CAJ | 학술논문

背景：单髁置换相比全膝置换具有微创优势，但相对于全膝置换金标准，单髁置换生存率仍存争议。目的：参数化建立人工单髁置换与全膝置换三维有限元模型，对比分析两者假体接触表面的应力变化。方法：选择1例单侧行人工单髁置换、对侧行人工全膝置换的志愿者，置换前采用3D CT扫描膝关节，通过三维软件建立膝关节模型，然后通过参数化软件设计与膝关节模型相匹配的关节假体，建立膝关节单髁置换与全膝置换三维模型，最后通过有限元分析软件模拟膝关节在站立和水平行走情况下，膝关节屈曲度分别为0°，10°，30°，60°时内髁的最大等效应力，并进行比较分析。结果与结论：在模拟站立位时，单髁置换假体与全膝置换假体0°，10°时最大等效应力差异无显著性意义(P>0.05)，模拟30°，60°时单髁置换假体最大等效应力分别高于全膝置换假体15.01%，6.08%，差异有显著性意义(P <0.05)。模拟水平行走时，模拟0°，10°，30°，60°时单髁置换假体最大等效应力分别高于全膝置换假体5.45%，6.65%，6.67%，9.01%，差异有显著性意义(P<0.05)。提示单髁置换假体与全膝置换假体水平位元件对聚乙烯垫片磨损无实际意义，但在水平运动时，单髁置换假体聚乙烯垫片磨损可能高于全膝置换假体，可为临床进一步提供指导意义。
배경：단과치환상비전슬치환구유미창우세，단상대우전슬치환금표준，단과치환생존솔잉존쟁의。목적：삼수화건립인공단과치환여전슬치환삼유유한원모형，대비분석량자가체접촉표면적응력변화。방법：선택1례단측행인공단과치환、대측행인공전슬치환적지원자，치환전채용3D CT소묘슬관절，통과삼유연건건립슬관절모형，연후통과삼수화연건설계여슬관절모형상필배적관절가체，건립슬관절단과치환여전슬치환삼유모형，최후통과유한원분석연건모의슬관절재참립화수평행주정황하，슬관절굴곡도분별위0°，10°，30°，60°시내과적최대등효응력，병진행비교분석。결과여결론：재모의참립위시，단과치환가체여전슬치환가체0°，10°시최대등효응력차이무현저성의의(P>0.05)，모의30°，60°시단과치환가체최대등효응력분별고우전슬치환가체15.01%，6.08%，차이유현저성의의(P <0.05)。모의수평행주시，모의0°，10°，30°，60°시단과치환가체최대등효응력분별고우전슬치환가체5.45%，6.65%，6.67%，9.01%，차이유현저성의의(P<0.05)。제시단과치환가체여전슬치환가체수평위원건대취을희점편마손무실제의의，단재수평운동시，단과치환가체취을희점편마손가능고우전슬치환가체，가위림상진일보제공지도의의。
BACKGROUND:Compared with total knee arthroplasty, unicompartmental arthroplasty has the advantage of minimal invasion. Regarding the gold standard of total knee arthroplasty, the survival rate of unicompartmental arthroplasty remains controversial. OBJECTIVE:To establish three-dimensional finite element model of unicompartmental arthroplasty and total knee arthroplasty, and comparatively analyze the changes in stress on the prosthetic contact surface. METHODS:One case underwent unicompartmental arthroplasty on one side, and received total knee arthroplasty on the opposite side. Knees were scanned by 3D CT before operation. Knee models were established by three-dimensional software. The matched prosthesis was designed by parameterization software. Three-dimensional models for unicompartmental arthroplasty and total knee arthroplasty were established. By finite element analysis software, maximal equivalent stress was simulated when knee flexion was 0°, 10°, 30° and 60° in standing and walking cases, and results were compared and analyzed. RESULTS AND CONCLUSION: No significant difference in maximal equivalent stress was detected when knee flexion was 0° and 10° in unicompartmental arthroplasty prosthesis and total knee arthroplasty prosthesis in standing case (P > 0.05). At knee flexion of 30° and 60° in standing case, the maximal equivalent stress was significantly greater in unicompartmental arthroplasty prosthesis than in the total knee arthroplasty prosthesis (15.01%, 6.08%;P < 0.05). When knee flexion was 0°, 10° 30° and 60° in standing case, the maximal equivalent stress was higher in unicompartmental arthroplasty prosthesis than in the total knee arthroplasty prosthesis (5.45%, 6.65%, 6.67%, 9.01%;P < 0.05). These findings verified that in the case of standing, there was no practical significance in wearing of polyethylene insert between unicompartmental arthroplasty prosthesis and total knee arthroplasty prosthesis. In the case of walking, the wearing of unicompartmental arthroplasty may be higher than that of total knee arthroplasty prosthesis, which provides guidance for the clinical practice.