股骨髁滑移截骨技术在初次人工全膝关节置换术中应用研究  

Application of femoral condyle sliding osteotomy in initial total knee arthroplasty

作　　者：王鑫[1] 马剑 张淞炎 谭瑞[1] WANG Xin;MA Jian;ZHANG Songyan;TAN Rui(Department of Orthopedics,Bishan Hospital of Chongqing Medical University,Chongqing,402760,P.R.China)

机构地区：[1]重庆医科大学附属璧山医院骨科,重庆402760

出　　处：《中国修复重建外科杂志》2025年第4期425-433,共9页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨初次人工全膝关节置换术(total knee arthroplasty,TKA)中采用股骨髁滑移截骨技术(femoral condyle sliding osteotomy,FCSO)在平衡冠状位内、外侧间隙时对屈曲间隙和假体外旋的影响。方法2021年11月—2024年10月于3例初次TKA术中应用FCSO行冠状位内、外侧间隙平衡,包括股骨内侧髁滑移截骨(medial condyle sliding osteotomy,MCSO)及股骨外侧髁滑移截骨(lateral condyle sliding osteotomy,LCSO)。男1例,女2例;年龄81、68、68岁。患膝存在内翻或外翻畸形,胫股角169.7°、203.3°、162.2°。术后采用髋-膝-踝角(hip-knee-ankle angle,HKA)、膝关节活动度(range of motion,ROM)、膝关节学会评分系统(KSS)评分、疼痛视觉模拟评分(VAS)评价关节功能及疼痛缓解程度。基于模型骨测量FCSO股骨内、外侧髁截骨块厚度及骨床面积,于临床12例TKA术中测量评估截骨块移动范围;截骨块上移及前移简化为几何模型后,计算其移位对屈曲间隙和假体外旋的影响。结果3例术中应用FCSO后力线及伸直、屈曲位内外侧平衡均恢复;术后患者分别获随访23、11、3个月,HKA以及疼痛VAS评分、KSS评分及ROM均较术前明显改善。截骨块相关测量示,MCSO及LCSO截骨块理论最大厚度分别为17、12 mm;截骨块单纯上移主要影响伸直间隙,对屈曲间隙和假体外旋无明显影响;截骨块上移同时前移会对屈曲间隙及假体外旋产生明显影响,尤其是LCSO,轻度前移即可导致3°以上外旋减小,对髌骨轨迹会产生严重影响。结论FCSO可有效解决初次TKA时内、外侧间隙不平衡问题,避免过度松解导致的膝关节不稳及髁限制性假体使用。MCSO及LCSO截骨块可分别向下移动3~5、6~8 mm及向前10~15 mm,基本没有后移空间。对于MCSO,截骨块上移合并前移会导致假体外旋增加,有利于髌骨轨迹改善,适用于外翻膝;LCSO则适用于内翻膝,且截骨块以垂直方向上下滑动,不作前后移动。Objective To investigate the effect of femoral condyle sliding osteotomy(FCSO)on the flexion gap and external rotation of the prosthesis in balancing coronal instability during initial total knee arthroplasty(TKA).Methods Between November 2021 and October 2024,FCSO technique was applied to balance the coronal medial and lateral spaces during initial TKA in 3 patients,including medial condyle sliding osteotomy(MCSO)and lateral condyle sliding osteotomy(LCSO).There were 1 male and 2 females with the age of 81,68,and 68 years old.The affected knee has varus or valgus deformity,with tibia-femoral angles of 169.7°,203.3°,and 162.2°,respectively.The hip-knee-ankle angle(HKA),range of motion(ROM),knee society scoring system(KSS),and pain visual analogue scale(VAS)score were used to evaluate joint function and pain relief.Based on model bone,the thickness and bone bed area of the medial and lateral femoral condyle osteotomy blocks in FCSO were measured.During TKA in 12 patients,the range of osteotomy block movement was evaluated.By simplifying the upward and forward movement of the osteotomy block into a geometric model,the impact of movement on the flexion gap and external rotation of the prosthesis was calculated.Results After application of FCSO during TKA,the limb alignment and medial and lateral balance at extension and flexion positions were restored in 3 patients.Three patients were followed up 23,11,and 3 months,respectively.Postoperative HKA,pain VAS score,KSS score,and ROM all showed significant improvement compared to preoperative levels.The maximum thickness of osteotomy blocks by MCSO and LCSO was 17 and 12 mm,respectively.The simple upward movement of the osteotomy block mainly affected the extension gap,and had little effect on the flexion gap and external rotation of the prosthesis.Moving the osteotomy block forward at the same time had a significant impact on the flexion gap and external rotation of the prosthesis,especially on LCSO.Mild forward movement leaded to a decrease in external rotation of mo

关 键 词：股骨髁滑移截骨技术 人工全膝关节置换术 软组织平衡 髌骨轨迹 

分 类 号：R687.4[医药卫生—骨科学]