摘要目的 评价全膝关节置换术中采用测量截骨联合间隙平衡技术的临床疗效。方法 回顾性收集2017年5月至2019年7月在聊城市人民医院接受初次全膝关节置换术(total knee arthroplasty，TKA)的92例患者临床资料，其中47例单纯应用测量截骨技术纳入测量截骨组，男16例，女31例；年龄55~74岁，平均年龄(66.26±4.56)岁。45例应用测量截骨联合新型间隙测量垫辅助的间隙平衡技术纳入联合截骨组，男18例，女27例；年龄52~76岁，平均年龄(64.69±5.83)岁。比较两组的手术情况、影像学及膝关节功能恢复的情况。结果 92例患者完成至少2年随访，联合截骨组的手术时间(68.62±11.06)min，少于测量截骨组(74.81±13.21)min，差异有统计学意义(P＝0.017)。联合截骨组的股骨后髁连线外旋截骨角为(4.22±1.27)°，高于测量截骨组的(3.43±0.83)°，差异有统计学意义(P＝0.001)，联合截骨组的股骨内后髁的截骨厚度为(9.77±0.81)mm，测量截骨组为(9.35±0.69)mm，两者比较差异有统计学意义(P＝0.009)。术后1、3个月联合截骨组的西安大略和麦克马斯特大学(Western Ontario and McMaster Universities，WOMAC)骨关节炎指数评分为(37.96±6.42)分、(25.64±3.52)分，优于测量截骨组的(40.76±6.70)分、(27.44±4.41)分，差异有统计学意义(P＝0.044，P＝0.032)。术后1年、2年两组膝关节活动度(range of motion，ROM)、美国膝关节协会评分(knee society score，KSS)及WOMAC评分比较差异无统计学意义(P＞0.05)。结论 TKA术中应用测量截骨联合间隙平衡截骨技术在术后早期能更好恢复膝关节日常功能，股骨后髁连线外旋截骨角及内后髁的截骨量略大于测量截骨技术，但两种技术在术后1年、2年随访的临床效果无差别。
Abstract：Objective To evaluate the clinical effect of measuring osteotomy combined with gap balancing osteotomy in total knee arthroplasty.Methods A total of 92 patients who underwent consecutive primary TKA between May 2017 and July 2019 were retrospectively reviewed.Among them，47 cases (16 males and 31 females) were included in the measurement osteotomy group using the measurement osteotomy technique alone.The average age was (66.26±4.56) years.45 cases (18 males and 27 females) were enrolled in the combined osteotomy group by using the measured resection combined with gap balancing technique assisted by a modified spacer block.The average age was (64.69±5.83) years.The surgical，imaging and knee function outcomes of the two groups were compared.Results 92 patients were followed up for at least 2 years.The operation time in the combined osteotomy group was (68.62±11.06) min，which was less than that in the measured resection group (74.81±13.21) min，the difference was statistically significant (P＝0.017).Compared with the measured resection group (3.43±0.83)°，the combined osteotomy group had a greater external rotation resection angle of the femur (4.22±1.27)°.The osteotomy thickness of the medial posterior condyle of femur in the combined osteotomy group was (9.77±0.81) mm，which was higher than (9.35±0.69) mm in the measured resection group (P＝0.009).At 1 and 3 months follow-ups，the Western Ontario and McMaster Universities(WOMAC) score of the combined osteotomy group was (37.96±6.42)，(25.64±3.52)，which was better than that of the measured resection group (40.76±6.70)，(27.44±4.41)，the difference was statistically significant (P＝0.044，P＝0.032).There was no significant difference in range of motion(ROM)，knee society score(KSS) and WOMAC scores between the two groups at 1 and 2 year follow-ups (P＞0.05).Conclusion The application of measuring osteotomy combined with gap balancing technique in total knee arthroplasty has better daily function of knee joint in the early stage.The external rotation osteotomy angle of posterior condyle and the amount of osteotomy of medial posterior condyle of femur is slightly larger than that of measuring osteotomy，but there is no difference between the two techniques in clinical effect at 1 and 2 years of follow-ups.
胡艳辉，宋达，苑振峰，杨轶群，王朝海，刘义. 测量截骨联合间隙平衡技术在全膝关节置换术中的应用[J]. 实用骨科杂志, 2022, 28(7): 596-601.
Hu Yanhui，Song Da，Yuan Zhenfeng，Yang Yiqun，Wang Chaohai，Liu Yi. Application of Measuring Osteotomy Combined with Gap Balancing Technique in Total Knee Arthroplasty. sygkzz, 2022, 28(7): 596-601.
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