膝关节置换中以ROM技术定位胫骨假体的旋转力线  

Application of ROM technique in rotational alignment of tibial prosthesis during knee arthroplasty

作　　者：李叶天[1] 刘富恩 尹力[1] 张辉[1] 陆鸣[1] 高维陆[1] 尹宗生[1] Li Yetian;Liu Fuen;Yin Li;Zhang Hui;Lu Ming;Gao Weilu;Yin Zongsheng(Department of Joint Surgery,the First Affiliated Hospital of Anhui Medical University,Hefei 230022,Anhui Province,China)

机构地区：[1]安徽医科大学第一附属医院关节外科,安徽省合肥市230022

出　　处：《中国组织工程研究》2020年第24期3840-3845,共6页Chinese Journal of Tissue Engineering Research

摘　　要：背景:ROM技术是膝关节置换过程中确定胫骨假体旋转力线的常用方法,但该技术的准确性仍存在争议,目前ROM技术可能的影响因素尚未见报道。目的:探讨膝关节置换过程中运用ROM技术确定胫骨假体旋转力线的影响因素。方法:纳入61例初次接受单侧膝关节置换的患者,男18例,女43例,年龄55-78岁,术前均诊断为膝关节骨性关节炎,所有手术均采用后稳定型膝关节假体。所有患者对治疗方案均知情同意,且得到医院伦理委员会批准。根据ROM技术确定闭合与未闭合内侧支持带时胫骨假体旋转轴线,同时定位后交叉韧带止点中点与髌韧带内侧缘连线(Akagi线)作为参考线,测量2种情况下ROM技术确定的胫骨假体旋转轴线与Akagi线的相对位置关系,术中判断髌骨轨迹分型,从而确定髌骨轨迹分型及闭合内侧支持带与否是否为ROM技术的影响因素。结果与结论:①术中出现Ⅰ,Ⅱ及Ⅲ型髌骨轨迹时,未闭合内侧支持带时ROM技术确定的胫骨假体旋转轴线与Akagi线之间的夹角分别为(0.5±2.5)°,(-0.9±2.6)°及(-3.9±3.4)°;闭合内侧支持带时夹角分别为(0.6±2.3)°,(-0.3±2.2)°及(-1.5±2.9)°;②Ⅲ型髌骨轨迹可导致ROM技术确定的胫骨旋转轴线与Akagi线之间的夹角明显偏内(P<0.05);③对于Ⅰ,Ⅱ型髌骨轨迹,是否闭合内侧支持带对ROM技术确定的胫骨假体轴线无明显影响(P>0.05);对于Ⅲ型髌骨轨迹,闭合内侧支持带可明显减小ROM技术确定的胫骨假体旋转轴线与Akagi线之间的差异(P<0.05);④结果提示,ROM技术对Ⅰ,Ⅱ型髌骨轨迹的全膝关节置换能够较准确地定位胫骨假体的旋转轴线,无需闭合内侧支持带;出现Ⅲ型髌骨轨迹时,无论是否闭合内侧支持带都可能造成胫骨假体过度内旋。BACKGROUND:The ROM technique has been widely used to determine the rotational alignment of tibial prosthesis in total knee arthroplasty,but the accuracy of this technique remains controversial.However,there is no report on the influencing factors of ROM technique.OBJECTIVE:To explore the influencing factors of ROM technique in determining the rotational alignment of tibial prosthesis in total knee arthroplasty.METHODS:Totally 61 patients underwent unilateral knee arthroplasty,including 18 males and 43 females,aged between 55 and 78 years.All patients were diagnosed as knee osteoarthritis before operation.All operations were performed with the posterior cruciate-stabilizing total knee prostheses.All patients signed the informed consent.This study was approved by the Hospital Ethics Committee.The rotational orientation of the tibial prosthesis was determined by the ROM technique with closed and unclosed medial retinaculum.A line from the center of the posterior cruciate ligament to the medial border of the patellar tendon was used as the anteroposterior axis of tibia(Akagi line).The angles between the anteroposterior axis of tibia and lines determined by the ROM technique were measured to identify the classification of patellar track so as to decide whether the classification of patellar track,closing and unclosing medial retinaculum are the influencing factors of ROM technology.RESULTS AND CONCLUSION:(1)The angles between the Akagi line and lines determined by the ROM technique respectively were(0.5±2.5)°,(-0.9±2.6)°,and(-3.9±3.4)°for the unclosed medial retinaculum and(0.6±2.3)°,(-0.3±2.2)°,and(-1.5±2.9)°for the closed medial retinaculum.(2)For type III patellar track,the angle between line determined by the ROM and Akagi line was significantly internal rotation compared with type I and type II patellar track(P<0.05).(3)For type I and type II patellar track,whether the medial retinaculum was closed or not had no significant effect on the rotational alignment of tibia prosthesis determined by ROM techn

关 键 词：膝关节置换 ROM技术 胫骨旋转轴线 髌骨轨迹 胫骨前后轴 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学]