Mobile and fixed bearing total knee prosthesis functional comparison during stair climbing
Mobile and fixed bearing total knee prosthesis functional comparison during stair climbing
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DOI：
10.1016/s0268-0033(03)00044-5
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发表时间：
2003-06-01
影响因子：
1.8
通讯作者：
Aglietti, P
中科院分区：
文献类型：
--
作者：
Catani, F;Benedetti, MG;Aglietti, P
目标。本研究的目的是确定活动支承型全膝关节置换假体与固定支承型全膝关节置换假体的功能性能。对10例活动负重和10例固定负重Insall Burstein II后稳定型全膝关节置换术患者在上行和下行过程中的运动学、动力学和肌电数据进行了分析。对10名年龄和性别匹配的正常受试者的对照组也进行了分析。在水平行走研究中，不同全膝关节置换设计的患者之间没有显著的生物力学差异。爬楼梯研究表明，相对于十字牺牲的全膝关节置换设计，后路保留的性能略好一些。通过步态分析评估，目前只有一项关于活动和固定承重全膝关节置换术的研究。这项研究没有显示出两组之间的任何生物力学差异。采用运动分析的方法对膝关节在上下楼梯过程中的运动学、动力学和肌电(左右背最长肌、臀中肌、股直肌、股二头肌、半腱肌、腓肠肌和胫前肌)进行量化。活动负重组在爬楼梯和下楼时膝关节伸缩力矩减少，在爬楼梯时膝关节内收力矩减少。上楼时，大多数活动负重患者在双支撑期的站立晚期出现屈膝峰值和屈膝最大力矩。这种运动学和运动学模式在正常受试者中是不存在的。活动负重组和固定负重组均表现为肌电下降和上升的异常模式。在爬楼梯的过程中，活动支承设计表现出与固定支承全膝关节置换术不同的运动学模式。上楼时活动负重患者似乎更多采用肢体代偿机制。
Objective. The purpose of this investigation is to determine the functional performance of the mobile bearing total knee replacement prosthesis as compared to the fixed bearing type total knee replacement prosthesis.Design. Kinematics, kinetics, and electromyography data were gained from 10 patients with mobile bearing and 10 patients with a fixed bearing posterior stabilized Insall Burstein II total knee replacement during ascending and descending stairs. A control group of 10 normal subjects, matched by sex and age, was also analysed.Background. No significant biomechanical differences in patients with different total knee replacement designs have been reported from level-walking studies. Slightly better performance of posterior retaining with respect to cruciate sacrificing total knee replacement designs have been claimed from stair climbing studies. Only one study has been conducted regarding mobile versus fixed bearing total knee replacement assessed by gait analysis. This study did not show any biomechanical differences between the two groups.Methods. Motion analysis was used to quantify the knee kinematics, kinetics, and electromyography (right and left longissimus dorsi, gluteus medius, rectus femoris, biceps femoris, semitendinosus, gastrocnemius and tibialis anterior muscles) during stair ascent and descent.Results. The mobile bearing group demonstrated a reduced knee extensor moment during stair climbing and descending, and a reduced knee adductor moment during stair climbing. When ascending stairs, most of the mobile bearing patients show a peak knee flexion and a peak knee flexion moment at the late stance phase during the double support period. This kinematic and kinetic pattern is absent in normal subject. Both mobile bearing and fixed bearing groups showed abnormal electromyography patterns in both descending and ascending.Conclusions. During stair climbing, the mobile bearing design demonstrates a different kinematic pattern to the fixed bearing total knee replacement. Lower limb compensatory mechanisms seemed to be adopted particularly by the mobile bearing patients during ascending stairs.