应用间隙平衡技术可减少人工全膝关节置换中截骨量及维持下肢力线与屈伸间隙平衡  

Gap balance technology can reduce the amount of osteotomy and maintain the balance of lower limb alignment and flexion and extension gap in total knee arthroplasty

作　　者：陈洪强[1] 周华 陈德斌[1] 吴西智 吴德伟[1] 赵滨[1] Chen Hongqiang;Zhou Hua;Chen Debin;Wu Xizhi;Wu Dewei;Zhao Bin(Department of Orthopedics,Guiyang Fourth People’s Hospital,Guiyang 550002,Guizhou Province,China)

机构地区：[1]贵阳市第四人民医院骨科,贵州省贵阳市550002

出　　处：《中国组织工程研究》2021年第30期4828-4832,共5页Chinese Journal of Tissue Engineering Research

摘　　要：背景:全膝关节置换是治疗终末期膝骨关节病的有效方法,恢复精确力线与良好的屈伸间隙平衡是全膝关节置换的关键。间隙平衡技术与测量截骨技术为两种经典截骨方式,选择何种方式目前仍有争议。目的:通过比较应用间隙平衡技术与测量截骨技术的全膝关节置换患者的影像学表现,分析间隙平衡技术在全膝关节置换患者中的应用效果。方法:回顾性分析118例全膝关节置换患者的临床资料,其中男42例,女76例,年龄53-72岁,根据术中截骨方式分为间隙平衡组61例、测量截骨组57例。术后随访12个月,拍摄X射线片测量冠状面髋-膝-踝角、下线力线角与股骨屈曲角,采用目测类比评分、美国膝关节协会评分KSS分别评估疼痛程度与膝关节功能。研究获得贵阳市第四人民医院伦理委员会批准。结果与结论:(1)间隙平衡组发生局部感染3例,测量截骨组发生局部感染4例、排斥反应1例、免疫反应1例,两组并发症发生率比较差异无显著性意义(4.92%,10.53%,P>0.05);(2)术后随访12个月时,间隙平衡组屈膝90°应力位内侧、外侧的胫股关节角均低于截骨测量组(P<0.001),冠状面髋-膝-踝角、下线力线角小于测量截骨组(P<0.001),关节最大屈曲角大于测量截骨组(P<0.001);(3)术后随访12个月时,间隙平衡组患者的目测类比评分低于测量截骨组(P<0.001),KSS评分高于测量截骨组(P<0.01);(4)结果表明,在全膝关节置换中,应用间隙平衡技术有助于维持良好的下肢力线与屈伸间隙平衡、缓解疼痛程度、改善膝关节功能。BACKGROUND:Total knee arthroplasty is an effective method for the treatment of end-stage knee osteoarthritis.The key to total knee arthroplasty is to restore the accurate lower limb alignment and good flexion and extension space balance.Gap balance technique and measurement osteotomy technique are two classical osteotomy methods,which methods to choose is still controversial.OBJECTIVE:To compare radiographical manifestations of gap balance technique and measurement osteotomy technique in total knee arthroplasty patients,and analyze application effect of gap balance technique in total knee arthroplasty patients.METHODS:Clinical data of 118 patients with total knee arthroplasty were retrospectively analyzed,including 42 males and 76 females,aged 53-72 years old.According to intraoperative osteotomy methods,they were divided into gap balance group(61 cases)and measurement osteotomy group(57 cases).In 12-month follow-up,X-ray films were taken to measure the coronal hip-knee-ankle angle,lower line force angle and femoral flexion angle.Visual analogue scale score and American knee society knee score were used to evaluate the pain degree and knee function.This study was approved by the Ethics Committee of Guiyang Fourth People’s Hospital.RESULTS AND CONCLUSION:(1)The gap balance group had local infection in three cases.The measurement osteotomy group had local infection in four cases,rejection in one case,and immune reaction in one case.There was no significant difference in complications between the two groups(4.92%,10.53%,P>0.05).(2)In 12-month follow-up,knee flexion 90°stress angle of medial and lateral tibiofemoral joint was lower in the gap balance group than that in the measurement osteotomy group(P<0.001).Coronal hip-knee-ankle angle and lower limb alignment were smaller in the gap balance group than those in the measurement osteotomy group(P<0.001).Maximum femoral flexion angle was larger in the gap balance group than that in the measurement osteotomy group(P<0.001).(3)In 12-month follow-up,visual analogue sc

关 键 词：膝关节 骨性关节炎 全膝关节置换 间隙平衡技术 测量截骨技术 假体 屈伸间隙平衡 下肢力线 疼痛 关节功能 

分 类 号：R459.9[医药卫生—治疗学] R319[医药卫生—临床医学]