透過您的圖書館登入
IP:3.236.219.157
  • 學位論文

單髁人工膝關節置換術脛骨近端骨折機轉之研究

Proximal tibial fracture mechanism analysis in unicompartmental knee arthroplasty

指導教授 : 黎文龍 劉建緯

摘要


在近幾年的單髁人工膝關節置換術臨床追蹤報告之中,脛骨近端骨折而需要二次手術的情形仍然存在,由於相關生物力學研究並無足夠的研究報告是針對單髁人工膝關節對脛骨本身所造成的影響,因此,本研究擬藉有限元素分析方式模擬脛股骨關節接受單髁人工膝關節置換術後的多種受力狀態,探討單髁人工膝關節置換術對脛骨近端之應力變化。 本研究藉由三種不同設計之單髁人工膝關節在脛股骨關節屈膝0°的步態行為下,施以相當65kg 的重量對脛骨平台內側施以1435 N 之淨負荷,脛骨平台外側施以478 N 之淨負荷以進行各項影響因子分析,其中包括有脛骨元件後傾分析、脛骨元件內/外翻傾斜分析、脛骨骨切器械之導引孔分析及脛骨平台骨切過深分析。 經由本研究結果得知,植入角的影響確實會對脛骨近端骨幹內側之硬質骨有所影響,其中脛骨元件外翻傾斜之影響,相對於正常脛骨則產生較高之應力。負責承載脛骨元件之脛骨平台因不同植入角影響造成鬆質骨之邊緣或是支承栓腳植入處產生較高之應力。在導引孔分析中,若是在脛骨近端骨幹內側出現不良導引孔則會造成過大的應力集中問題。脛骨平台骨切過深則造成脛骨平台承載力減少,使脛骨平台硬質骨部分產生較高之應力。基於減低脛骨近端骨折或 是脛骨平台塌陷發生之理由,本研究建議脛骨元件膝內/外翻對位應避免使用超過10°,且在手術過程中避免出現不良導引孔及骨切過深之情形發生。

並列摘要


Second operation for proximal tibial fractures is still exists in recent years unicompartmental knee arthroplasty clinical reports, it is insufficient about the influence of unicompartmental knee on tibia in biomechanical research, thus, this study is discuss proximal tibial stress changes after unicompartmental knee arthroplasty to simulate multiple force state on tibiofemoral joint acceptance unicompartmental knee arthroplasty. This study through flexion in the tibiofemoral joint actions under the 0 ° gait for three different designs of unicompartmental knee, with a 1435 N and a 478 N compression load applied on the medial and lateral tibial plateau consists with body weight 65kg to investigate the effects of mal-resection including varus/valgus tilt,posterior slope, pin hole of tibial cutting block and Tibial plateau extended sagittalsaw cuts. Through this research results, implantation angle of the proximal end of the medial diaphysis indeed have occurs higher stress relative to the normal tibia. Different implant angle caused the edges of cancellous bone or peg hole stress generated at higher on responsible for bearing tibial components tibial plateau. If pin hole violates proximal end of the medial diaphysis will cause an excessive stress concentration in pin hole analysis. Extended sagittal saw cuts on tibial plateau will reduce fracture loads for tibial plateau case had higher stress on cortical bone. based on the reasons for reduce risk of proximal tibial fractures or collapsed of the tibial plateau, this study is still recommended tibial components varus/ valgus tilt alignment should avoid using more than 10 °and avoid pin hole violates proximal end of the medial diaphysis and extended sagittal saw cuts too deep in the surgery.

參考文獻


[39] 劉建緯,單髁人工膝關節脛骨植入物之生物力學研究-有限元素分析,國立臺北科技大學博士論文,2008。
[37] 方強如,人工關節用骨水泥調製機轉之影響研究,國立臺北科技大學碩士論文,2011。
[33] Zimmer, ZimmerR Unicompartmental High Flex KneeSpacer Block Surgical Technique,USA: Zimmer, Inc., 2011.
[32] Kenneth A. Krackow, “THE MEASUREMENT AND ANALYSIS OF AXIAL DEFORMITY AT THE KNEE,” 2008, pp. 23-26.
[31] Yi-ming ZENG, You WANG, Zhen-an ZHU, Ke-rong DAI, “Effects of sex and lower extremity alignment on orientation of the knee joint line in knee surgery,”Chin Med J. 125(12), 2012, pp. 2126-2131

延伸閱讀