精确截骨技术在运动学对线全膝关节置换术的应用研究进展  

Research progress on the application of precise osteotomy technology in kinematic alignment total knee arthroplasty

作　　者：余沐洋 徐溢明 王英杰[2] 杨兴东 翁习生[2] 冯宾[2] YU Muyang;XU Yiming;WANG Yingjie;YANG Xingdong;WENG Xisheng;FENG Bin(Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100730,China;Department of Orthopaedics,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100730,China)

机构地区：[1]中国医学科学院,北京协和医学院,北京100730 [2]中国医学科学院,北京协和医学院,北京协和医院骨科,北京100730

出　　处：《中华骨与关节外科杂志》2024年第6期504-510,共7页Chinese Journal of Bone and Joint Surgery

基　　金：北京市自然科学基金(L232006);中国医学科学院医学与健康科技创新工程项目(2022-I2M-C&T-B-031);中央高水平医院临床科研专项(2022-PUMCH-C-036)。

摘　　要：全膝关节置换术(TKA)可以显著减轻患者疼痛,改善膝关节功能,已成为公认的治疗终末期膝骨关节炎的“金标准”。机械学对线(MA)一直以来被认为是TKA术中“黄金”对线原则。但是,尽管假体设计和手术精度在不断进步,MA-TKA的功能结果却没有明显改善。运动学对线(KA)旨在更好地恢复膝关节的自然解剖结构,以促进恢复生理性运动,被认为较MA可进一步提高术后患者满意度。但也有研究指出,与MA-TKA相比,KA-TKA术后临床疗效无明显改善,这或许与传统TKA难以实现KA-TKA理论上需要的精确截骨有关。近年来,随着个体化截骨导板(PSI)、计算机辅助导航系统(CANS)、机器人辅助手术等多种新技术相继应用于TKA,KA-TKA截骨的准确性明显提高,但KA-TKA的临床结果是否得到改善尚不明确。本文对精确截骨技术在KA-TKA应用的研究进展进行综述。Total knee arthroplasty(TKA) can significantly relieve pain and improve knee joint function,and it has become the recognized "gold standard" for treating end-stage knee osteoarthritis.Traditionally,mechanical alignment(MA) has been considered the "golden" alignment principle during TKA.Despite advancements in prosthesis design and surgical precision,the functional outcomes of MA-TKA have not shown marked improvement.Kinematic alignment(KA) aims to better restore the natural anatomy of the knee joint to promote physiological movement,potentially offering better postoperative patient satisfaction compared to MA.Nevertheless,some studies have pointed out that there is no significant improvement in clinical outcomes with KA-TKA compared to MA-TKA.This lack of improvement may be attributed to the challenge of achieving the precise osteotomy that KA-TKA necessitates.In recent years,the application of new technologies such as patient-specific instrument,computer-assisted navigation system,and orthopedic robot in TKA has significantly enhanced the precision of osteotomies in KA-TKA.However,it remains unclear whether these advancements have led to improved clinical outcomes.This article reviews the research progress on the application of precise osteotomy techniques in KA-TKA.

关 键 词：全膝关节置换术 运动学对线 个体化截骨导板 计算机辅助导航系统 骨科机器人 

分 类 号：R684[医药卫生—骨科学]