三组件式全踝关节置换假体的设计及应用现状

doi:10.3969/j.issn.2095-4344.2834

中国组织工程研究 ›› 2020, Vol. 24 ›› Issue (30): 4847-4853.doi: 10.3969/j.issn.2095-4344.2834

• 骨与关节综述 bone and joint review • 上一篇下一篇

三组件式全踝关节置换假体的设计及应用现状

王松波1，凌鸣2，王继成1，刘时璋2

1西安医学院，陕西省西安市 710068；2陕西省人民医院骨科病院，陕西省西安市 710068

收稿日期:2020-03-03 修回日期:2020-03-07 接受日期:2020-03-30 出版日期:2020-10-28 发布日期:2020-09-19
通讯作者: 刘时璋，博士，主任医师，陕西省人民医院骨科病院，陕西省西安市 710068
作者简介:王松波，男，1990年生，陕西省西安市人，汉族，西安医学院在读硕士，主要从事骨关节相关疾病的研究。
基金资助:
陕西省重点研发计划项目(2018ZDXM-SF-057)

Design and application status of three-component total ankle replacement prosthesis

Wang Songbo1, Ling Ming2, Wang Jicheng1, Liu Shizhang2

1Xi’an Medical University, Xi’an 710068, Shaanxi Province, China; 2Orthopedic Hospital of Shaanxi Provincial People’s Hospital, Xi’an 710068, Shaanxi Province, China

Received:2020-03-03 Revised:2020-03-07 Accepted:2020-03-30 Online:2020-10-28 Published:2020-09-19
Contact: Liu Shizhang, MD, Chief physician, Orthopedic Hospital of Shaanxi Provincial People’s Hospital, Xi’an 710068, Shaanxi Province, China
About author:Wang Songbo, Master candidate, Xi’an Medical University, Xi’an 710068, Shaanxi Province, China
Supported by:
the Key Research and Development Project of Shaanxi Province, No. 2018ZDXM-SF-057

摘要/Abstract

摘要：

文题释义：

全踝关节置换：是一种踝关节表面置换术，通过截除胫距关节的表面软骨，安装关节表面假体后，从而形成人工关节。

三组件式全踝关节置换假体：是全踝关节置换术所用到的一种假体，它由胫骨金属假体、距骨金属假体和一个插入金属假体之间的移动式轴承构成。

背景：早期的全踝关节置换假体，由于对踝关节生物力学的认识不足，较高的置入失败率和并发症发生率使得外科医生放弃了这种治疗方案。随着踝关节假体设计理念的不断更新，全踝关节置换越来越受到外科医生的青睐。目前，三组件式全踝关节置换假体被认为更符合正常踝关节生物力学的要求，并且被逐步推广应用于临床。

目的：了解踝关节生物力学，总结3种三组件式全踝关节置换假体的设计特点，为进一步的假体设计总结经验。

方法：由第一作者应用计算机检索 CNKI、PubMed等数据库建库至2020年2月有关全踝关节置换假体的文献，中文检索词为“全踝关节置换假体设计，STAR假体，HINTEGRA假体，BOX假体”，英文检索词为“Total ankle replacement prosthesis design，STAR prosthesis，HINTEGRA prosthesis，BOX prosthesis”。

结果与结论：①STAR假体、HINTEGRA假体、BOX假体在临床应用中表现出了可接受的生存率及临床结果，但仍然需要大量病例和长时间的随访进行验证；②3种全踝关节置换假体的设计都着重于恢复生理踝关节的解剖结构，再现踝关节的运动轴，兼容韧带的几何形状、减少踝关节周围组织的应力和机械对准；③要实现最大化的韧带兼容，假体组件的关节面设计必须是2个生理解剖形状或2个非生理解剖形状的关节面；④国人踝关节的形态和高加索人踝关节的形态有差异，期待设计研发符合国人踝关节要求的假体。

ORCID: 0000-0003-0032-4729(王松波)

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

关键词: 关节, 假体, 力学, 全踝关节置换, STAR假体, HINTEGRA假体, BOX假体, 三组件式

Abstract:

BACKGROUND: The early total ankle replacement has been abandoned for long times due to the insufficient understanding of the ankle joint biomechanics, higher implant failure rates and complications. With the updating of the design concept about ankle prosthesis, total ankle replacement surgery is now more and more popular among surgeons. At present, the three-component total ankle replacement prosthesis is considered to be more in line with the normal biomechanical requirements of the ankle joint, and has been gradually promoted for clinical application.

OBJECTIVE: To understand the biomechanics of the ankle joint, summarize the design features of the three-component total ankle joint replacement prostheses, and summarize experience for further prosthetic design.

METHODS: The first author used a computer to search CNKI and PubMed for the literature on total ankle replacement prostheses from inception to February 2020. The key words were “total ankle replacement prosthesis design, STAR prosthesis, HINTEGRA prosthesis, BOX prosthesis”.

RESULTS AND CONCLUSION: (1) The STAR, HINTEGRA, and BOX prostheses have shown acceptable survival rates and clinical results in clinical applications; however, a large number of cases and long-term follow-up were also required. (2) The designs of the three kinds of total ankle replacement prostheses all focus on restoring the anatomy of the physiological ankle joint, reproducing the axis of motion of the ankle joint, being compatible with the geometry of the ligament, and reducing the mechanical alignment of the tissue around the ankle joint. (3) To achieve maximum ligament compatibility, the articular surface design of the prosthetic component must be two physiological anatomic shapes or two non-physiological anatomic shapes. (4) There is a significant difference between the shape of the Chinese ankle and that of Caucasian. We are looking forward to design and develop a more suitable prosthesis for Chinese peoples.

Key words: ">joint, prosthesis, mechanics, total ankle replacement, STAR prosthesis, HINTEGRA prosthesis, BOX prosthesis, three-component

中图分类号:

王松波, 凌鸣, 王继成, 刘时璋. 三组件式全踝关节置换假体的设计及应用现状[J]. 中国组织工程研究, 2020, 24(30): 4847-4853.

Wang Songbo, Ling Ming, Wang Jicheng, Liu Shizhang. Design and application status of three-component total ankle replacement prosthesis[J]. Chinese Journal of Tissue Engineering Research, 2020, 24(30): 4847-4853.

图/表（结果） 1

参考文献

[1] GLAZEBROOK M, DANIELS T, YOUNGER A , et al. Comparison of health-related quality of life between patients with end-stage ankle and hip arthrosis. J Bone Joint Surg. 2008;90(3):499-505.

[2] GROSS CE, PALANCA AA, DEORIO JK. Design rationale for total ankle arthroplasty systems: an update. J Am Acad Orthop Surg. 2018; 26(10): 353-359.

[3] KOFOED H. Die Entwicklung der Sprunggelenksarthroplastik. Der Orthopäde. 1999; 28(9):804-811.

[4] VICKERSTAFF JA, MILES AW, CUNNINGHAM JL . A brief history of total ankle replacement and a review of the current status. Med Eng Phys. 2007;29(10):1056-1064.

[5] HENRICSON A, CARLSSON A. Survival analysis of the single- and double-coated STAR ankle up to 20 years: long-term follow-up of 324 cases from the Swedish ankle registry. Foot Ankle Int. 2015; 36(10):1156-1160.

[6] PRISSEL MA, ROUKIS TS. Incidence of revision after primary implantation of the Scandinavian Total Ankle Replacement system: a systematic review. Clin Podiatr Med Surg. 2013; 30(2): 237- 250.

[7] ZERAHN B, KOFOED H, BORGWARDT A. Increased bone mineral density adjacent to hydroxy- apatite- coated ankle arthroplasty. Foot Ankle Int.2000;21(4):285-289.

[8] KOFOED H. Scandinavian Total Ankle Replacement (STAR). Clin Orthop Relat Res. 2004; (424):73-79.

[9] CRACCHIOLO A, DEORIO JK. Design features of current total ankle replacements: implants and instrumentation. J Am Acad Orthop Surg.2008;16(9): 530 -540.

[10] BARG A, KNUPP M, HENNINGER HB,et al. Total ankle replacement using HINTEGRA, an unconstrained, three-component system: surgical technique and pitfalls. Foot Ankle Clin. 2012;17(4):607-635.

[11] DE LA FUENTE C, MARTINEZ-VALDES E, CRUZ-MONTECINOS C, et al. Changes in the ankle muscles co-activation pattern after 5 years following total ankle joint replacement. Clin Biomech (Bristol, Avon).2018;59:130-135.

[12] LEARDINI A, O'CONNOR JJ, CATANI F, et al. Mobility of the human ankle and the design of total ankle replacement. Clin Orthop Relat Res.2004;(424):39-46.

[13] PAPPAS M, BUECHEL FF, DEPALMA AF. Cylindrical total ankle joint replacement: surgical and biomechanical rationale. Clin Orthop Relat Res.1976;(118):82-92.

[14] SCRANTON PE,MCMASTER JG,KELLY E. Dynamic fibular function: a new concept.Clin Orthop Relat Res.1976;(118): 76-81.

[15] KOFOED H. Cylindrical cemented ankle arthroplasty: a prospective series with long-term follow-up.Foot Ankle Int. 1995;16(8):474-479.

[16] GITTINS J, MANN RA. The history of the STAR total ankle arthroplasty. Foot Ankle Clin. 2002;7(4):809-816.

[17] BURGE P, EVANS M. Effect of surface replacement arthroplasty on stability of the ankle. Foot Ankle.1986;7(1):10-17.

[18] BUECHEL F F, PAPPAS MJ, IORIO LJ. New Jersey low contact stress total ankle replacement: biomechanical rationale and review of 23 cementless cases. Foot Ankle. 1988;8(6):279-290.

[19] STAUFFER RN, CHAO EY, BREWSTER RC. Force and motion analysis of the normal, diseased, and prosthetic ankle joint. Clin Orthop Relat Res.1977;(127):189-196.

[20] LEARDINI A, O'CONNOR JJ, CATANI F, et al. A geometric model of the human ankle joint. J Biomech.1999;32(6): 585-591.

[21] LEARDINI A, O'CONNOR JJ, CATANI F, et al. Kinematics of the human ankle complex in passive flexion; a single degree of freedom system. J Biomech.1999,32(2):111-118.

[22] LEARDINI A, O'CONNOR JJ. A model for lever-arm length calculation of the flexor and extensor muscles at the ankle. Gait Posture.2002;15(3):220-229.

[23] LEARDINI A, O'CONNOR JJ, CATANI F, et al. The role of the passive structures in the mobility and stability of the human ankle joint: a literature review. Foot Ankle Int. 2000; 21(7):. 602-615.

[24] LEARDINI A, CATANI F, GIANNINI S, et al. Computer-assisted design of the sagittal shapes of a ligament-compatible total ankle replacement.Med Biol Eng Comput.2001;39(2):168-175.

[25] LEARDINI A, STAGNI R, O'CONNOR JJ. Mobility of the subtalar joint in the intact ankle complex. J Biomech.2001; 34(6):805-809.

[26] LEARDINI A, MOSCHELLA D. Dynamic simulation of the natural and replaced human ankle joint. Med Biol Eng Comput. 2002;40(2):193-199.

[27] 朱敏,唐康来.全踝关节置换假体设计的研究进展[J].中国矫形外科杂志,2019,27(24):2267-2271.

[28] HINTERMANN B, VALDERRABANO V, KNUPP M, et al. Die HINTEGRA- Sprunggelenkprothese: Kurz - und mittelfristige Erfahrungen. Orthopäde.2006;35(5):533-545.

[29] HINTERMANN B, VALDERRABANO V, DEREYMAEKER G, et al. The HINTEGRA ankle: rationale and short-term results of 122 consecutive ankles. Clin Orthop Relat Res. 2004;(424): 57-68.

[30] SMYTH A, FISHER J, SUÑER S, et al. Influence of kinematics on the wear of a total ankle replacement. J Biomech. 2017;53:105-110.

[31] MANN JA, MANN RA, HORTON E. STAR™ ankle: long-term results. Foot Ankle Int. 2011;32(5):473-484.

[32] CLOUGH T, BODO K, MAJEED H, et al. Survivorship and long-term outcome of a consecutive series of 200 Scandinavian Total Ankle Replacement (STAR) implants. Bone Joint J.2019;101- B(1):47-54.

[33] 林清,杜斌,魏攀登,等. STAR非限制活动型全踝假体的研究:现状及应用分析[J].中国组织工程研究,2014,18(9):1410-1415.

[34] NAJEFI A, MALHOTRA K, CHAN O, et al. The Bologna-Oxford ankle replacement: a case series of clinical and radiological outcomes. Int Orthop.2019;43(10): 2333-2339.

[35] KOIVU H, KOHONEN I, MATTILA K, et al. Long-term Results of Scandinavian Total Ankle Replacement. Foot Ankle Int. 2017;38(7):723-731.

[36] LOEWY EM, SANDERS TH, WALLING AK. Intermediate-term Experience With the STAR Total Ankle in the United States. Foot Ankle Int.2019;40(3):268-275.

[37] 吴剑,刘艳西,郑勇,等.人工全踝关节置换假体类型及其评价系统[J].中国组织工程研究与临床康复,2011,15(30):5627-5630.

[38] KITAOKA HB, ALEXANDER IJ, ADELAAR RS, et al. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int .1994;15(7): 349-353.

[39] DELEU PA, DEVOS BEVERNAGE B, GOMBAULT V,et al. Intermediate-term Results of Mobile-bearing Total Ankle Replacement. Foot Ankle Int. 2015;36(5):518-530.

[40] LEFRANCOIS T, YOUNGER A, WING K, et al. A prospective study of four total ankle arthroplasty implants by non-designer investigators. J Bone Joint Surg Am.2017; 99(4):342-348.

[41] YANG HY, WANG SH, LEE KB. The hintegra total ankle arthroplasty: functional outcomes and implant survivorship in 210 osteoarthritic ankles at a mean of 6.4 years.Bone Joint J. 2019; 101-B(6):695-701.

[42] GIANNINI S, ROMAGNOLI M, O'CONNOR JJ, et al. Total ankle replacement compatible with ligament function produces mobility, good clinical scores, and low complication rates: an early clinical assessment.Clin Orthop Relat Res. 2010;468(10):2746-2753.

[43] GIANNINI S, ROMAGNOLI M, BARBADORO P, et al. Results at a minimum follow-up of 5 years of a ligaments-compatible total ankle replacement design.Foot Ankle Surg.2017;23(2): 116-121.

[44] DANIELS TR, MAYICH DJ, PENNER MJ. Intermediate to long-term outcomes of total ankle replacement with the scandinavian total ankle replacement (STAR). J Bone Joint Surg Am.2015;97(11):895-903.

[45] BIANCHI A, MARTINELLI N, SARTORELLI E, et al. The Bologna-Oxford total ankle replacement: a mid-term follow-up study. Bone Joint Surgery Br. 2012;94(6): 793-798.

[46] LEE GW, SEON JK, KIM NS, et al. Comparison of intermediate-term outcomes of total ankle arthroplasty in patients younger and older than 55 years. Foot Ankle Int. 2019; 40(7): 762-768.

[47] LEE GW, SANTOSO A, LEE KB. Comparison of intermediate-term outcomes of total ankle arthroplasty in primary and ligamentous post-traumatic osteoarthritis. Foot Ankle Int. 2019; 40(11):1273-1281.

[48] LEE GW, WANG SH, LEE KB. Comparison of intermediate to long-term outcomes of total ankle arthroplasty in ankles with preoperative varus, valgus, and neutral alignment. J Bone Joint Surg Am. 2018;100(10):835-842.

[49] ESCUDERO M I, LE V, BARAHONA M, et al. Total ankle arthroplasty survival and risk factors for failure. Foot Ankle Int. 2019;40(9):997-1006.

[50] KUO CC, LU HL, LEARDINI A, et al.Three-dimensional computer graphics-based ankle morphometry with computerized tomography for total ankle replacement design and positioning. Clin Anat. 2014;27(4): 659-668.

三组件式全踝关节置换假体的设计及应用现状

Design and application status of three-component total ankle replacement prosthesis

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