以最低风险程度最大化肌肉骨骼系统的功能范围。
