表面置換型單髁人工膝關節的設計與分析

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姓名

李柏亨(Bo-Heng Lee) 查詢紙本館藏

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機械工程學系

論文名稱

表面置換型單髁人工膝關節的設計與分析
(Design and Analysis of Unicompartmental Knee Arthroplasty)

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摘要(中)

膝關節是人體中承受最大負載的關節之一。近年來隨著醫學的發達，人類平均壽命逐年延長，罹患退化性關節炎的人逐漸增加。目前台灣約有三十二萬人深受膝關節疼痛之苦。他們因行走疼痛，上下樓梯困難，外出無法使用蹲式廁所而造成許多生活上的不便。若施行人工關節置換術，病患可以減輕、甚至完全解除疼痛；關節的功能、活動度及變形亦可明顯改善。
　　微創手術是現代醫學發展的趨勢。據統計，在台灣一年大約有一萬個病人需接受人工膝關節置換手術。本研究目的為：1.發展創新的微小局部人膝關節，讓小面積軟骨損傷的患者有更合適病況的選擇；2.對手術器械及植入物客製化：客製化手術器械使得手術流程變得較為簡單，客製化人工膝關節曲面將與病患關節曲面完全貼合，減少手術過後的骨骼外型不平滑造成應力集中的現象； 3.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，評估客製化單髁人工膝關節設計對整個膝關節動作之影響，得到植入物之受力曲線與接觸軌跡，藉以改進人工脛股骨關節之設計。

摘要(英)

Among all joints in human bodies, the knee joint bears the biggest load. With the development of medical science in recent years, the average human life-span has been lengthened year by year. Nevertheless, more and more people are troubled by osteoarthritis. Nowadays around three hundred and twenty thousand people in Taiwan are suffering from the pain of knee joints. Serious pain can be caused during walking and going upstairs and downstairs. Furthermore, it is very inconvenient for they are unable to use squat toilet. If patients receive the operation of knee arthroplasty, the pain would be lightened or even totally eliminated. In addition, the function, movement and the problem of deformation of joints can be improved.
Minimally invasive surgery is definitely an important modern medical development tendency. According to the statistics, in one year, nearly ten thousand patients in Taiwan need the surgery of knee arthroplasty. This research aims to: 1. develop a brand-new smaller knee joint; therefore, the patient with a small area cartilage damage can have choice according the symptoms; 2. design custom-made implants and its surgical instruments: custom-made surgical instruments make the operation procedure comparatively simple; the surface of custom-made implants will fit the curved surfaces of patients’ joints, reducing the stress-concentration caused by the uneven surfaces of skeletons after the operation; 3. build and construct the true knee joint simulation of dynamic sport and movement and the analysis platform of force, hoping to improve the design of the knee joint implant.

關鍵字(中)

★ 局部置換
★ 植入物
★ 表面置換
★ 單髁人工膝關節
★ 客製化

關鍵字(英)

★ implant
★ partial knee resurface
★ Custom-made
★ UKA

論文目次

目　錄
摘　要....................................................................................................................i
Abstract.................................................................................................................ii
誌　謝..................................................................................................................iv
目　錄...................................................................................................................v
圖目錄................................................................................................................viii
表目錄................................................................................................................xiii
第一章、緒論.......................................................................................................1
1-1　研究的動機與目的...............................................................................1
1-2　文獻回顧...............................................................................................2
1-2-1　膝關節的解剖學與生物力學介紹............................................2
1-2-2　膝關節運動學介紹....................................................................6
1-2-3　膝關節的病理學及其治療......................................................13
1-2-4　膝關節之高度彎曲模擬分析..................................................18
1-2-5　膝關節動態模擬......................................................................24
1-3　本文架構..............................................................................................26
第二章、研究方法.............................................................................................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..........................................................30
2-2　表面置換型植入物與手術器械設計..................................................33
2-2-1　表面置換型植入物設計理念..................................................34
2-2-2　手術器械設計理念..................................................................38
2-2-3　遠端股骨模型製作..................................................................42
2-2-4　手術器械樣本製作..................................................................46
2-2-5　銑除手術模擬流程..................................................................47
2-3　膝關節動態模擬分析..........................................................................48
2-3-1　膝關節運動學參數資料..........................................................48
2-3-2　電腦動態分析模型的建立......................................................54
2-3-3　膝關節韌帶組織建立..............................................................58
2-3-4　脛股骨關節接觸力設定..........................................................61
第三章、實驗結果.............................................................................................62
3-1　手術器械模擬實驗結果......................................................................62
3-2　膝關節動態模擬分析結果..................................................................62
3-2-1　膝關節屈曲動作模擬結果......................................................62
3-2-2　植入物受力資訊......................................................................66
第四章、結果討論.............................................................................................68
4-1　手術模擬實驗結果討論......................................................................68
4-2　動態模擬分析結果討論......................................................................68
4-2-1　股骨後旋 (Femoral rollback)..................................................69
4-2-2　螺旋歸位機轉 (Screw-home mechanis)….............................72
第五章、結論與未來展望.................................................................................74
5-1　客製化單髁人工膝關節設計......................................................74
5-2　手術模擬設計..............................................................................74
5-4　膝關節動態模擬分析..................................................................75
參考文獻.............................................................................................................76

參考文獻

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指導教授

黃俊仁、林上智
(Jiun-Ren Hwang、Son-Jyh Lin)

審核日期

2009-7-21

推文