全膝关节置换术植入物设计在步态中的运动学和动力学差异。

IF 1.4 3区医学 Q4 ENGINEERING, BIOMEDICAL

Clinical Biomechanics Pub Date : 2025-02-01 DOI:10.1016/j.clinbiomech.2024.106404

Kohei Nishizawa , Kengo Harato , Satoshi Hakukawa , Shu Kobayashi , Yasuo Niki , Takeo Nagura

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引用次数: 0

摘要

背景：在膝关节置换术后的步态中，植入物的设计对于获得适当的膝关节生物力学是很重要的。双十字关节稳定全膝关节置换术试图复制前路稳定性和旋转促进。然而，与其他植入体设计相比，其详细的步态生物力学尚未得到分析。本研究的目的是比较双交叉关节稳定全膝关节置换术、后稳定全膝关节置换术、单腔膝关节置换术和正常膝关节的运动学和动力学。方法：选取10例健康受试者，其中后路稳定型全膝关节置换术16例，双十字关节稳定型全膝关节置换术12例，单室膝关节置换术13例。关节置换术后平均随访11.0个月。使用运动捕捉系统评估三维运动学和动力学，受试者在5米的人行道上行走。采用Kruskal-Wallis检验进行组间比较，并对差异显著的参数进行事后分析。结果：与单室膝关节置换术组相比，双交叉关节稳定全膝关节置换术组显示内旋减少。与对照组相比，后稳定全膝关节置换术组表现出膝关节伸展和内旋力矩的减少。结论：与单室膝关节置换术相比，双交叉关节稳定全膝关节置换术在终末站立时表现出不同的生物力学特征。与单室膝关节置换术相比，双关节稳定和后关节稳定全膝关节置换术中均存在膝关节屈伸活动不足的情况，这可能是由于步态中膝关节旋转运动不足造成的，因此术后全膝关节置换术的康复应侧重于缓解膝关节僵硬。

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Differences in kinematics and kinetics during gait between total knee arthroplasty implant designs

Background

Implant design is important for achieving proper knee biomechanics during gait following knee arthroplasty. Bicruciate-stabilized total knee arthroplasty attempts to replicate anterior stability and rotational facilitation. However, its detailed gait biomechanics compared with other implant designs have not been analyzed. The purpose of this study is to compare knee kinematics and kinetics between bicruciate-stabilized total knee arthroplasty, posterior-stabilized total knee arthroplasty, unicompartmental knee arthroplasty, and normal knees.

Methods

Ten healthy subjects, 16 who underwent posterior stabilized total knee arthroplasty, 12 who underwent bicruciate-stabilized total knee arthroplasty, and 13 who underwent unicompartmental knee arthroplasty were recruited. The mean follow-up period after arthroplasty was 11.0 months. Three-dimensional kinematics and kinetics were assessed using a motion capture system with subjects walking on a 5-m walkway. Comparisons between groups were conducted using the Kruskal–Wallis test, and post hoc analysis was performed for those parameters that differed significantly.

Findings

The bicruciate-stabilized total knee arthroplasty group showed decreased internal rotation compared to the unicompartmental knee arthroplasty group. Compared to the control group, the posterior-stabilized total knee arthroplasty group exhibited reduced knee extension and internal rotation moment.

Interpretation

Bicruciate-stabilized total knee arthroplasties exhibited different biomechanical characteristics compared to unicompartmental knee arthroplasties during terminal stance. Postoperative total knee arthroplasty rehabilitation should focus on relieving stiffness owing to insufficient knee flexion-extension motion observed in both bicruciate-stabilized and posterior-stabilized total knee arthroplasties compared with unicompartmental knee arthroplasty, which may be due to a lack of knee rotational motion during gait.

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来源期刊

Clinical Biomechanics 医学-工程：生物医学

CiteScore

3.30

自引率

5.60%

发文量

189

审稿时长

12.3 weeks

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.