全膝关节置换术中胫骨假体旋转对线研究进展  

Rotational alignment of the tibial component in total knee arthroplasty:a narrative review

作　　者：吾米提·塔西 刘爱峰[1] 纪能能 曹东东 张宇[1] Umiti Tashi;Liu Aifeng;Ji Nengneng;Cao Dongdong;Zhang Yu(First Teaching Hospital of Tianjin University of Traditional Chinese Medicine,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion,Tianjin 300381,China)

机构地区：[1]天津中医药大学第一附属医院国家中医针灸临床医学研究中心,天津300381

出　　处：《中华外科杂志》2022年第3期268-272,共5页Chinese Journal of Surgery

基　　金：国家自然科学基金(81873316);天津市卫生计生委、天津市中医药管理局中医、中西医结合科研课题(2017118)。

摘　　要：旋转对线不良是目前全膝关节置换术(TKA)失败的主要原因之一。各种常用的胫骨假体旋转对线方法中,Insall线存在过度外旋倾向;Akagi线虽是目前认可度最高的解剖轴,但仍存在一定内旋倾向。胫骨后髁轴不适合对称型假体,而曲面重叠技术则不适合解剖型假体。此外,参考任何固定解剖标志放置胫骨假体均不能保证伸膝位胫股假体的旋转一致性,而自我形合技术虽有利于胫股旋转同步,但其临床应用效果并不稳定。尽管如此,上述各种主流技术及其改良方法均可使多数患者获得良好的髌骨轨迹与临床效果。在“金标准”明确之前,骨科医师可按照自己最习惯的手术方式来确定胫骨假体旋转对线位置。随着对膝关节解剖、生物力学与运动学理解的加深,数字化辅助技术或许有望成为TKA胫骨旋转对线领域的突破点。Component malrotation is one of the major causes of failure in total knee arthroplasty.Based on previous researches,Insall line has excessive external rotation tendency.Although Akagi line is the most recognized anatomical axis at present,it still has a certain tendency of internal rotation.The tibial posterior condylar axis is not suitable for symmetrical component and yet the Curve-on-Curve technique is not suitable for anatomic component.In addition,reference to any fixed anatomical markers cannot ensure the rotation consistency of tibiofemoral component in extension position.Although range of motion technique is beneficial to tibiofemoral rotation synchronization,its clinical effect seems to be unstable.Nevertheless,Patients can obtain good postoperative results with all major techniques.Before the recognized"gold standard"is defined,orthopedic surgeons can determine the rotation alignment of tibial component according to their most accustomed surgical method.With a deeper understanding of knee anatomy,biomechanics and kinematics,digital assistive technology may be expected to become a breakthrough in the tibial rotational alignment.

关 键 词：关节成形术 置换 膝 膝关节 胫骨近端 旋转对线 

分 类 号：R687.4[医药卫生—骨科学]