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中华关节外科杂志(电子版) ›› 2024, Vol. 18 ›› Issue (04) : 505 -516. doi: 10.3877/cma.j.issn.1674-134X.2024.04.010

综述

连接型人工膝关节假体运动和负重模式的演变和进展
高小康1, 张净宇2, 刘金伟2, 田东牧3, 胡永成4, 徐卫国4,()   
  1. 1. 300202 天津市天津医院;300202 天津医科大学骨科临床学院;056000 邯郸,华北医疗健康集团峰峰总医院
    2. 300202 天津市天津医院
    3. 264200 威海,山东威高骨科材料股份有限公司
    4. 300202 天津市天津医院;300202 天津医科大学骨科临床学院
  • 收稿日期:2024-04-02 出版日期:2024-08-01
  • 通信作者: 徐卫国
  • 基金资助:
    天津市卫生健康委员会科技项目重点学科专项(TJWJ2024XK015)

Evolution and trend of motion and loading modes in hinge knee prosthesis

Xiaokang Gao1, Jingyu Zhang2, Jinwei Liu2, Dongmu Tian3, Yongcheng Hu4, Weiguo Xu4,()   

  1. 1. Tianjin Hospital, Tianjin 300202, China;Clinical School/College of Orthopedics, Tianjin Medical University, Tianjin 300202, China;North China Medical Health Group Fengfeng General Hospital, Handan 056000, China
    2. Tianjin Hospital, Tianjin 300202, China
    3. Shandong Weigao Orthopaedic Device Co.,Ltd., Weihai 264200, China
    4. Tianjin Hospital, Tianjin 300202, China;Clinical School/College of Orthopedics, Tianjin Medical University, Tianjin 300202, China
  • Received:2024-04-02 Published:2024-08-01
  • Corresponding author: Weiguo Xu
引用本文:

高小康, 张净宇, 刘金伟, 田东牧, 胡永成, 徐卫国. 连接型人工膝关节假体运动和负重模式的演变和进展[J]. 中华关节外科杂志(电子版), 2024, 18(04): 505-516.

Xiaokang Gao, Jingyu Zhang, Jinwei Liu, Dongmu Tian, Yongcheng Hu, Weiguo Xu. Evolution and trend of motion and loading modes in hinge knee prosthesis[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2024, 18(04): 505-516.

人工假体的普及,翻修患者的逐年增加和骨肿瘤保肢手术的成功应用,导致应用和潜在应用连接型膝关节假体的患者数量增加。连接型膝关节假体是关节内外韧带稳定机制失效的重建手段,目前经历了从屈曲铰链的单轴运动、旋转铰链的双轴运动、球轴铰链的多轴运动三代演变。连接型膝关节假体运动模式经历由屈曲铰链单轴运动,到旋转铰链双轴运动,再到球轴铰链多轴运动。负重模式从完全由铰链负重,到髁负重比例增大和完全髁负重。假体的限制和约束逐步减小,生物力学分布更合理,减少了应力集中,降低了磨损、松动和断裂几率,假体的生存率提高,并发症降低。然而和非限制性假体相比,连接型假体术后的远期效果差。本文总结归纳连接型人工膝关节假体在运动和负重模式的演变规律,为假体研究和设计提供借鉴和思路。

The popularity of prostheses, the annual increase in revision patients and the successful application of limb salvage surgery for bone tumors have led to an increase in the number of patients with the application and potential application of hinge knee prostheses. Hinge knee prosthesis is a means to reconstruct the failure of the stability mechanism of the internal and external ligaments of the joint. It has undergone three generations of evolution from the uniaxial movement of fixed hinge, the biaxial movement of rotating hinge, and multi-axial movement of spherical axis. The motion mode of the hinge knee prosthesis goes through uniaxial movement of fixed hinge, biaxial movement of rotating hinge, and multi-axial movement of spherical axis hinge. Loading modes range from full hinge load, to increased condylar load ratio and then full condylar load. The limitations and constraints of the prosthesis gradually decrease, the biomechanical distribution becomes more reasonable, stress concentration is reduced, the probability of wear, loosening, and fracture is declined, the survival rate of the prosthesis is improved, and complications are lowered. However, compared with primary total knee arthroplasty prostheses, hinge prostheses have poorer long-term outcomes. This article summarized the evolution of hinge knee prostheses in motion and loading modes, and to provide references and ideas for prosthetic research and design.

图1 人体膝关节运动模式示意图 注:沿冠状轴屈伸活动,沿垂直轴旋转活动,沿矢状轴内外翻活动
Figure 1 Schematic diagram of knee joint motion mode Note: flexion and extension along the coronal axis, rotation along the vertical axis, and abduction and adduction along the sagittal axis
图2 第三代假体-中国骨巨细胞瘤协作组假体(GTOC)的运动模式和负重模式示意图 注:沿球轴铰链多轴运动,胫骨髁完全负重
Figure 2 Schematic diagram of motion and loading modes of the third generation prosthesis-Giant Cell Tumor of China (GTOC) Note: multi-axis movement along the spherical axis hinge and full weight bearing of tibial condyle
图3 第二代假体-骨科保肢系统(OSS)的负重模式示意图 注:胫骨髁和铰链共同承担向下的应力,承担应力的比例不同
Figure 3 Schematic diagram of loading mode of the second generation prosthesis-orthopedic limb salvage system (OSS) Note: tibial condyle and hinge bear axial stress in different proportions
图4 文献检索流程
Figure 4 The process of literature retrieval
图5 假体演变进展时间轴
Figure 5 Timeline of the evolution and trend of prostheses.
表1 屈曲铰链连接型膝关节假体设计特点和随访效果
Table 1 Design characteristics and follow-up results of fixed hinge knee prostheses
表2 旋转铰链连接型膝关节假体设计特点和随访效果
Table 2 Design characteristics and follow-up results of rotating hinge knee prostheses
表3 球轴铰链连接型膝关节假体设计特点和随访效果
Table 3 Design characteristics and follow-up results of spherical axis hinge knee prostheses
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