CONTACT PRESSURES IN THE HUMAN HIP-JOINT MEASURED INVIVO
CONTACT PRESSURES IN THE HUMAN HIP-JOINT MEASURED INVIVO
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DOI：
10.1073/pnas.83.9.2879
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发表时间：
1986-05-01
影响因子：
11.1
通讯作者：
MANN, RW
中科院分区：
文献类型：
--
作者：
HODGE, WA;FIJAN, RS;MANN, RW
人体关节软骨上的压力已经在体内测量。一个仪器股骨头假体，遥测关节间的压力在10个离散的位置每秒253次被植入在自然髋臼软骨并置。在手术、恢复、康复和正常活动期间采集数据，手术后超过1年。压力大小与身体部分运动学数据和足底力测量同步，以便定位自然髋臼上的转换压力区域，并将运动学和动力学与局部软骨压力相关联。数据显示非常高的局部（高达18 MPa）和不均匀的压力，突然的空间和时间梯度，以及相关的幅度和分布与体外数据和计算机模拟的滑膜关节力学。然而，体内峰值压力远高于在生活中关节所经历的假定力下体外测量的压力，特别是在正常运动中，髋关节的激动肌和拮抗肌发生共同收缩。因此，现有的步态分析研究应用逆牛顿计算来推断关节力建立了这种力的下限，因为这种分析只包括关节周围的净肌肉扭矩，而不能解释由于肌肉共同收缩引起的关节力增量的贡献。我们的数据也有助于理解正常的滑膜关节摩擦学和机械因素在骨关节炎明显恶化中的可能作用。此外，部分和全髋关节置换假体的设计标准以及髋关节手术后康复方案的具体方面（例如，拐杖和手杖对髋关节的负重程度）需要根据日常生活活动中测得的异常高压进行重新考虑。
The pressures on human articular cartilage have been measured in vivo. An instrumental femoral head prosthesis that telemeters interarticular pressure at 10 discrete locations 253 times per second was implanted in apposition to natural acetabular cartilage. Data were acquired during surgery, recovery, rehabilitation, and normal activity, for longer than 1 year after surgery. Pressure magnitudes were synchronized with body-segment kinematic data and foot-floor force measurements so as to locate transduced pressure areas on the natural acetabulum and correlate movement kinematics and dynamics with local cartilage pressures. The data reveal very high local (up to 18 MPa) and nonuniform pressures, with abrupt spatial and temporal gradients, that correlate well both in magnitude and distribution with in vitro data and computer simulations of synovial joint mechanics. Peak pressures in vivo are, however, considerably higher than pressures measured in vitro under the putative forces experienced by the joint in life, particularly in normal movements where cocontraction occurs in agonist and antagonist muscles across the hip joint. Thus, extant gait-analysis studies which apply inverse Newtonian calculations to infer joint forces establish the lower limit on such forces, since such analyses include only the net muscular torques about the joint and cannot account for the contribution of the increment in joint force due to muscular cocontraction. Our data also contribute to the understanding of normal synovial joint tribology and the possible role of mechanical factors in the deterioration evident in osteoarthritis. Further, design criteria for both partial and total hip replacement prosthesis and specific aspects of rehabilitation protocols following hip surgery (e.g., the extent to which crutches and canes unload the hip joint) warrant reconsideration in light of the extraordinary high pressures measured during the activities of daily living.