祁昕征,张家铭,谭传明,张英泽,郑诚功.从生物力学角度评价单髁置换术与腓骨截骨术[J].医用生物力学,2016,30(4):479-487
从生物力学角度评价单髁置换术与腓骨截骨术
Evaluation of unicondylar knee arthroplasty and fibulectomy from a biomechanical viewpoint
投稿时间:2015-10-22  修订日期:2015-11-19
DOI:10.3871/j.1004-7220.2015.06.479
中文关键词:  膝骨关节炎  单髁置换术  腓骨截骨术  生物力学
英文关键词:Knee osteoarthritis  Unicondylar knee arthroplasty  Fibulectomy  Biomechanics
基金项目:国家自然科学基金项目(376391)
作者单位
祁昕征  
张家铭  
谭传明  
张英泽  
郑诚功  
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中文摘要:
      膝关节单间室骨性关节炎引起的膝内翻是常见病症之一,目前手术方法主要有胫骨高位截骨术、单髁置换术以及最新推广的腓骨截骨术。单髁置换术自开展以来已有60余年历史,相比全膝关节置换术具有可保留膝关节正常运动、手术创伤小、保留骨量多以及术后关节活动度大等优点,故单髁置换术已成为治疗内侧间室骨关节炎一种可靠的治疗方式。腓骨截骨术是一种治疗膝内翻的新治疗手段,具有手术简单、费用低、恢复快等优点,目前正在被大力推广,但其治病机制尚不很清楚。综述单髁置换和腓骨截骨两种临床手术方式,并从生物力学角度推论腓骨截骨术治疗内侧间室骨性关节炎的可能机制,提出腓骨截骨术后外侧收缩肌力下降导致关节合力矩再平衡,故关节接触位置改变、关节接触力下降可能是腓骨截骨术能够缓解疼痛治疗骨性关节炎的原因。
英文摘要:
      Varus deformation in knee joint is one of the common symptoms caused by unicompartment knee osteoarthritis. Currently, several operations can be used for correcting such deformation, including high tibial osteotomy, unicondylar knee arthroplasty (UKA) and fibulectomy. UKA has been developed for over 60 years, with the advantage of normal knee kinematics restored, less incision, more bony tissue preserved and larger range of motion than total knee arthroplasty (TKA). Therefore, UKA has become a reliable method for treating unicompartment knee osteoarthritis. Fibulectomy is a new kind of surgical technique for treating varus deformation in knee joint, with the advantage of simple operation, low cost and fast recovery. At present, fibulectomy has been widely applied, but its treatment mechanism is still not clear. In this review, two clinical operations UKA and fibulectomy were summarized, and the possible mechanism of fibulectomy for treating unicompartment knee osteoarthritis was proposed from the viewpoint of biomechanics. The author hypothesized that reduction in lateral muscle force after fibulectomy would cause rebalance of the resultant joint moment, therefore, the change of joint contact position and the decrease in joint contact force might be the cause of fibulectomy to release the pain for knee osteoarthritis patients.
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