三组件式全踝关节置换假体的设计及应用现状

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。

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 the updating of the design concept about ankle prosthesis,total ankle replacement surgery is now more and more popular among 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 are looking forward to design and develop a more suitable prosthesis for Chinese peoples.

0 引言 Introduction

随着全踝关节置换的发展，假体的不断改进，越来越多的外科医生希望通过全踝关节置换来获得一个稳定、无痛、活动度良好的踝关节。目前，全踝关节置换在临床中被用于治疗原发性踝关节炎、继发性踝关节炎(包括风湿病、血友病、血色病、痛风、缺血性坏死和感染后状态所引起的关节炎)和创伤性关节炎[1]。在全踝关节置换发展的50年里，推出了各式各样的踝关节假体，按组件的类型可以分成固定轴承的二组件式假体和包含移动式轴承的三组件式假体。三组件式假体能更好地复制踝关节运动，表现出了良好的生物力学优势，越来越多的三组件式假体被推广应用，文章就3种三组件式全踝关节置换假体进行了综述。

1 资料和方法 Data and methods

1.1 资料来源 由第一作者应用计算机检索CNKI、PubMed等数据库建库至2020年2月收录的有关全踝关节置换假体的综述、原著、病例报告，以中文检索词为“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”进行关键词检索。

1.2 入选标准

纳入标准：①与全踝关节置换假体设计高度相关的研究文献，包括踝关节生物力学的研究文献；②与使用STAR、HINTEGRA、BOX全踝关节置换假体治疗原发性踝关节炎、继发性踝关节炎和创伤性踝关节炎相关的研究文献，包括与使用3种假体治疗后的短、中、长期随访研究相关的文献；③与STAR、HINTEGRA、BOX全踝关节置换假体关于其设计者和非设计者在临床应用研究相关的文献；④与STAR、HINTEGRA、BOX全踝关节置换假体和其他踝关节置换假体在临床应用对比研究的相关文献；⑤此领域发表的高质量文献及经典文献；⑥能查到全文的文献。

文章来源：《力学季刊》 网址: http://www.lxjkzz.cn/qikandaodu/2021/0208/334.html