{"title":"全膝关节置换术中的软组织弹性：活体定量分析","authors":"","doi":"10.1016/j.clinbiomech.2024.106335","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>Soft tissue balance is essential for total knee arthroplasty success. The elastic properties of soft tissues affect knee-joint stability and flexibility. This study proposed a novel methodology for in vivo quantitative analysis of soft tissue elasticity during total knee arthroplasty. In this study, we aimed to (1) establish a mathematical model to depict medial and lateral soft tissue elasticity, (2) report the individual differences and interindividual commonalities in soft tissue elasticity.</p></div><div><h3>Methods</h3><p>A specifically designed knee tensor was used to evaluate soft tissue elasticity by dynamically applying sequential tensions to medial and lateral compartments while measuring knee joint gaps in both compartments. Measurements were performed on ten knees of six cadavers. Bivariate polynomial regression was used for analysis, and the equivalent elastic coefficient (N/mm) was calculated.</p></div><div><h3>Findings</h3><p>Soft-tissue elasticity showed high individual differences. The equivalent elastic coefficient was larger in the medial compartment than in the lateral compartment, and the equivalent elastic coefficient of the lateral compartment gradually decreased while the medial equivalent elastic coefficient remained constant when the knee was flexed. The lateral gaps increased from 0.1 to 3.9 mm, and the medial gaps increased from 0 to 1.5 mm when the tension increased from 60 to 90 N. The shapes and distributions of the silkworm-like lattices in elasticity and balance evaluations are clinically relevant to knee balance.</p></div><div><h3>Interpretation</h3><p>Soft-tissue balance in total knee arthroplasty is significantly affected by soft-tissue elasticity. 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引用次数: 0
摘要
背景软组织平衡对全膝关节置换术的成功至关重要。软组织的弹性特性会影响膝关节的稳定性和灵活性。本研究提出了一种新方法，用于体内定量分析全膝关节置换术中软组织的弹性。本研究的目的是：（1）建立一个数学模型来描述内侧和外侧软组织的弹性；（2）报告软组织弹性的个体差异和个体间的共性。方法使用专门设计的膝关节张力器，通过对内侧和外侧分区连续施加动态张力来评估软组织弹性，同时测量两个分区的膝关节间隙。对六具尸体的十个膝关节进行了测量。结果软组织弹性表现出很大的个体差异。当膝关节屈曲时，内侧间隙的等效弹性系数大于外侧间隙，外侧间隙的等效弹性系数逐渐减小，而内侧间隙的等效弹性系数保持不变。当拉力从 60 N 增加到 90 N 时，外侧间隙从 0.1 mm 增加到 3.9 mm，内侧间隙从 0 mm 增加到 1.5 mm。弹性和平衡评估中蚕状网格的形状和分布与膝关节平衡的临床意义相关。术中对弹性的定量分析有助于为全膝关节置换术确定个体化的平衡目标。
Soft tissue elasticity in total knee arthroplasty: An in vivo quantitative analysis
Background
Soft tissue balance is essential for total knee arthroplasty success. The elastic properties of soft tissues affect knee-joint stability and flexibility. This study proposed a novel methodology for in vivo quantitative analysis of soft tissue elasticity during total knee arthroplasty. In this study, we aimed to (1) establish a mathematical model to depict medial and lateral soft tissue elasticity, (2) report the individual differences and interindividual commonalities in soft tissue elasticity.
Methods
A specifically designed knee tensor was used to evaluate soft tissue elasticity by dynamically applying sequential tensions to medial and lateral compartments while measuring knee joint gaps in both compartments. Measurements were performed on ten knees of six cadavers. Bivariate polynomial regression was used for analysis, and the equivalent elastic coefficient (N/mm) was calculated.
Findings
Soft-tissue elasticity showed high individual differences. The equivalent elastic coefficient was larger in the medial compartment than in the lateral compartment, and the equivalent elastic coefficient of the lateral compartment gradually decreased while the medial equivalent elastic coefficient remained constant when the knee was flexed. The lateral gaps increased from 0.1 to 3.9 mm, and the medial gaps increased from 0 to 1.5 mm when the tension increased from 60 to 90 N. The shapes and distributions of the silkworm-like lattices in elasticity and balance evaluations are clinically relevant to knee balance.
Interpretation
Soft-tissue balance in total knee arthroplasty is significantly affected by soft-tissue elasticity. An intraoperative quantitative analysis of elasticity helps to tail an individualized balancing target for total knee arthroplasty.
期刊介绍：
Clinical Biomechanics is an international multidisciplinary journal of biomechanics with a focus on medical and clinical applications of new knowledge in the field.
The science of biomechanics helps explain the causes of cell, tissue, organ and body system disorders, and supports clinicians in the diagnosis, prognosis and evaluation of treatment methods and technologies. Clinical Biomechanics aims to strengthen the links between laboratory and clinic by publishing cutting-edge biomechanics research which helps to explain the causes of injury and disease, and which provides evidence contributing to improved clinical management.
A rigorous peer review system is employed and every attempt is made to process and publish top-quality papers promptly.
Clinical Biomechanics explores all facets of body system, organ, tissue and cell biomechanics, with an emphasis on medical and clinical applications of the basic science aspects. The role of basic science is therefore recognized in a medical or clinical context. The readership of the journal closely reflects its multi-disciplinary contents, being a balance of scientists, engineers and clinicians.
The contents are in the form of research papers, brief reports, review papers and correspondence, whilst special interest issues and supplements are published from time to time.
Disciplines covered include biomechanics and mechanobiology at all scales, bioengineering and use of tissue engineering and biomaterials for clinical applications, biophysics, as well as biomechanical aspects of medical robotics, ergonomics, physical and occupational therapeutics and rehabilitation.
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