人工膝关节假体参数化设计影响因素与现状分析

Influencing factors and current situation of parametric design of knee prosthesis

背景:人工膝关节假体参数化设计是降低假体损耗、提高假体生存率的有效办法,但目前尚缺少对于人工膝关节假体参数化研究的综述性分析。目的:总结全膝关节置换假体的失效形式,综述膝关节假体参数化设计的研究进展并提出建议。方法:以“TKA,Knee prosthesis,Tibial liner,Parametric design,Prosthesis replacement,Prosthesis loosening,Failure mode,Durability,Kinematics”为英文检索词,以“全膝关节置换、膝关节假体、胫骨衬垫、参数化设计、无菌松动、失效形式、运动学、接触力学”为中文检索词,检索Pub Med、Embase、中国知网、万方和维普数据库中的相关文献,最终纳入64篇文献,从人工膝关节假体失效形式、膝关节假体参数化设计发展历程、完善膝关节假体参数化设计3方面对膝关节假体的研究进行综述分析。结果与结论:(1)无菌性松动、假体感染、假体失稳以及胫骨衬垫磨损是膝关节假体的主要失效形式。假体植入人体后需保留数年,假体损坏、骨质流失、原有膝关节平衡的破坏等都会对病情恢复与人体健康产生不利影响,因此应当注重病变膝关节的去除与假体的植入,治疗前后一旦出现意外,应尽快根据病情进行诊治。(2)假体参数化设计应使其具备较优的生物相容性、良好的接触性能、稳定的运动学特征与较低的摩擦力,从而使患者获得更佳的康复效果。(3)人工膝关节假体接触力学性能与运动学性能分别受冠状面曲率半径和矢状面曲率半径一致性影响,而参数的变化必然引起性能的变化,所以膝关节假体运动学性能与接触力学性能之间的竞争关系是不可避免的,在进行假体参数化设计时应使二者控制在一个合理的范围内。(4)形合度是假体参数化设计的一个重要指标,其高低水平的划分至今仍未实现,这将是学者们进行参数化设计时应克服的一个重要问题。(5)因此,对人工膝关节假体假体进行参数化研究,能够提高假体接触性能,使其具有更稳定的运动学特性,能够为假体的生产开发与临床应用提供重要的理论依据,对提高假体关节置换成功率、降低假体翻修率及提高患者生活质量有重要意义。

BACKGROUND:Parametric design of knee prosthesis is an effective method to reduce the loss of prosthesis and im p rove the survival rate of prosthesis.However,there is still a lack of comprehensive analysis on the paramete rization of knee prosthesis.OBJECTIVE:To summarize the failure forms of total knee arthroplasty,the research progress of parametric design of knee prosthesis,and put forward some suggestions.METHODS:Using the terms "TKA,Knee prosthesis,Tibial liner,Parametric design,Prosthesis re placement,Prosthesis loosening,Failure mode,Durability,Kinematics" as Chinese and English key words,relevant articles were searched in PubMed,Embase,CNKI,Wanfang and VIP databases.Finally,64 articles were included.The development of knee prosthesis from three aspects was summarized and analyzed:Failure form of artificial knee joint prosthesis;development of parametric design of knee prosthesis;perfecting the parametric design of knee prosthesis.RESULTS AND CONCLUSION:(1) Aseptic loosening,prosthesis infection,instability and tibial pad wear are the main failure forms of knee prosthesis.The knee prosthesis should be retained for several years after implantation.The damage of knee prosthesis,bone loss and the destruction of the original knee balance will have adverse effects on the recovery of the disease and human health.Therefo re,we should pay attention to the removal of diseased knee joint and the implantation of prosthesis.Once an accident occurs before and after treatment,it should be diagnosed and treated according to the condition as soon as possible to prevent accidents.(2) The parametric design of prosthesis should make it have better biocompatibility,good contact performance,stable kinematic characte ristics and low friction,so that patients can get better rehabilitation effect.(3) The contact mechanical and kinematic prope rties of knee prosthesis are affected by the consistency of coronal and sagittal curvature radii,respectively.The change of parameters will inevitably lead to the change of performance,so the competition between the kinematic performance and conta ct mechanical performance of knee prosthesis is inevitable.In the parametric design of knee prosthesis,both should be controlled within a reasonable range.(4) Fitness is an important index in the parametric design of prosthesis,and the division of its high and low levels has not yet been realized,which will be an important problem that schola rs should overcome in the parametric design.(5) The research on the parameterization of knee prosthesis can improve its contact performance,make it have more stable kinematic characte ristics,and provide important theoretical basis for the production,development and clinical application of prosthesis.It is of great significance to improve the success rate of knee prosthesis replacement,reduce the revision rate of knee prosthesis,and im p rove the quality of life of patients.