膝关节PS型固定平台与旋转平台假体置换术后三维数字化测量及三维步态分析

发布时间：2018-04-27 07:10

本文选题：全膝关节置换术 + 固定平台　；参考：《昆明医科大学》2017年硕士论文

【摘要】：[目的]对比分析PS型固定平台与旋转平台置换术后的近期临床疗效、膝关节形态学纠正情况及三维步态恢复情况。[方法]选取2015年3月至2016年3月到昆明医科大学第一附属医院确诊的膝关节骨性关节炎病例30例30膝,其中男性11例,女性19例,平均年龄(64.86±5.37)岁,随机分为固定平台组及旋转平台组,分别行固定平台及旋转平台假体置换术。对所有患者进行临床随访、膝关节形态学测量及三维步态分析。[结果]固定平台组与旋转平台组术后较术前的HSS评分、KSS评分及WOMAC评分明显改善。固定平台组与旋转平台组术后各随访时间点的KSS膝评分、KSS功能评分、HSS评分及WOMAC评分比较,差异均无统计学意义(P0.05)。PS型固定平台组与旋转平台组组内术前与术后测量数值之间差异有统计学意义(P0.05);两组术前测量数值与国人标准值比较差异有统计学意义(P0.05);两组术后测量数值与国人标准值比较差异无统计学意义(P0.05);固定平台组与旋转平台组组间术后测量角度进行比较差异无统计学意义(P0.05)。通过对术后1年的两组患者进行步态分析,并将两组所获相关参数进行对比,发现两组患者在行走过程中的最大伸直角、最大屈曲角、最大内翻角、最大外翻角、最大内旋角、最大外旋角、最大后位移、最大前位移、最大下位移、最大上位移、最大内位移及最大外位移等参数的比较,差异无显著性意义(P0.05),但两组患者在行走过程中的最大内翻角、最大外翻角、最大内旋角、最大外旋角、最大后位移、最大前位移、最大下位移、最大上位移、最大内位移及最大外位移等参数与正常人相关参数对比,差异有显著性意义(P0.05)。[结论]膝关节PS型固定平台型假体与旋转平台型假体置换术后均能获得较好的手术效果、很好的恢复正常膝关节形态学及较好的步态恢复情况。第一部分膝关节PS型固定平台与旋转平台假体置换术后早期临床疗效对比分析[目的]对比分析PS型固定平台与旋转平台置换术后的近期临床疗效。[方法]选取2015年3月至2016年3月到昆明医科大学第一附属医院确诊的膝关节骨性关节炎病例30例30膝,其中男性11例,女性19例,平均年龄(64.86±5.37)岁,随机分为固定平台组及旋转平台组,分别行固定平台及旋转平台假体置换术。对所有患者手术前及术后1月、3月、6月、1年进行HSS评分、KSS评分及WOMAC评分,探讨两组假体的近期临床疗效。[结果]术前旋转平台组和固定平台组的年龄、体重指数、膝关节HSS评分、KSS评分及WOMAC评分无统计学差异(P0.05)。术后所有患者恢复良好,无切口皮缘坏死、感染、深静脉血栓等并发症。固定平台组与旋转平台组术后较术前的HSS评分、KSS评分及WOMAC评分明显改善。固定平台组与旋转平台组术后各随访时间点的KSS膝评分、KSS功能评分、HSS评分及WOMAC评分比较,差异均无统计学意义(P0.05)。[结论]膝关节PS型固定平台型假体与旋转平台型假体置换术后均能获得较好的手术效果,均能明显改善膝关节功能。第二部分膝关节PS型固定平台与旋转平台假体置换术后膝关节三维数字化测量对比分析[目的]基于CT二维图像数据构建出旋转平台组及固定平台组膝关节置换术前及术后双下肢三维数字模型并对膝关节相关形态学进行测量;对比分析其差异性。[方法]1.选取2015年3月至2016年3月在昆明医科大学第一附属医院确诊的膝关节骨性关节炎病例30例30膝,其中男性11例,女性19例,平均年龄(64.86±5.37)岁,随机分为固定平台组及旋转平台组,分别行固定平台及旋转平台假体置换术。每组各15膝。2.收集患者的术前、术后双下肢二维CT全长位片;数据运用Mimics17.0软件将术前及术后患肢全长进行三维重建。选择患者术中所用对应型号的全膝关节假体,通过三维激光扫描逆向重建相应假体三维模型,在Mimics17.0软件中使用点对点配准技术将假体三维模型装配到术后患肢三维模型膝关节上;3.三维重建后通过软件自带测量工具对两组模型测量如下指标:髋-膝-踝角、胫骨平台后倾角、胫骨角、股骨角、股骨外翻角、胫骨平台内翻角,并将测量结果进行对比,并与正常国人标准值进行对比分析。[结果]PS型固定平台组与旋转平台组组内术前与术后测量数值之间差异有统计学意义(P0.05);两组术前测量数值与国人标准值比较差异有统计学意义(P0.05);两组术后测量数值与国人标准值比较差异无统计学意义(P0.05);固定平台组与旋转平台组组间术后测量角度进行比较差异无统计学意义(P0.05)。[结论]基于CT二维图像能对膝关节置换术后进行精确三维重建,并通过三维重建模型能够精确的测量膝关节形态学,避免了因通过手工测量、X线拍摄时存在患肢的旋转或姿势摆放不正导致骨性标志轮廓的不清晰而引起测量误差。PS型旋转平台与固定平台假体置换均能较好的恢复正常膝关节形态学。第三部分膝关节PS型固定平台与旋转平台假体置换术后的三维步态对比分析[目的]观察两组全膝关节置换术后近期步态恢复情况,通过三维步态对比固定平台假体与旋转平台假体置换术后膝关节行走步态方面的差异。[方法]选取2015年3月至2016年3月到昆明医科大学第一附属医院确诊的膝关节骨性关节炎病例30例30膝,其中男性11例,女性19例,平均年龄(64.86±5.37)岁,随机分为固定平台组及旋转平台组,分别行固定平台及旋转平台假体置换术。术后1年对所有患者进行三维步态分析,同时收集15例健康志愿者膝关节三维步态数据,对两组患者三维步态数据进行对比,并将两组患者与正常人数据进行对比。[结果]通过对术后1年的两组患者进行步态分析,并将两组所获相关参数进行对比,发现两组患者在行走过程中的最大伸直角、最大屈曲角、最大内翻角、最大外翻角、最大内旋角、最大外旋角、最大后位移、最大前位移、最大下位移、最大上位移、最大内位移及最大外位移等参数的比较,差异无显著性意义(P0.05),但两组患者在行走过程中的最大内翻角、最大外翻角、最大内旋角、最大外旋角、最大后位移、最大前位移、最大下位移、最大上位移、最大内位移及最大外位移等参数与正常人相关参数对比,差异有显著性意义(P0.05)。
[Abstract]:[Objective] to compare the short-term clinical efficacy of PS type fixed platform and rotating platform replacement, the morphological correction of knee joint and the recovery of three dimensional gait. [Methods] 30 cases of 30 knee osteoarthritis cases were selected from March 2015 to March 2016 to the First Affiliated Hospital of Kunming Medical University, of which 11 cases were male and 19 of women were 19. The average age (64.86 + 5.37) years was randomly divided into fixed platform group and rotating platform group. The fixed platform and rotating platform prosthesis replacement were performed respectively. All patients were followed up, the morphological measurement of the knee joint and the three-dimensional gait analysis. [results] the HSS score, KSS score and WOMAC of the fixed platform group and the rotating platform group were compared with that of the rotation platform group. There was no significant difference in KSS knee score, KSS function score, HSS score and WOMAC score (P0.05) between the fixed platform group and the rotation platform group after the operation (P0.05), and there was a significant difference between the preoperative and postoperative measurements (P0.05) between the group.PS and the rotation platform group (P0.05); the two groups were measured before operation. There was significant difference between the values and the national standard values (P0.05), and there was no significant difference between the two groups after operation and the standard values of the Chinese people (P0.05). There was no statistical difference between the fixed platform group and the rotation platform group after the operation (P0.05). The gait analysis was carried out in two groups of patients after 1 years of operation, And comparing the related parameters of the two groups, the maximum extension angle, maximum angle of flexion, maximum angle of valgus, maximum angle of valgus, maximum angle of extroversion, maximum angle of rotation, maximum angle of rotation, maximum displacement, maximum displacement, maximum displacement, maximum upper displacement, maximum displacement, maximum internal displacement and maximum external displacement are compared. There was no significant difference (P0.05), but the maximum angle of valgus, maximum angle of valgus, maximum rotation angle, maximum rotation angle, maximum lateral rotation angle, maximum displacement, maximum displacement, maximum upper displacement, maximum displacement, maximum internal displacement and maximum external displacement were compared with those of normal human related parameters in the two groups (P0.05). Conclusion: the knee joint PS fixed platform prosthesis and the rotating platform prosthesis can achieve better results after the replacement of the rotary platform prosthesis. The normal knee joint morphology and the better gait recovery are well restored. The comparison of the early clinical efficacy of the first part of the knee joint PS fixed platform and the rotating platform prosthesis is compared. The short-term clinical effects of PS type fixed platform and rotating platform replacement were analyzed. [Methods] 30 cases of 30 knee osteoarthritis cases confirmed by the First Affiliated Hospital of Kunming Medical University from March 2015 to March 2016 were selected, including 11 males and 19 females, with an average age of 64.86 + 5.37 years old, randomly divided into fixed platform group and rotating flat. The HSS score, KSS score and WOMAC score were performed for all patients before and after operation, January, March, June, and WOMAC. [results] the age, body mass index, HSS score of knee joint, KSS score, and WOMAC of the pre operation rotating platform group and the fixed platform group were studied. There was no statistical difference (P0.05). All patients recovered well after operation without incision skin necrosis, infection, deep vein thrombosis and other complications. The fixed platform group and the rotation platform group were compared with the preoperative HSS score, KSS score and the WOMAC score. The KSS knee score and the KSS function at the fixed platform group and the rotation platform group were followed up at each follow-up time point. There was no significant difference in score, HSS score and WOMAC score (P0.05). [Conclusion] both knee joint PS fixed platform prosthesis and rotary platform prosthesis were all able to obtain better surgical results and significantly improve the function of knee joint. Second part of the knee joint PS fixed platform and the knee joint prosthesis replacement after the rotation platform prosthesis replacement. Three dimensional digital measurement comparative analysis [Objective] to construct the three dimensional digital model of the knee joint before and after the operation of the rotation platform group and the fixed platform group based on the CT two-dimensional image data and measure the knee joint related morphology, and compare the differences. [method]1. selected the Kunming Medical University from March 2015 to March 2016. In a Affiliated Hospital, 30 cases of knee osteoarthritis were diagnosed as 30 knees, including 11 males and 19 females, with an average age of 64.86 + 5.37 years old. The fixed platform group and rotating platform group were randomly divided into fixed platform and rotating platform prosthesis replacement. Each group of 15 knee.2. collected the patients before and after the operation. The total length of the affected limb before and after the operation was reconstructed by Mimics17.0 software. The total knee prosthesis of the corresponding model used in the patient's operation was selected, the three-dimensional model of the corresponding prosthesis was reconstructed by the three-dimensional laser scanning, and the 3D model of the false body was assembled by point to point registration in the Mimics17.0 software to the three dimensional model of the affected limb after the operation. On the knee joint; 3. after three dimensional reconstruction, the following indexes were measured by software self measuring tools: hip knee ankle angle, tibial plateau tilt angle, tibial angle, femur angle, femur valgus angle, tibial plateau inverted angle, and compared the measured results, and compared with normal national standard value. [result]PS type fixed platform group and There was a statistically significant difference between the preoperative and postoperative measurements in the group of rotating platforms (P0.05); there was a significant difference between the two groups before operation and the standard values of the National People (P0.05); there was no statistical difference between the two groups after the operation (P0.05) and the postoperative measurement between the fixed platform group and the rotating platform group. There is no significant difference between the angles and the differences (P0.05). [Conclusion] the two-dimensional image based on CT can accurately reconstruct the knee joint after the replacement of the knee joint, and can accurately measure the morphology of the knee joint through the three-dimensional reconstruction model. The uncertainty of the profile and the measurement error caused by the measurement error.PS rotary platform and the fixed platform prosthesis can better restore the normal knee joint morphology. Third part of the knee joint PS fixed platform and the rotation platform prosthesis replacement of the three-dimensional gait analysis [Objective] to observe the recent gait recovery after two groups of total knee arthroplasty The difference in walking gait of knee joint after replacement of fixed platform prosthesis and rotating platform prosthesis was compared by three dimensional gait. [Methods] 30 cases of 30 knees were selected from March 2015 to March 2016 to the First Affiliated Hospital of Kunming Medical University, including 11 males and 19 females with an average age of (64.86 + 5.37) years. The fixed platform group and the rotating platform group were randomly divided into fixed platform and rotating platform prosthesis replacement. Three dimensional gait analysis was carried out for all patients 1 years after operation, and the three dimensional gait data of 15 healthy volunteers were collected at the same time. The three dimensional gait data of the two groups were compared, and the data of the two groups were carried out with the normal person data. Comparison. [results] by analyzing the gait of two groups of patients after 1 years of operation, and comparing the related parameters of the two groups, the maximum extension angle, maximum angle of flexion, maximum angle of turn, maximum angle, maximum rotation angle, maximum external rotation angle, maximum back angle, maximum displacement, maximum displacement, maximum displacement and maximum displacement of two groups of patients were found in the course of walking. There is no significant difference between the maximum displacement, maximum internal displacement and maximum external displacement (P0.05), but the maximum angle of inversion, maximum angle, maximum rotation angle, maximum external rotation angle, maximum displacement, maximum displacement, maximum displacement, maximum upper displacement, maximum displacement, maximum internal displacement and maximum displacement in the two groups of patients in the course of walking. There was a significant difference between parameters and normal human parameters (P0.05).

【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.4

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