表面置換型人工臏股骨關節的設計與分析

Design and Analysis of Surface Replacement Prosthesis for Patellofemoral Joint

吳昇財(Sheng-Tsai Wu)

指導教授 ： 林上智

國立中央大學/工學院/機械工程學系/碩士(2008年)

摘要

近年來隨著生活型態的改變及醫學的進步，人類平均壽命逐年延長，老年病患也隨之逐年增加，其中以退化性關節炎就是明顯的例子；目前單一退化性臏股骨關節炎，臨床治療方式有：(1)全人工膝關節置換；(2)表面置換型人工臏股骨關節。其可以改善病患因為關節發炎而造成膝關節活動的不方便與臏骨周圍軟組織的不平衡等，進而增進臏骨與股骨之間的相互滑動正常。表面置換型人工臏股骨關節好處是微小骨切除量，且未來可在關節炎較為嚴重時再次進行全關節置換手術。
人工臏股骨關節目前最大的問題是在於植入物植入後不穩定，容易發生沈陷現象，而且植入物尺寸是定製化，人工關節之曲面與病患關節曲面無法完全配合。本研究針對現今臨床上臏股骨關節設計的缺點，考慮臏股骨關節退化部位的曲面差異，結合醫學影像重建的技術，依據不同病患，建構客製化關節的曲面設計與相對應之手術器械，實際模擬測試評估其整體可行性，並建構動態運動模擬真實之膝關節股骨與脛骨運動及受力之間的分析平台，藉以改進人工臏股骨關節之設計。

關鍵字

人工臏股骨關節 ； 客製化 ； 動態分析

並列摘要

In recent years, because the improvement of lifestyle and medical science has increased human age and the elder patient has increased every year too. The most obvious example is the osteoarthritis. Now the way of cure for isolated patellofemoral osteoarthritis has total knee replacement and surface replacement prosthesis for patellofemoral joint. It can improve inconvenient action of knee and unbalance of soft tissue nearby patella by osteoarthritis and then procure the normal slide of patella and femur. The advantage of surface replacement prosthesis for patellofemoral joint is not as much bone removed. Furthermore, it will perform the total knee replacement if the osteoarthritis becomes serious in future.
The most serious problem in the prosthesis for patellofemoral joint has consisted in the implant unstable and cave after the PFA surgery. Because the size of implant is ready made, the curved surface of implant can''t complete match with the joint of an affected part. This research has aimed at the defect of nowadays design in clinical. Think of the difference between curved surface of implant and patellofemoral joint have combined with the reconstructing technology of medical image. We has construct the custom-made implant of patellofemoral joint and its surgical instruments and to estimate the feasibility by imitate the actual operation. In order to improve the design of the prosthesis for patellofemoral joint, we also has reconstruct the analytic simulation for kinematic of the knee.

並列關鍵字

kinematic analysis ； patellofemoral joint

參考文獻

[5]John B. Meding, Jennifer T. Wing, E. Michael Keating, and Merrill A. Ritter,. “Total Knee Arthroplasty for Isolated Patellofemoral Arthritis in Younger Patients” CLINICAL ORTHOPAEDICS AND RELATED RESEARCH, Vol.464, pp. 78-82, 2007.

[6]Jess H. Lonner., “Patellofemoral Arthroplasty: Pros, Cons, and Design Considerations” Clinical Orthopaedics and Related, Vol.428, pp. 158-165, 2004.

[7]Andrew A. Amis., Wongwit Senavongse., Peter Darcy., “Biomechanics of Patellofemoral Joint Prostheses”, Clinical Orthopaedics and Related, Vol.436, pp. 20-29, 2005.

[8]B. Tauro, C. E. Ackroyd, J. H. Newman, and N. A. Shah., “The Lubinus patellofemoral arthroplasty：A FIVE-TO TEN-YEAR PROSPECTIVE STUDY” Journal of Bone and Joint Surgery-British, Vol.83-B, pp. 696-701, 2001.

[9]C. E. Ackroyd, J. H. Newman, R. Evans, J. D. J. Eldridge, and C. C. Joslin., “The Avon patellofemoral arthroplasty: FIVE-YEAR SURVIVORSHIP AND FUNCTIONAL RESULTS” Journal of Bone and Joint Surgery-British, Vol.89-B, pp. 310-315, 2007.