表面置換型人工臏股骨關節的設計與分析

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姓名

吳昇財(Sheng-Tsai Wu) 查詢紙本館藏

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機械工程學系

論文名稱

表面置換型人工臏股骨關節的設計與分析
(Design and Analysis of Surface Replacement Prosthesis for Patellofemoral Joint)

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摘要(中)

近年來隨著生活型態的改變及醫學的進步，人類平均壽命逐年延長，老年病患也隨之逐年增加，其中以退化性關節炎就是明顯的例子；目前單一退化性臏股骨關節炎，臨床治療方式有：(1)全人工膝關節置換；(2)表面置換型人工臏股骨關節。其可以改善病患因為關節發炎而造成膝關節活動的不方便與臏骨周圍軟組織的不平衡等，進而增進臏骨與股骨之間的相互滑動正常。表面置換型人工臏股骨關節好處是微小骨切除量，且未來可在關節炎較為嚴重時再次進行全關節置換手術。
人工臏股骨關節目前最大的問題是在於植入物植入後不穩定，容易發生沈陷現象，而且植入物尺寸是定製化，人工關節之曲面與病患關節曲面無法完全配合。本研究針對現今臨床上臏股骨關節設計的缺點，考慮臏股骨關節退化部位的曲面差異，結合醫學影像重建的技術，依據不同病患，建構客製化關節的曲面設計與相對應之手術器械，實際模擬測試評估其整體可行性，並建構動態運動模擬真實之膝關節股骨與脛骨運動及受力之間的分析平台，藉以改進人工臏股骨關節之設計。

摘要(英)

In recent years, because the improvement of lifestyle and medical science has increased human age and the elder patient has increased every year too. The most obvious example is the osteoarthritis. Now the way of cure for isolated patellofemoral osteoarthritis has total knee replacement and surface replacement prosthesis for patellofemoral joint. It can improve inconvenient action of knee and unbalance of soft tissue nearby patella by osteoarthritis and then procure the normal slide of patella and femur. The advantage of surface replacement prosthesis for patellofemoral joint is not as much bone removed. Furthermore, it will perform the total knee replacement if the osteoarthritis becomes serious in future.
The most serious problem in the prosthesis for patellofemoral joint has consisted in the implant unstable and cave after the PFA surgery. Because the size of implant is ready made, the curved surface of implant can’’t complete match with the joint of an affected part. This research has aimed at the defect of nowadays design in clinical. Think of the difference between curved surface of implant and patellofemoral joint have combined with the reconstructing technology of medical image. We has construct the custom-made implant of patellofemoral joint and its surgical instruments and to estimate the feasibility by imitate the actual operation. In order to improve the design of the prosthesis for patellofemoral joint, we also has reconstruct the analytic simulation for kinematic of the knee.

關鍵字(中)

★ 人工臏股骨關節
★ 客製化
★ 動態分析

關鍵字(英)

★ kinematic analysis
★ patellofemoral joint

論文目次

目錄
摘要 i
ABSTRACT ii
誌謝 iii
目錄 iv
圖目錄 vii
表目錄 xiv
一、緒論 1
1-1 研究動機與目的 1
1-2 研究背景與文獻回顧 2
1-2-1 膝關節解剖學與生物力學介紹 2
1-2-2 膝關節病理學介紹 8
1-2-3 膝關節正常步態與高度彎曲運動介紹 12
1-2-4 人工臏股骨關節介紹 17
1-2-5 膝關節之高度彎曲模擬分析 21
1-3 本文架構 26
二、材料與方法 27
2-1 三維膝關節電腦模型的建立 27
2-1-1 醫學影像資料之蒐集 27
2-1-2 膝關節模型之立體重建 29
2-2 臏股骨植入物設計與打樣 33
2-2-1 植入物與手術器械之設計 33
2-2-2 植入物與手術器械打樣（prototype） 39
2-3 手術模擬實驗 44
2-3-1 手術器械銑料方式 44
2-3-2 遠端股骨模型製作 49
2-3-3 銑除手術模擬流程 54
2-4 銑削溫度熱效應實驗 54
2-4-1 實驗材料與設備 55
2-4-2 實驗方法與規劃 58
2-5 膝關節動態模擬分析 60
2-5-1 膝關節運動學參數資料 60
2-5-3 電腦動態分析模型的建立 67
三、結果 71
3-1 手術器械模擬實驗結果 71
3-2 銑削溫度熱效應實驗結果 73
3-3 膝關節動態模擬分析結果 76
四、討論 80
4-1 手術器械改良演進討論 80
4-1-1 第一代手術器械模擬結果討論 80
4-1-2 第二代定位塊之改良： 83
4-1-3 第三代定位塊改良 84
4-2 溫度實驗討論 85
4-3 動態模擬分析結果討論 88
五、結論與未來展望 94
參考文獻 96

參考文獻

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指導教授

林上智(Shang-Chih Lin)

審核日期

2008-7-22

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