固定平台单髁置换假体合适位置的研究进展  

Research progress in optimal position of fixed-bearing unicompartmental knee arthroplasty

作　　者：王相迎 杨长生 曲铁兵[2] Wang Xiangying;Yang Changsheng;Qu Tiebing(Department of Orthopedic Oncology Surgery,Shandong Cancer Hospital and Institute Affiliated to Shandong First Medical University and Shandong Academy of Medical Science,Jinan 250117,China;School of Rehabilitation Medicine,Beijing BoAi Hospital,Capital Medical University,Beijing 100068,China)

机构地区：[1]山东第一医科大学附属肿瘤医院,山东省肿瘤医院骨软外科,济南250117 [2]中国康复研究中心北京博爱医院骨与关节疾病诊疗中心,北京100068

出　　处：《中华关节外科杂志(电子版)》2024年第5期638-645,共8页Chinese Journal of Joint Surgery(Electronic Edition)

摘　　要：膝关节骨关节炎(KOA)已经成为影响老年人生活质量的重要因素。研究显示早期KOA主要局限在单一间室。对于单间室KOA,单髁膝关节置换(UKA)已经成为重要的治疗手段。与全膝关节置换(TKA)相比,UKA优势明显,但假体的远期生存率较低。在影响UKA假体生存率的因素中,假体的位置是其中重要的因素,因此在手术过程中选择合适的假体位置至关重要。本研究通过在Pubmed、Medline、ClinicalKey数据库中检索关键词“unicompartmental knee arthroplasty”、“fixed-bearing”、“prosthesis”、“appropriate position”;以及“中国知网”、“万方”、“维普”数据库中检索“单髁置换”、“固定平台”、“假体”、“合适位置”搜集整理了近些年来相关文献。总结归纳出股骨假体在冠状面上的位置应该放置在股骨髁中心位置、在矢状面上可以放置在屈曲5°至伸直10°之间、在横断面上可以放在内外旋3°之间;胫骨假体在冠状面上可以放置在中立位或者轻度内翻位、在矢状面上可以放置在0°~8°之间,但是也要将患者自身的解剖后倾角考虑在内;在横断面上选择内外旋3°之间;而术前术后关节线高度的差异应该控制在2 mm之内。通过上述的归纳总结,期望可以给临床医生提供参考,提高UKA术中假体放置的精确度,改善假体的远期生存率。Knee osteoarthritis(KOA)has become an important factor affecting the quality of life of the elderly.Studies have shown that early KOA is mainly confined to the single compartment.For unicompartmental KOA,unicompartmental knee arthroplasty(UKA)has become an important treatment.Compared with total knee arthroplasty(TKA),UKA has significant advantages,but the long-term survival of the prosthesis is lower.Among the factors affecting the survival rate of UKA prosthesis,the position of the prosthesis is one of the important factors,so it is crucial to choose the appropriate position of the prosthesis during the surgical procedure.In this study,by searching the keywords"unicompartmental knee arthroplasty","fixedbearing","prosthesis","appropriate position"in Pubmed,Medline,Clinical Key,China National Knowledge Infrastructure(CNKI),Wanfang,and China Science and Technology Journal Databases(VIP).Relevant literature in recent years was collected and organized.In summary,the femoral prosthesis should be placed in the coronal plane at the center of the femoral condyle,in the sagittal plane between flexion of five degrees and extension of 10°,and in the transverse plane between internal and external rotations of three degrees.The tibial prosthesis can be placed in the coronal plane in a neutral position or in a mildly inverted position,and in the sagittal plane between zero and eight degrees,but the anatomical posterior slope angle of the patient has to be taken into account.In the transverse plane,internal and external rotations of three degrees should be chosen.The difference in height between the preoperative and postoperative joint lines should be limited to less than two minimeters.The above summarization is expected to provide clinicians with a reference to improve the accuracy of prosthesis placement in unicompartmental knee arthroplasty and to improve the long-term survival of the prosthesis.

关 键 词：关节成形术 置换 膝 假体和植入物 

分 类 号：R687.4[医药卫生—骨科学]