슬관절 전치환술의 운동학
Kinematics in Total Knee Arthroplasty
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최근의 기술의 발전에 의해, 슬관절 인공관절 치환술에서 삽입물의 마모를 최소화하고 관절운동범위를 증가시키며, 하지의 정렬과 안정성을 확보하기 위해 정상 슬관절의 굴곡 운동을 재현하는 것이 가장 중요한 목표가 되어가고 있다. 실제로 전치환술 이후의 보행 분석과 방사선 투시를 이용한 분석에 의하면 슬관절 전치환술의 운동 패턴은 여러 인자에 의해 복잡하게 영향을 받는 것을 알 수 있다. 시상면에서, 정상 슬관절의 굴곡 시 대퇴골은 경골 고평부에서 후방으로 구름과 동시에 또한 미끄러지는 운동을 하는 것은 잘 알려진 사실이며 이런 슬관절의 운동 양식은 대퇴과와 경골 고평부의 모양뿐만 아니라 후방 십자인대의 기능과 긴밀하게 연관이 있다. 이 두 가지 인자에 의해 슬관절 굴곡 시에는 중간 운동 범위에서 내측에 회전 축을 가지는 경골의 내회전을 일으키게 되며 120o 이상의 고도 굴곡 시에는 양측 대퇴과 모두 후방으로 전위되게 된다. 슬관절 전치환술시에도 굴곡시에 마찬가지로 대퇴골의 후방전위는 나타나며 캠-포스트를 가지는 후방 십자인대 대치형 슬관절 전치환술에서 이런 대퇴골의 후방전위는 더 일정하게 나타나게 된다. 또한 슬관절 전치환술 후 대퇴 후과의 오프셋의 회복은 고도 굴곡 시 생기는 대퇴골과 경골의 충돌을 막게 되어 좀 더 증가된 관절운동 범위를 가지게 된다.
Abstract
In the current age of technological advances, reproducing the knee kinematics for minimizing wear and increasing the range of motion, together with obtaining proper alignment and stability, have become the major goals of total joint replacement. The kinetics of total knee arthroplasty (TKA) have a complex influence on its performance, and differing abnormal patterns have been shown after TKA by using gait analysis, fluoroscopy and radiostereometry. In the sagittal plane, it is now understood that the femoral condyles roll and glide simultaneously on the tibial plateau during flexion. The kinematics of the knee and the shape of the condyles and the tibial plateau are closely interrelated with the functions of the cruciate ligaments. The kinematics result from the combined actions of the surface geometry of the joint and the soft tissues attached to it. To a variable extent in the mid-range, these factors cause tibial internal rotation to occur with flexion around a medial axis. From 120_ to full flexion, both condyles roll back onto the posterior horn so that the tibio-femoral joint subluxes. In TKA, it has been demonstrated that substituting a cam-and-post mechanism for the PCL (posterior cruciate ligament) shows consistent posterior femoral rollback during flexion. Restoration of the posterior condylar offset is important since it allows a greater degree of flexion before impingement occurs.
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