https://scholars.lib.ntu.edu.tw/handle/123456789/83323
標題: | 人工全膝關節設計與評估用之膝關節三維電腦圖像生物力學模型(3/3) A 3D computer graphics-based biomechanical model of the knee joint for the design and evaluation of total knee replacements (3/3) |
作者: | 呂東武 | 關鍵字: | 膝關節生物力學;人工全膝關節;電腦模型;步態分析;knee biomechanics;total knee replacement;computer model;gait analysis | 公開日期: | 31-七月-2004 | 出版社: | 臺北市:國立臺灣大學醫學工程學研究所 | 摘要: | 人工全膝關節置換手術數十年來一直是治療退化性膝關節炎的主要選擇。目標在於有效 消除疼痛、恢復功能性活動度以及提供足夠的關節穩定度。雖然現有設計長期存續率己經相 當高,可是仍有許多改善空間,而未來可能發生的潛在問題在進行新設計時亦需一併考慮。 特別值得注意的是,高存續率並不代表病人膝功能恢復程度的高低。因此,除了持續加強人 工全膝關節本身耐磨耗性與固定外,如何恢復病人術後日常動作的功能,以提高其生活品質, 是現階段新型人工全膝關節設計一個相當重要的課題。 要針對現階段人工全膝關節功能需求,發展一個好的設計,必須先充份了解正常膝關節 的力學與功能。由於道德上的考量以及技術上的限制,直接量取膝關節內力有其困難。是以, 文獻中常以死體試驗研究膝關節。但是,死體試驗不易模擬膝關節之動態荷重。因此,三維 膝關節電腦模型的建立對人工全膝關節設計、測試、手術前規劃以及手術後的復健均極其重 要。基於此,本計畫旨在發展一個三維的膝關節電腦模型以補現階段研究之不足,並分三階 段(年)進行研發。 本計畫第一年完成膝關節三維電腦生物力學模型之建立,並以個別受試者之CT 或MRI 資料將模型個人化。該模型模擬分析正常膝關節於單關節動作(活動度、穩定度與肌力測試) 時之生物力學行為,所得結果與文獻及關節鬆弛度量測和動作分析實驗數據均相當一致。 第二年研究結果顯示,人工全膝關節置換後,膝關節的穩定度明顯下降,因為韌帶及關 節面等被動受力結構被去除或改變,而目前人工全膝關節之設計無法重建之。因此,肌肉控 制對人工全膝關節穩定度非常重要。人工關節之被動運動因前十字韌帶之切除,在其功能未 被代償的情形下,不可能重建正常關節運動。兩種人工關節(保留型、替代型)對恢復正常 運動各有優缺點,但均不足。當正常膝關節之前十字韌帶去除之後,其穩定性可藉由後腿肌 30-50%最大收縮力量補償之。其中兩種人工全膝關節及前十字韌帶缺損膝關節表現出的型態 相似,但是前十字韌帶缺損膝關節比人工全膝關節較接近正常膝關節。因此,未來人工全膝 關節或許應考慮如何補償前十字韌帶之功能。 第三年度計畫的目的在於整合第一年建立之三維膝關節電腦模型與計畫主持人己建立之 下肢模型以分析功能性動作。本階段研究結合步態分析技術以探討進行功能性動作時(步行、 爬梯)正常與人工全膝關節之生物力學行為。本計畫依據既定時程完成膝關節三維電腦模型 與既有下肢模型之整合,並探討功能性動作下膝關節的力學行為,所得結果與文獻韌帶與關 節接觸面力學行為表現一致。本研究有助於充份了解正常膝關節肌肉、韌帶與關節接觸面在 動作中提供膝關節動態平衡時彼此的力學互動。三維膝關節電腦模型與下肢模型的整合對人 工全膝關節設計、測試、手術前規劃以及手術後的復健均極其重要,進而可了解現有人工全 膝關節功能表現。 Total knee arthroplasty has been the main choice of treatment for advanced degenerative knee osteoarthritis over the last few decades, aiming at effective relief of pain, recovery of functional mobility and providing sufficient stability. Despite the excellent long-term survivorship of current total knee designs, there are a number of improvements that can be made, as well as potential problems that may emerge in the future. Also, it is noted that good survivorship does not necessarily imply satisfactory functional recovery. Therefore, in developing a new prosthesis, it is essential to ensure the functional performance that the prosthesis may bring to the patient, apart from improving its wear resistance and fixation in the body. Complete knowledge of the function and biomechanics of the natural knee is critical in developing a new total knee prosthesis that is aimed at improving the patient’s function. Due to ethical considerations and technical limitation, direct measurement of internal forces in the knee joint is difficult. In vitro experiments with cadavers thus have been used in the literature to study knee biomechanics. However, it has been agreed that it is difficult to simulate dynamic physiological loading in an in vitro experimental setting. Therefore, a three-dimensional computer graphics-based model of the knee joint will be useful for the design and pre-clinical testing of total knee replacements. It is also important for the evaluation and rehabilitation of patients post-surgery. It is the purpose of the present project to establish such a model. The project was carried out in three stages (years). During the first year, a 3D computer graphics-based biomechanical model of the knee joint was developed. The model was customized to specific subjects with their own CT or MRI data. Simulation study of knee biomechanics during single joint movement (mobility, stability and muscle strength tests) has also been performed and the results validated with experimental data. During the second year, the 3D computer graphics-based biomechanical model of the knee joint that was developed in the first year has been used to simulate total knee replacement surgeries for the study of the effects of TKR designs (PCL retaining/substitution) on the biomechanical performance of the knee during functional activities. The results of the study showed that the stability of knee significantly reduced after surgery as the stabilization structures such as ligaments and articular surfaces were removed or changed. Existing total knees were unable to reconstruct the normal stability of the joint. Therefore, muscles are important for knee stability during movement. Since the ACL was removed, normal knee kinematics cannot be recovered simply by total knees without any substituting mechanism for the ACL. Both types of TKR produced passive knee kinematics that were very different from normal. The removal of the ACL reduced significantly the stability of the knee but could be recovered by hamstrings actions with 30-50% level of its maximum force. Responses of the joint with hamstrings action were similar for the two types of TKR and the ACL-deficient knee. It seems that reconstruction of the ACL function maybe a consideration in future TKR designs. The 3D computer graphics-based biomechanical model of the knee joint developed in the first year has been incorporated into an existing lower limb model developed by the prime investigator. It was used to simulate on the biomechanical performance of the knee during functional activities. The results of the study showed that the mechanical performance of ligaments and articular surfaces were in agreement with the patterns reported in the literature. The results of this 3-year study will be useful for the design and pre-clinical testing of total knee replacements. It is also helpful for the evaluation and rehabilitation of patients post-surgery. |
URI: | http://ntur.lib.ntu.edu.tw//handle/246246/22390 | 其他識別: | 922320B002060 | Rights: | 國立臺灣大學醫學工程學研究所 |
顯示於: | 醫學工程學研究所 |
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