A Computational Modeling Approach for Investigating Soft Tissue Balancing in Bicruciate Retaining Knee Arthroplasty
A Computational Modeling Approach for Investigating Soft Tissue Balancing in Bicruciate Retaining Knee Arthroplasty
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DOI：
10.1155/2012/652865
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发表时间：
2012-01-01
影响因子：
--
通讯作者：
Wilson, David R.
中科院分区：
文献类型：
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作者：
Amiri, Shahram;Wilson, David R.
双交叉韧带保留型膝关节置换术虽然与其他设计的全膝关节置换术相比，已显示出改善的功能和患者满意度，但仍然是治疗严重膝关节炎病例的技术要求较高的选择。双交叉韧带保留型关节成形术的主要挑战之一是手术过程中软组织的适当平衡。在这项研究中，使用经过验证的膝关节计算模型（具有软组织结构的高保真度定义）以及田口实验设计方法（沿着）研究了软组织平衡的生物力学。该模型被用来模拟术中的软组织结构的平衡后的组合建议的正交阵列设计。结果用于量化在前后、内外和内翻-外翻载荷下对关节松弛度的相应影响。对每个韧带束的这些影响进行排名，以确定对相应手术修改最敏感的松弛成分。所有韧带束的灵敏度图确定了术中软组织平衡期间最适合检查的松弛分量。最后，提出了双交叉韧带保留型膝关节置换术术中软组织平衡的顺序。
Bicruciate retaining knee arthroplasty, although has shown improved functions and patient satisfaction compared to other designs of total knee replacement, remains a technically demanding option for treating severe cases of arthritic knees. One of the main challenges in bicruciate retaining arthroplasty is proper balancing of the soft tissue during the surgery. In this study biomechanics of soft tissue balancing was investigated using a validated computational model of the knee joint with high fidelity definitions of the soft tissue structures along with a Taguchi method for design of experiments. The model was used to simulate intraoperative balancing of soft tissue structures following the combinations suggested by an orthogonal array design. The results were used to quantify the corresponding effects on the laxity of the joint under anterior-posterior, internal-external, and varus-valgus loads. These effects were ranked for each ligament bundle to identify the components of laxity which were most sensitive to the corresponding surgical modifications. The resulting map of sensitivity for all the ligament bundles determined the components of laxity most suitable for examination during intraoperative balancing of the soft tissue. Ultimately, a sequence for intraoperative soft tissue balancing was suggested for a bicruciate retaining knee arthroplasty.