Gemini MK-Ⅱ活动垫片膝关节假体置换术中胫骨结节内1/3解剖定位法对胫骨假体旋转力线的影响  

EFFECT OF MEDIAL 1/3 ANATOMICAL ORIENTATION OF TIBIAL TUBERCLE ON ROTATIONAL ALIGNMENT OF Gemini MK-II TIBIAL COMPONENTS IN TOTAL KNEE ARTHROPLASTY

作　　者：孙振辉[1] 孙云波[1] 任志帅 刘军[2] 王磊[2] 

机构地区：[1]天津市人民医院关节外科天津,300000 [2]天津市天津医院关节外科

出　　处：《中国修复重建外科杂志》2015年第9期1062-1066,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨采用Gemini MK-Ⅱ活动垫片膝关节假体行人工全膝关节置换术（total knee arthroplasty,TKA）中,采用胫骨结节内1/3解剖定位法对胫骨假体旋转力线的影响。方法回顾分析2011年3月-2012年12月采用Gemini MK-Ⅱ活动垫片膝关节假体行TKA治疗的61例（67膝）内翻型膝关节骨关节炎患者临床资料。男12例,女49例;年龄50～82岁,平均67.6岁。体质量指数20.9～33.7 kg/m2,平均28.2 kg/m2。单膝55例,双膝6例。病程2～30年,平均12.1年。骨关节炎Kellgren-Lawrence分级：Ⅲ级56膝,Ⅳ级11膝。术中采用后交叉韧带中点至胫骨结节内1/3连线确定胫骨假体旋转轴。对手术前后膝关节正侧位X线片及CT进行测量,分析术后胫骨假体旋转情况。结果患者均获随访,随访时间18～41个月,平均20.5个月。术前及末次随访时膝关节活动度分别为（98.806±16.969）、（116.806±11.458）°,KSS评分分别为（111.239±20.344）、（160.522±17.872）分,末次随访时均明显优于术前（t=—11.760,P=0.000;t=—27.271,P=0.000）。影像学检查示,末次随访时胫股解剖角（anatomic tibiofemoral angle,ATFA）、股骨后髁角（posterior condylar angle,PCA）、胫骨旋转角（tibial rotation angle,TRA）与术前比较,差异均有统计学意义（P〈0.05）。术前11膝（16.42%）胫骨旋转力线不良,术后1周CT复查提示14膝（20.90%）胫骨假体旋转力线不良,不良发生率比较差异无统计学意义（χ2=0.443,P=0.506）;术后胫骨假体内旋〉8°8膝（11.94%）,外旋〉8°6膝（8.96%）。术后胫骨假体TRA与术前ATFA、胫骨平台TRA及术后PCA、ATFA均无相关性（r=—0.174,P=0.159;r=0.220,P=0.074;r=0.237,P=0.053;r=—0.095,P=0.442）。结论对于内翻型膝关节骨关节炎患者,采用Gemini MK-Ⅱ活动垫片膝关节假体行TKA时,采用胫骨结节内1/3解剖定位法易出现胫骨假体旋转不良。Objective To investigate the effect of medial 1/3 anatomical orientation of the tibial tubercle on the rotational alignment of Gemini MK-II tibial components in total knee arthroplasty（TKA）. Methods Between March 2011 and December 2012, 61 cases（67 knees） of varus knee osteoarthritis underwent Gemini MK-II knee arthroplasty, and the clinical data were retrospectively analyzed. There were 12 males and 49 females, with an average age of 67.6 years（range, 50-82 years）. The body mass index ranged from 20.9 to 33.7 kg/m2（mean, 28.2 kg/m2）. Unilateral TKA was performed in 55 cases and bilateral TKA in 6 cases. The duration of knee osteoarthritis ranged from 2 to 30 years（mean, 12.1 years）. According to radiographic changes, 56 knees were rated as Kellgren-Lawrence grade III and 11 knees as grade IV. During TKA, the tibial rotational alignment was determined by medial 1/3 anatomical orientation of the tibial tubercle. The anteroposterior and lateral X-ray films and CT scan were taken to measure the tibial rotational angle（TRA） at pre- and post-operation and to analyze the relative factors for TRA by Pearson correlation analysis. Results All the patients were followed up 18-41 months（mean, 20.5 months）. The range of motion（ROM） significantly increased from（98.806±16.969）° preoperatively to（116.806±11.458）° at last follow-up（t= —11.760, P=0.000）. The knee society score（KSS） significantly increased from 111.239±20.344 to 160.522±17.872 at last follow-up（t= —27.271, P=0.000）. The anatomical tibiofemoral angle（ATFA）, posterior condylar angle（PCA）, and TRA were all improved after TKA, showing significant differences when compared with preoperative ones（P〈0.05）. Rotational malalignment was observed in 11 knees（16.42%） before TKA, and in 14 knees（20.90%） at 1 week after TKA, showing no significant difference（χ2=0.443, P=0.506）. There were 8 knees（11.94%） of internal rotation（〉8°） and 6 knees（8.96%） of external rotation（〉8

关 键 词：人工全膝关节置换术 胫骨假体 旋转定位 胫骨结节 

分 类 号：R687.4[医药卫生—骨科学]