测量截骨联合间隙平衡全膝关节置换治疗膝骨关节炎  

Measured resection combined gap balancing technique in total knee arthroplasty for knee osteoarthritis

作　　者：苗卫华[1] 王宏[1] 李康 MIAO Wei-hua;WANG Hong;LI Kang(Department of Joint Surgery,Heze Municipal Hospital,Heze 274000,China)

机构地区：[1]菏泽市立医院关节外科,山东菏泽274000

出　　处：《中国矫形外科杂志》2021年第14期1254-1258,共5页Orthopedic Journal of China

摘　　要：[目的]比较单纯测量截骨与测量截骨联合间隙平衡技术全膝关节置换治疗膝骨性关节炎的临床效果。[方法]回顾性分析2015年8月—2018年8月全膝关节置换术治疗膝骨关节炎116例患者的临床资料,其中57例采用单纯测量截骨技术,59例采用测量截骨联合间隙平衡技术。比较两组患者围手术期、随访和影像资料。[结果]两组患者手术均顺利完成。两组患者手术时间、出血量、住院时间差异无统计学意义(P>0.05)。联合截骨组股骨内后髁截骨量显著大于测量截骨组[(9.84±1.12) mm vs (8.79±0.72) mm,P<0.05],而联合截骨组术中髌骨外侧支持带松解率显著低于测量截骨组(3.39%vs 15.79%, P<0.05)。术后1个月联合截骨组膝关节KSS评分[(72.22±7.85) vs (68.23±8.10),P<0.05]和膝伸屈活动度(ROM)[(103.78±7.93)°vs (99.84±7.56)°,P<0.05]均显著优于测量截骨组,但术后6个月及末次随访时,两组间KSS评分和ROM的差异均无统计学意义(P>0.05)。影像方面,相应时间点,两组间FTA、TPA、PTS测量结果差异无统计学意义(P>0.05)。[结论]骨性关节炎全膝关节置换术中测量截骨联合间隙平衡技术能够获得更适当的膝关节屈曲间隙,减少软组织松解,并改善术后早期功能。[Objective] To compare the clinical outcomes of total knee arthroplasty(TKA) by measured resection technique only versus measured resection combined with gap balancing technique for knee osteoarthritis. [Methods] A retrospective study was conducted on 116 patients who received TKA for knee osteoarthritis from August 2015 to August 2018. Of them, 57 patients had TKA performed by the measured resection technique only(the MR group), while the remaining 59 patients had the procedures finished by measured resection combined gap balancing technique(the MR-GB group). The perioperative, follow-up and imaging data were compared between the two groups.[Results] All the patients in both groups underwent operation smoothly. Although no significant differences were noticed in operation time,blood loss, and hospital stay between the two groups(P>0.05), the MR-GB group had significantly greater thickness of osteotomy in the medial femoral posterior condyle [(9.84±1.12) mm vs(8.79±0.72) mm, P<0.05], whereas significantly less chance of lateral patellar retinaculum release than the MR group(3.39% vs 15.79%, P<0.05). The MR-GB group proved significantly superior to the MR group in term of KSS score [(72.22±7.85) vs(68.23±8.10), P<0.05], and knee flexion-extension range of motion(ROM) [(103.78±7.93)° vs(99.84±7.56)°,P<0.05] at 1 month postoperatively(P<0.05), whereas which became not statistically significant at 6 months after surgery and the latest follow-up between the two groups(P>0.05). With respect of imaging assessment, no statistically significant differences in the femorotibial angle(FTA), tibial plateau angle(TPA), and posterior tibial slope(PTS) were found at any matching time point between the two groups(P>0.05). [Conclusion] The measured resection combined with gap balancing technique does obtain a more appropriate knee flexion gap with less soft tissue release in TKA for knee osteoarthritis, and improve postoperative functional recovery in early stage.

关 键 词：膝骨性关节炎 全膝关节置换术 测量截骨技术 间隙平衡技术 

分 类 号：R687.4[医药卫生—骨科学]