胫骨后倾角的改变与牛津活动衬垫单髁置换术中间隙压力及术后膝关节活动度的关系  

The association of posterior tibial slope changes between joint gap contact force and the range of motion in Oxford mobile bearing unicompartmental knee arthroplasty

作　　者：孙晓威 柳昌全 黄诚 王卫国[2] 郭万首[2] 张启栋[2] Sun Xiaowei;Liu Changquan;Huang Cheng;Wang Weiguo;Guo Wanshou;Zhang Qidong(Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Orthopedic Surgery,China‑Japan Friendship Hospital,Beijing 100029,China)

机构地区：[1]中国医学科学院北京协和医学院研究生院,北京100730 [2]中日友好医院骨关节科,北京100029

出　　处：《中华医学杂志》2022年第25期1904-1909,共6页National Medical Journal of China

基　　金：国家自然科学基金(82072494、81972130);首都卫生发展科研专项(2020‑2‑4067);北京市自然科学基金(7202183);中日友好医院“菁英计划”人才培育工程(ZRJY2021‑GG08)。

摘　　要：目的研究膝关节单髁置换(UKA)手术前后胫骨后倾角(PTS)的改变与术中关节屈伸末端间隙压力以及术后膝关节活动范围的关系。方法分析2020年6月至2021年6月中日友好医院收治的38例(46膝)UKA患者的临床资料。术中应用自行设计的压力传感器测量不同屈膝角度时内侧膝关节间隙的压力,分析手术前后PTS变化(ΔPTS)与术中屈伸末端膝关节间隙压力及术后关节屈伸活动度的关系。结果共纳入38例患者46膝,男14例,女24例,年龄(69.1±7.4)岁,随访(11.2±3.7)个月。经计算,间隙压力为(88.3±40.6)N;调整后的伸直末端间隙压力为81.7%±33.8%,屈曲末端间隙压力为55.6%±31.0%。术后随访时固定屈曲畸形[M(Q_(1),Q_(3))]为0°(0°,3°),较术前0°(0°,5°)减少(P<0.05),术后最大屈曲度为115.9°±16.4°,较术前的112.0°±16.8°增加(P<0.05),术后PTS为8.3°±2.7°,与术前的8.6°±2.1°差异无统计学意义(P>0.05)。相关分析发现,ΔPTS与伸直末端压力及固定屈曲畸形间均呈正相关(r=0.334、0.317,均P<0.05);伸直末端压力与固定屈曲畸形呈正相关(r=0.472,P<0.05)。而ΔPTS与屈曲末端压力呈负相关(r=-0.397,P<0.05),但此两者与最大屈曲度无相关性(均P>0.05)。结论UKA术中减少PTS会减小伸直末端间隙压力并减小术后膝关节固定屈曲畸形,同时会增加屈曲末端间隙压力,但并不会因此减少术后最大屈曲度。Objective To investigate the correlation between the change of posterior tibial slope(PTS)after unicompartmental knee arthroplasty(UKA)and the contact force at the end stage of knee flexion and extension,as well as the postoperative range of motion.Methods The data of 38 cases(46 knees)of UKAs undertaken in China-Japan Friendship Hospital from June 2020 to June 2021 were analyzed in this study.A custom-designed force sensor was used to measure gap contact force in the medial gap of UKA.The correlations between each two of the three factors—the change of PTS(ΔPTS),the gap contact force of full extension and deep flexion and the range of knee motion were analyzed.Results Totally of 38 patients(46 knees)were enrolled,including 14 males and 24 females,aged(69.1±7.4)years,with an average follow-up of(11.2±3.7)months.The average gap contact force was(88.3±40.6)N,the adjusted contact force of the full extension gap was 81.7%±33.8%,while that of the deep flexion gap was 55.6%±31.0%.At the last follow-up,the fixed flexion degree[M(Q_(1),Q_(3))]was 0°(0°,3°),which was significantly lower than the preoperative value of 0°(0°,5°)(P<0.05);the postoperative max flexion degree was 115.9°±16.4°,it was increased when compared with the preoperative value of 112.0°±16.8°(P<0.05);and the postoperative PTS was 8.3°±2.7°,and there was no significant difference with the preoperative value(8.6°±2.1°,P>0.05).There was a positive correlation betweenΔPTS and both the contact force of full extension gap and the fixed flexion degree(r=0.334 and 0.317,P<0.05).Besides,there was a negative correlation betweenΔPTS and the contact force of the deep flexion gap(r=-0.397,P<0.05).However,the correlations between these two factors and the max flexion degree were not significant(P>0.05).Conclusions The reduction of PTS in UKA would reduce the contact force of the full extension gap,as well as the postoperative fixed flexion deformity.Besides,it could increase the contact force of the deep flexion gap,but would not influence

关 键 词：关节成形术 置换 膝 膝关节单髁置换术 胫骨后倾角 传感器 膝关节间隙压力 病例系列研究 

分 类 号：R687.4[医药卫生—骨科学]