摘要：本文就全膝关节置换（total knee arthroplasty，TKA）技术中不同假体的选择以及手术技术对于术后髌股关节生物力学、髌骨运动轨迹以及假体旋转位置的影响加以分析，探讨影响TKA术后膝关节功能以及假体使用寿命的相关力学因素。传统的解剖标志线受到多种因素的影响缺乏准确性, 因此胫骨假体不存在统一的线性定位。股骨上髁轴作为TKA术中确定假体旋转对线的参照轴较为可靠，能获得较为理想的髌股关节生物力学，减少术后并发症。胫骨结节内侧缘至中内1/3 线被认为是最理想的胫骨假体旋转定位区间, 线性的定位应根据患者膝关节内外翻畸形的程度而定。固定平台和移动平台假体TKA术后都明显的改善了患膝的症状和功能, 这两种假体在膝关节评分、疼痛评分、功能评分、髌骨评分及X线片检查结果方面均没有明显差异。但是移动平台假体组TKA术后的最大屈曲度小于固定平台假体组的最大屈曲度。虽然在实验室研究中移动平台型假体在耐磨损和关节运动学方面优于固定平台型假体, 但是在临床研究中的观点却并不一致。
关键词：全膝关节置换术；髌骨运动轨迹；髌股关节；假体旋转位置；生物力学

李宝文.全膝人工关节置换涉及的生物力学变化[J].中国组织工程研究与临床康复，2008，12(17):3313-3316
[www.zglckf.com/zglckf/ejournal/upfiles/08-17/17k-3313(ps).pdf]

Biomechanical alterations in total knee arthroplasty

Abstract:This paper analyzed the effects of prosthesis selection and surgical technique in total knee arthroplasty (TKA) on patellofemoral joint biomechanics, patella movement track and prosthesis rotational alignment to explore the mechanics-related factors of knee joint function and prosthesis service life after TKA. Traditional anatomic landmark line lacks of accuracy due to various factors, so there is no uniform linear localization for tibial prosthesis. Femoral epicondylar axis functions as the reference axis of prosthesis rotational alignment in TKA, which can achieve ideal patellofemoral joint biomechanics, and reduce postoperative complications. 1/3 line of medial border to moderate medial border of the tibial tubercle is regarded as the ideal rotational interval of the tibial prosthesis, and introversion and extroversion degrees of the knee joint are determinant of linear localization. Knee symptoms and function are significantly improved after fixed and mobile-bearing arthroplasties. These two kinds of prosthesis do not significantly vary in knee joint, pain, function, and patella scores as well as radiography. However, the knee motions during maximum flexion in the mobile-bearing arthroplasty are smaller than in the fixed one. It has been proven by experimental studies that mobile-bearing arthroplasty shows wearing resistance and joint movement superior over the fixed one, but there is no agreement in clinical studies.

Li BW.Biomechanical alterations in total knee arthroplasty. Zhongguo Zuzhi Gongcheng Yanjiu yu Linchuang Kangfu 2008;12(17):3313-3316(China) [www.zglckf.com/zglckf/ejournal/upfiles/08-17/17k-3313(ps).pdf]