后稳定型全膝关节置换使用限制性垫片的原因分析  

Constrained liner in posterior stabilized total knee replacement

作　　者：王晓华[1] 蔡宏[1] 张克[1] 刘忠军[1] 刘岩[1] 田华[1] 李子剑[1] 李锋[1] 

机构地区：[1]北京大学第三医院,骨科100191

出　　处：《中国矫形外科杂志》2016年第5期416-420,共5页Orthopedic Journal of China

基　　金：北京市科学技术委员会基金(编号:D121100004212005)

摘　　要：[目的]分析后稳定型全膝关节置换使用限制性垫片的原因,为临床决策提供支持。[方法]回顾性分析本院骨科关节组2013年1月~2014年12月行后稳定型假体全膝关节置换的连续病例,筛选使用限制性垫片的病例,测量术前内翻角度、术后力线、术后股骨角和胫骨角、术前与术后股骨后髁偏心距差,收集垫片高度、股骨和胫骨假体型号、股骨和胫骨内外侧截骨量、内侧副韧带松解情况、前交叉韧带情况、术中间隙测量和力线情况,统计分析使用限制型垫片的原因并计算结果。[结果]本组连续性病例共616膝,使用限制性垫片共32膝,使用率5.2%。使用限制性垫片原因共4类：中重度内翻畸形、软组织松解不足或过度、截骨误差、医源性损伤。内翻畸形〈15°共14膝,占43.8%;15°~20°之间共7膝,占21.9%;≥20°共11膝,占34.4%。膝关节内翻〈15°组中,软组织松解不足共3膝,占21.4%;软组织松解过度共5膝,占35.7%;截骨误差共6膝,占42.9%;医源性损伤共1膝,占7.1%。膝关节内翻≥15°组中,软组织松解不足共5膝,占27.8%;松解过度共2膝,占11.1%;截骨误差7膝,占38.9%;医源性损伤共2膝,占11.1%。[结论]中重度内翻畸形、软组织松解不足或过度、截骨误差、医源性损伤是导致合并膝内翻骨性关节炎患者行后稳定型全膝关节置换使用限制性垫片的重要原因;在全膝关节置换中,轻度内翻畸形容易出现软组织松解过度,中重度内翻畸形容易出现软组织松解不足的情况;降低截骨误差、医源性损伤可以有效减少间隙不平衡的发生,进而减少对限制性垫片的使用。[Objective] To find out the reasons and influencing factors of using constrained line in posterior stabilized total knee replacement. [Methods] A retrospective study on sequencing cases of posterior stabilized primary total knee arthroplasty from January 2013 to December 2014 was carried on. Of which,cases using onstrained liner were selected. Serious measurements were made including the preoperative and postoperative line of force,postoperative femoral angle,tibial angle,preoperative and postoperative posterior femoral condylar offset, preoperative and postoperative femoral posterior condylar offset difference. The postoperative liner height,size of femoral and tibial prosthesis,volume of tibial medial and lateral osteotomy,volume of femoral medial and lateral osteotomy,medial collateral ligament release,anterior cruciate ligament,intraoperative gap measurement,intraoperative force line were also recorded,respectively. The reasons for using constrained liner were analyzed statistically and the results were calculated. [Results] In total 616 knees,32 cases were found using constrained liner,accounting for 5. 2% of the total. This group of cases using constrained liner had 4 reasons： moderate and severe varus deformity,soft tissue release insufficient or excessive, osteotomy error, iatrogenic injury. Among them,17 cases had 1 reason, accounting for53. 1% of the total,11 cases had 2 reasons,accounting for 34. 4% of the total,4 cases had 3 reasons,accounting for 12. 5%of the total. From the view of classification of influencing factors, 15° of varus deformity were found in 14 cases,accounting for 43. 8% of the total,15° ~ 20° in 7 cases,accounting for 21. 9% of the total,≥20°in 11 cases,accounting for 34. 4% of the total. In the group of the varus 15°,soft tissue release insufficient were in 3 cases,accounting for 21. 4% of the total,theexcessive release in 5 cases,accounting for 35. 7% of the tota,osteotomy errors in 6 cases,accounting for 42. 9% of the total,iatrogenic injury in 1 cases,accounting for 7.

关 键 词：限制性垫片 内翻 截骨 韧带平衡 医源性损伤 

分 类 号：R687.4[医药卫生—骨科学]