限制性运动学对线在全膝关节置换中的应用  

The application of restricted kinematic alignment in total knee arthroplasty

作　　者：邵志强 吴登先 蔡宖钢 刘政 宋凯[1] 张晓峰 徐志宏[1] 蒋青[1] Shao Zhiqiang;Wu Dengxian;Cai Honggang;Liu Zheng;Song Kai;Zhang Xiaofeng;Xu Zhihong;Jiang Qing(Division of Sports Medicine and Adult Reconstructive Surgery,Department of Orthopedic Surgery,Nanjing Drum Tower Hospital,The Affiliated Hospital of Nanjing University Medical School(Branch of National Clinical Research Center for Orthopedics,Sports Medicine and Rehabilitation),Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院运动医学与成人重建外科(国家骨科与运动康复临床医学研究中心分中心),南京210008

出　　处：《中华骨科杂志》2023年第16期1076-1084,共9页Chinese Journal of Orthopaedics

摘　　要：目的探讨根据限制性运动学对线(restricted kinematic alignment,rKA)原理使用髓外定位工具进行后十字韧带保留型(cruciate-retaining,CR)假体的全膝关节置换术的可行性和治疗效果。方法回顾性收集2019年11月至2020年12月于南京鼓楼医院采用FEM-X1股骨髓外定位工具行rKA对线CR假体全膝关节置换的膝关节骨关节炎患者35例,男7例、女28例,年龄(71±8)岁(范围55~85岁)。术前第3天摄站立位下肢全长正侧位X线片测量rKA规划术前股骨远端外侧角(the lateral distal femoral angle,LDFA)与胫骨近端内侧角(the medial proximal tibial angle,MPTA)及髋膝踝角(hip-knee-ankle angle,HKA)。行全膝关节置换术,分别用胫骨、股骨髓外定位架依次对胫骨近端和股骨远端截骨,参考胫骨平台及内外侧软组织张力指导股骨后髁截骨,截骨完成后置入假体。记录术中侧副韧带松解情况、后十字韧带功能及松解情况、髌股轨迹情况、髌股支持带松解情况。术后第3天测量LDFA、MPTA、HKA、胫骨假体后倾角;功能评价采用膝关节学会评分(Knee Society score,KSS)。结果35例髓外rKA对线CR假体的全膝关节置换术均顺利完成,手术时间为100(90,110)min,术中出血量为100(100,200)ml。手术前后的LDFA分别为1.0°(-2.0°,4.0°)、0°(-2.0°,2.0°),MPTA分别为-4.0°(-5.0°,-1.0°)、-2.0°(-3.0°,-1.0°),HKA分别为-3.0°(-3.0°,-1.0°)、-2.0°(-3.0°,-1.0°),各指标手术前后测量比较的差异均无统计学意义(Z=-0.89,P=0.372;Z=1.87,P=0.061;Z=1.03,P=0.302);胫骨后倾角为5°(3°,7°)。30例获得随访,随访时间(12.5±0.7)个月(范围12~14个月),术后1年KSS临床评分为94(92,97)分、功能评分为80(70,90)分。术中发现后十字韧带张力过大1例,行后十字韧带松解;术中发现髌股轨迹不良1例,行外侧支持带松解。结论采用髓外定位工具rKA对线进行CR假体全膝关节置换术具有可行性、操作简便、手术效果确切、软组织平衡良好�Objective To investigate the feasibility and therapeutic effect of total knee arthroplasty(TKA)with cruciate-retaining(CR)prosthesis by using FEM-X1 femoral extramedullary positioning instrument based on the theory of restricted kinematic alignment(rKA).MethodsThirty five cases who underwent total knee arthroplasty in Nanjing Drum Tower Hospital from November 2019 to December 2020 were retrospectively analyzed,including 7 males and 28 females with an average age of 71±8 years(ranging from 55 to 85 years)Following the guidance of rKA alignment,the FEM-X1 femoral extramedullary positioning instrument was used for TKA with CR prosthesis.Before the operation,the full-length lower limb radiographs of both anteroposterior and lateral views were taken in a standing position for preoperative assessment of lateral distal femoral angle(LDFA),the medial proximal tibial angle(MPTA)and hip-knee-ankle angle(HKA).According to the principle of rKA alignment,the target LDFA,MPTA and HKA were calculated.The proximal end of tibia and distal end of femur were cut using extramedullary positioning instrument respectively.The posterior femoral condyle was cut according to the tibial plateau and mediolateral soft tissue tension.The prosthesis was installed after osteotomy.The release of collateral ligaments,PCL function,release of PCL,patellofemoral trajectory,release of patellofemoral support band,the amount of blood loss and time of operation were recorded.Postoperative LDFA,MPTA,HKA,and posterior slope angle of tibial prosthesis were measured on X-ray images.The Knee Society Score(KSS)was used for functional evaluation.ResultsThirty five cases of TKA with CR prosthesis following rKA alignment were successfully completed.The operation time was 100(90,110)min,and the blood loss was 100(100,200)ml.30 of them were followed up for 12.5±0.7 months(ranging from 12 to 14 months).The pre-operative and post-operative LDFA were 1.0°(-2.0°,4.0°),0°(-2.0°,2.0°),MPTA were-4.0°(-5.0°,-1.0°),-2.0°(-3.0°,-1.0°),HKA were-3.0°(-3.0°,-1.

关 键 词：关节成形术 置换 膝 定位标记 限制性运动力学对线 

分 类 号：R687.4[医药卫生—骨科学]