Background： Lateral compartmental osteoarthritis （LCOA）, a major complication after medial mobile-bearing unicompartmental knee arthroplasty （UKA）, is highly associated with the increased stress of the lateral co...Background： Lateral compartmental osteoarthritis （LCOA）, a major complication after medial mobile-bearing unicompartmental knee arthroplasty （UKA）, is highly associated with the increased stress of the lateral compartment. This study aimed to analyze the effects on the stress and load distribution of the lateral compartment induced by lower limb alignment and coronal inclination of the tibial component in UKA through a finite element analysis. Methods： Eight three-dimensional models were constructed based on a validated model for analyzing the biomechanical effects of implantation parameters on the lateral compartment after medial Oxford UKA： postoperative lower limb alignment of 3° valgus, neutral and 3° varus, and the inclination of tibial components placed in 4°, 2° valgus, square, and 2° and 4° varus. The contact stress of femoral and tibial cartilage and load distribution were calculated for all models. Results： In the 3° valgus lower limb alignment model, the contact stress of femoral （3.38 MPa） and tibial （3.50 MPa） cartilage as well as load percentage （45.78%） was highest compared to any other model, and was increased by 36.75%, 47.70%, and 27.63%, respectively when compared to 3° varus. In the condition of a neutral position, the outcome was comparable for the different tibial tray inclination models. The inclination did not greatly affect the lateral compartmental stress and load distribution. Conclusions： This study suggested that slightly varus （undercorrection） lower limb alignment might be a way to prevent LCOAin medial mobile-bearing UKA. However, the inclination （4° varus to 4° valgus） of the tibial component in the coronal plane would not be a risk factor for LCOA in neutral position.展开更多
背景:目前用于全膝关节置换的机器人系统设计的基本原理是将三维手术规划、术中危险区预警、实时数据反馈及机械臂辅助截骨等技术相结合,以实现全膝关节置换的精准化、个性化,这也恰好是它最大优势所在,因此近年来成为关节外科领域热点...背景:目前用于全膝关节置换的机器人系统设计的基本原理是将三维手术规划、术中危险区预警、实时数据反馈及机械臂辅助截骨等技术相结合,以实现全膝关节置换的精准化、个性化,这也恰好是它最大优势所在,因此近年来成为关节外科领域热点话题,备受关注。目的:文章将从机器人辅助全膝关节置换在关节外科领域的发展现状及其与传统全膝关节置换优劣势对比进行概述,此外,还将对机器人辅助全膝关节置换技术未来的发展进行展望。方法:应用计算机检索PubMed、中国知网、万方和维普数据库的相关文章,英文检索词:“robot OR robotic OR robotics OR robotically OR computer,total knee arthroplasty OR total knee replacement,TKA OR TKR”,中文检索词:“机器人辅助,计算机导航,全膝关节置换术”,最终纳入64篇文献进行综述分析。结果与结论:①用于辅助全膝关节置换的机器人系统根据其自由度分为主动式、半主动式和被动式。半主动式系统是目前使用最为广泛的机器人系统,该系统有效提高了全膝关节置换手术的精准性和个性化程度,但其高昂的使用成本与较长的学习曲线仍是在该领域内推广时需要权衡的主要因素。②机器人辅助全膝关节置换可实现膝关节局部三维空间的精准截骨、正确安置假体,已被广泛证明可以提供更好的假体植入精准度,减少影像学异常值,在术中可获得良好的软组织平衡,最终改善术后膝关节运动及功能状态。③但目前的机器人辅助系统依然存在客观的不足之处,包括不同机器人设备与术者之间的学习曲线问题、额外增加的安装和维护成本以及与机器人手术相关的潜在并发症,所以其能否让医疗系统及患者真正受益仍需要更长期的研究予以证明,机器人辅助系统也仍需进行更多实质性的改进。④机器人辅助全膝关节置换技术在临床上仍然处于初�展开更多
目的通过对比EOS成像系统(EOS imaging system),来评估全幅数字X线摄影(the full view digital radiography,DR)图像所测量下肢力线的准确性。方法本研究为前瞻性研究。对同一个膝关节骨关节炎患者在同一天分别使用全幅DR和EOS成像系统...目的通过对比EOS成像系统(EOS imaging system),来评估全幅数字X线摄影(the full view digital radiography,DR)图像所测量下肢力线的准确性。方法本研究为前瞻性研究。对同一个膝关节骨关节炎患者在同一天分别使用全幅DR和EOS成像系统进行下肢全长检查并测量下肢力线。结果共纳入27例,其中男6例,女21例。年龄48~80岁,平均(63.67±7.68)岁。所有研究对象分左、右下肢分别测量,共54例。下肢力线的测量在全幅DR和EOS成像系统两种检查方法,差异均无统计学意义(P>0.05),其中髋膝踝角(hip-knee-ankle angle,HKA)的P值为0.331,股骨远端外侧角(lateral distal femoral angle,LDFA)的P值为0.140,胫骨近端内侧角(medial proximal tibial angle,MPTA)的P值为0.359,股骨胫骨关节线夹角(joint line convergence angle,JLCA)的P值为0.974。结论全幅DR虽然存在边缘放大效应,但对于下肢力线测量的影响较小。展开更多
基金This study was supported by grants from the National Natural Science Foundation of China(No.81673776)the capital health research and development of special,China(No.2016-2-4062).
文摘Background： Lateral compartmental osteoarthritis （LCOA）, a major complication after medial mobile-bearing unicompartmental knee arthroplasty （UKA）, is highly associated with the increased stress of the lateral compartment. This study aimed to analyze the effects on the stress and load distribution of the lateral compartment induced by lower limb alignment and coronal inclination of the tibial component in UKA through a finite element analysis. Methods： Eight three-dimensional models were constructed based on a validated model for analyzing the biomechanical effects of implantation parameters on the lateral compartment after medial Oxford UKA： postoperative lower limb alignment of 3° valgus, neutral and 3° varus, and the inclination of tibial components placed in 4°, 2° valgus, square, and 2° and 4° varus. The contact stress of femoral and tibial cartilage and load distribution were calculated for all models. Results： In the 3° valgus lower limb alignment model, the contact stress of femoral （3.38 MPa） and tibial （3.50 MPa） cartilage as well as load percentage （45.78%） was highest compared to any other model, and was increased by 36.75%, 47.70%, and 27.63%, respectively when compared to 3° varus. In the condition of a neutral position, the outcome was comparable for the different tibial tray inclination models. The inclination did not greatly affect the lateral compartmental stress and load distribution. Conclusions： This study suggested that slightly varus （undercorrection） lower limb alignment might be a way to prevent LCOAin medial mobile-bearing UKA. However, the inclination （4° varus to 4° valgus） of the tibial component in the coronal plane would not be a risk factor for LCOA in neutral position.
文摘背景:目前用于全膝关节置换的机器人系统设计的基本原理是将三维手术规划、术中危险区预警、实时数据反馈及机械臂辅助截骨等技术相结合,以实现全膝关节置换的精准化、个性化,这也恰好是它最大优势所在,因此近年来成为关节外科领域热点话题,备受关注。目的:文章将从机器人辅助全膝关节置换在关节外科领域的发展现状及其与传统全膝关节置换优劣势对比进行概述,此外,还将对机器人辅助全膝关节置换技术未来的发展进行展望。方法:应用计算机检索PubMed、中国知网、万方和维普数据库的相关文章,英文检索词:“robot OR robotic OR robotics OR robotically OR computer,total knee arthroplasty OR total knee replacement,TKA OR TKR”,中文检索词:“机器人辅助,计算机导航,全膝关节置换术”,最终纳入64篇文献进行综述分析。结果与结论:①用于辅助全膝关节置换的机器人系统根据其自由度分为主动式、半主动式和被动式。半主动式系统是目前使用最为广泛的机器人系统,该系统有效提高了全膝关节置换手术的精准性和个性化程度,但其高昂的使用成本与较长的学习曲线仍是在该领域内推广时需要权衡的主要因素。②机器人辅助全膝关节置换可实现膝关节局部三维空间的精准截骨、正确安置假体,已被广泛证明可以提供更好的假体植入精准度,减少影像学异常值,在术中可获得良好的软组织平衡,最终改善术后膝关节运动及功能状态。③但目前的机器人辅助系统依然存在客观的不足之处,包括不同机器人设备与术者之间的学习曲线问题、额外增加的安装和维护成本以及与机器人手术相关的潜在并发症,所以其能否让医疗系统及患者真正受益仍需要更长期的研究予以证明,机器人辅助系统也仍需进行更多实质性的改进。④机器人辅助全膝关节置换技术在临床上仍然处于初�
