个性化股骨外翻角截骨全膝关节置换术  

Distal femoral osteotomy based on individual valgus cut angle in total knee arthroplasty

作　　者：徐石庄 郑欣 刘磊 杨冠杰 郭开今 赵凤朝 XU Shi-zhuang;ZHENG Xin;LIU Lei;YANG Guan-jie;GUO Kai-jin;ZHAO Feng-chao(Department of Orthopaedics,Affiliated Hospital,Xuzhou Medical University,Xuzhou221006,China)

机构地区：[1]徐州医科大学附属医院骨科,徐州市221006

出　　处：《中国矫形外科杂志》2020年第9期795-799,共5页Orthopedic Journal of China

基　　金：国家自然科学基金项目(编号:81672184);江苏省科委社会发展基金项目(编号:BE2016642);江苏省医学重点人才基金项目(编号:WSN-065)。

摘　　要：[目的]探讨非负重位股骨全长片测量个性化股骨外翻角(VCA)截骨全膝关节置换对下肢和假体力线的影响。[方法]2018年2月~2019年2月,126例(139膝)拟行初次全膝关节患者纳入本研究,采用随机数字表法将其分为两组。其中,63例(70膝)采用个性化非负重位测量VCA截骨TKA(个性化组);63例69膝采用固定VCA为6°截骨TKA(常规组)。记录围手术期资料;采用HSS膝关节评分评估膝关节功能;拍摄下肢负重位全长X线片,测量力线指标。[结果]两组患者手术顺利,均未发生严重并发症。个性化组70膝术前非负重股骨全长X线片上测量的个性化VCA的分布范围是3.40°~12.20°,平均(6.85±1.77)°,在5°~8°范围的比例为60.00%;负重位全长X线片上测量的VCA的分布范围3.40°~11.90°,平均(6.64±1.72)°,在5°~8°范围的比例为61.43%。非负重位与负重位全长X线片上VCA的差异有统计学意义(P<0.05)。非负重和负重状态下VCA的差异>1°的比例为20%。两组术后影像测量方面,个性化组的HKA角和FFC角显著大于常规组(P<0.05);但是,术后两组间FTC角的差异无统计学意义(P>0.05)。个性化组的HKA和FFC理想率显著高于常规组(P<0.05)。[结论]股骨外翻角变异性大,采用个性化股骨外翻角截骨较固定6°股骨外翻角截骨术后可获得更精确的下肢冠状面力线和股骨假体力线。[Objective]To explore the effect of distal femoral osteotomy in total knee arthroplasty(TKA)based on individu al valgus cut angle(VCA)measured on preoperative non-weight-bearing full length X-ray films on postoperative alignments of the lower extremity and prosthesis.[Methods]From February 2018 to February 2019,126 patients(139 knees)who were under going primary TKA were included into this study,and divided into two groups by random number table method.Of them,63 pa tients(70 knees)received TKA with distal femoral osteotomy based on individual VCA measured on preoperative non-weightbearing full length X-ray film(the individualized group),while the remaining 63 patients(69 knees)had TKA performed with conventional distal femoral osteotomy with universal 6°VCA(the conventional group).The clinical data,HSS score and align ment parameters measured on radiographs were compared between the two groups.[Results]All the patients in both group had TKA performed smoothly without serious complications.With regard to preoperative radiographic measurements in the individu alized group,the VCA on non-weight-bearing condition ranged from 3.40°to 12.20°with a mean of(6.85±1.77)°and 60.00%of them fell in a range of 5°~8°,while that on weight-bearing condition ranged from 3.40°to 11.90°with a mean of(6.64±1.72)°and 61.43%was within 5°~8°,which was of statistical significance(P<0.05).The knees with a difference more than 1°VCA un der the non-weight bearing and weight bearing conditions accounted for 20%of them.In term of postoperative radiographic as sessments,the individualized group had significantly greater hip knee ankle angle(HKA)and frontal femoral component angle(FFC)than the conventional group(P<0.05),consis tently,the individualized group proved significantly superior to the conventional group regarding to desirable rates in HKA and FFC(P<0.05).[Conclusion]There is a considerable variation in VCA among patients.The distal femoral osteoto my in TKA based on individual VCA measured on preoperative non-weight-bea

关 键 词：非负重位 个性化 外翻截骨角 全膝关节置换术 下肢力线 

分 类 号：R687.4[医药卫生—骨科学]