膝关节关节镜清理术中生物组织的高效低损伤刨削切除研究

Arthroscopic debridement is one of the most common methods to cut off the biological vivo tissue in arthroscopy surgery at home and abroad. But there are a lot basic scientific problems need to be solved in this filed. The cutting mechanism is still unclear which is important to know more about the cutting tools including shaver and burrs. In practice, the less sharpness of cutting edges, easily clogged cutting tool, long operation time, large cutting injuries and fast cutting tool wear are the usual problems. The evaluation of cutting tool performance rely also on doctors experience only. We proposal a plan to meet with the needs of clinical surgery based on the comprehensive knowledges of mechanical engineering, biomechanics and orthopedic surgery etc..The animal models for simulating research of arthroscopic surgery in laboratory and for the research of live animal arthroscopic surgery will be established. Several methods of biological tissue staining analysis are used. The cutting removal process and cutting damage mechanism , design and forming of cutting tool edges by grinding, the wear and breakage of cutting tool will be discussed in detail. The metal particles contamination of worn cutting tools and residual biological tissue contamination on the surface of cutting tools are also be detected. The the rules of the reuse and re-ground of cutting tools will be provided. The design of shapes, structure and angles of cutting tools will be optimized for get a small surgical injury, short surgery time, easy to manufacture cutting tools and low cost for arthroscopic knee debridement. A integrated performance evaluation rules of cutting tools combining qualitative and quantitative methods will be given. The results of this study will be benefit to the development of bio-manufacturing theory and to improve the effects of arthroscopic surgery and rehabilitation.

关节镜刨削清理术是国内外最常用的对生命体活体生物组织进行切除加工的方法。但刨削切除机理不明，刨削刀具存在切刃不锋利、易堵塞、手术时间长、切削损伤大、刀具磨损快、刀具性能评价依赖医生经验等问题。本项目从临床需求出发，综合机械、生物力学与骨科学等多学科的知识，采用建立动物模型，在实验室模拟关节镜下手术、动物活体镜下手术和数值计算等研究方法，采用生物组织多种染色法等测试分析方法；系统深入研究刨削切除膝关节多种生物活体组织的切除过程与切除损伤机理、刨削刀具刃口成形、刀具摩擦磨损与破损及其金属颗粒污染、生物组织残余污染、刀具重复使用与重磨使用的可行性、刨削刀具优化设计与使用，定性与定量相结合的刨削刀具性能综合评定方法；最终获得手术损伤小、手术时间短、易制造、成本低的膝关节镜清理术用刨削刀具优化设计、制造和应用的理论与方法。对发展生物制造理论与技术，改善关节镜手术与康复效果，具有鲜明的理论与应用价值。

关节镜刨削清理术是国内外最常用的对生命体活体生物组织进行切除加工的方法。项目针对微创刨刀在膝关节镜关节清理术中生物组织的切削机理，从临床医学的需求与应用问题出发，通过建立实验平台模拟临床膝关节镜刨削清理术，深入研究了膝关节软骨组织的纤维结构特性及组织形态、微创器械的刀具几何结构与膝关节软骨组织的作用机理、刨削刀具结构和角度等与生物组织的切削摩擦磨损特性、刀具磨损机理、刀具磨损金属颗粒导致的生物污染间的关系、微创刨刀的二次损伤检测以及刀具磨损所引起的生物安全性等问题，取得了一系列创新性成果。自主研发并搭建了生物组织切除多功能实验机和六轴机械手医疗实验平台，设计了冲裁型新型微创刨刀并优化了常用刨刀的刀具结构，获得了膝关节软骨及半月板生物组织的去除机理，建立了生物组织的切除模型和损伤模型，丰富了生物组织切除理论。