测量截骨联合间隙平衡截骨技术在全膝关节置换术中的应用研究  

The clinical outcome of measured resection combined with gap balancing technique in total knee arthroplasty

作　　者：齐志远[1] 陈秀民[1] 王在斌[1] 姜志圣[1] 李广彬[1] 韩鹏[1] 李宇亮 鲁先闯 Qi Zhiyuan;Chen Xiumin;Wang Zaibin;Jiang Zhisheng;Li Guangbin;Han Peng;Li Yuliang;Lu Xianchuang(Department of Orthopaedics,Puyang Traditional Chinese Medicine,Puyang 457003,China)

机构地区：[1]河南省濮阳市中医院关节外科,457003

出　　处：《中华骨科杂志》2021年第9期541-551,共11页Chinese Journal of Orthopaedics

基　　金：河南省濮阳市科技攻关项目(160229)。

摘　　要：目的探讨测量截骨联合间隙平衡截骨技术在全膝关节置换术中的临床应用价值。方法收集2016年1月至2017年10月期间采用测量截骨联合间隙平衡截骨技术行初次全膝关节置换术治疗膝内翻伴屈曲挛缩畸形骨关节炎61例患者的临床资料,男24例,女37例;年龄(66.80±8.2)岁(范围60~78岁)。均采用膝前正中切口、髌旁内侧入路,假体为后稳定型膝关节假体。术中使用测量截骨技术进行定位截骨,应用间隙平衡技术验证屈伸间隙。记录截骨厚度,影像学测量下肢力线、关节线距离、胫股关节角、股骨假体旋转角及股骨后髁偏心距;临床评估包括膝关节功能评分(knee society score,KSS)、膝关节活动度及患者满意度。结果手术时间为(54±12)min,术后引流量为(140±26)ml。术前血红蛋白与术后第5天的差值为(22±8.5)g/L。胫骨近端外侧截骨量为(10.2±1.5)mm,股骨远端外侧截骨量为(9.1±1.5)mm,股骨后外髁截骨量为(8.6±1.5)mm,股骨后内髁截骨量为(9.2±1.2)mm,明显高于股骨后外髁截骨量(t=2.44,P=0.006)。术中测量间隙平衡技术截骨线(B线)与测量截骨钉孔连线(A线)的夹角为1.15°±0.47°(范围1.02°~2.00°),外旋占27.8%,内旋占72.2%。术前膝关节线距离为(40.55±4.32)mm,术后第3天膝假体关节线距离为(40.99±3.86)mm,差异无统计学意义(t=1.225,P=0.256)。术后下肢力线与小腿解剖轴线夹角偏差均<±3°,其中72.1%的患者为内翻。术后第3天伸膝位和屈膝90°位内、外翻应力X线片示内、外侧股胫关节角的差异均无统计学意义(P >0.05)。术后膝关节CT示股骨假体旋转角≤±2°,其中65.6%的患者为内旋。术前股骨后髁偏心距为(31.87±4.01)mm,术后为(31.55±3.18)mm,差异无统计学意义(t=0.67,P=0.505)。术后KSS评分、患者满意度均较术前明显提高。术后3个月KSS评分(89.2±9.4)分、患者满意度评分(7.2±2.6)分,高于术后1个月(78.0±3.5)分、(5.2±1.8)分,差异均有�ObjectiveTo explore the clinical outcome of measured resection combined with gap balancing technique in total knee arthroplasty (TKA).MethodsFrom January 2016 to October 2017, 61 cases of varus knee joint flexion deformity were applied the procedure of measured resection combined with gap balancing technique in primary total knee arthroplasty, including 24 male and 37 female;the average age was 66.80±8.2 years old (range from 60 to 78 years old). All patients underwent antero-medial incision of knee joint,medial parapatellar approach and posterior stabilized prosthesis. Measurement osteotomy technique was used to localize osteotomy. Gap balancing technique was vitrificated flexion and extension. Operation time, surgical blood loss and osteotomy volume were recorded. Radiographic evaluation included alignment of lower extremity, knee joint linedistance, tibiofemoral joint angle, rotation angle of femoral prothesis and posterior condylar offset (PCO). Joint functions were assessed including KSS scores, ROM and patient satisfaction.ResultsThe average operation time was 54±12 min (range from 45 to 65 min). The average postoperative drainage was 140±26 ml (range from 120 to 180 ml). The difference in hemoglobin values were 22±8.5 g/L(range from 20 to 30 g/L) between preoperative and postoperative 5 days. The lateral proximal tibial bone mass was 10.2±1.5 mm (range from 9.2 to 11.5 mm). The lateral distal femoral bone mass was 9.1±1.5 mm (range from 8.8 to 10 mm). The bone mass of posterior lateral condyle of femur was 8.6±1.5 mm (range from 7.8 to 10 mm). The bone mass of posterior medial condyle of femur was 9.2±1.2 mm (range from 8.6 to 10 mm), compared with the bone mass of posterior lateral condyle of femur, and the difference was statistically significant (t=2.44, P=0.006). The intraoperative angle between osteotomy line of gap balanced osteotomy technique (line B) and connecting line of screw hole in measure osteotomy (line A) was 1.15°±0.47° (range from 1.02° to 2°). The external rotation angle was

关 键 词：关节成形术 置换 膝 截骨术 治疗结果 

分 类 号：R687.4[医药卫生—骨科学]