全膝关节置换术中股骨后髁个体化截骨方法与临床应用

Abstract
Figure/Table
References (0)
Related Citation (15)

Download: PDF (1642 KB) HTML (1 KB)
Export: BibTeX | EndNote (RIS)

Abstract Objective To introduce a method to accurately measure the posterior condylar angle (PCA) before operation and clinical application，and compare the traditional reference posterior femoral condylar line (PCL) with external rotation 3° osteotomy and individualized measurement PCA osteotomy for the short-term clinical efficacy of total knee arthroplasty (TKA) in the treatment of advanced knee osteoarthritis.Methods Six normal Chinese knee joint specimens were taken as the research objects，including 2 males and 4 females；aged 55~76 years，with an average age of (67.2±6.1)years；4 cases on the left and 2 cases on the right.CT scan analysis and anatomical marking were performed respectively，and the four images of the most convex point of the femoral lateral epicondyle，the most concave point of the medial epicondyle，the lowest point of the lateral posterior condyle and the lowest point of the medial posterior condyle were superimposed into one image.The PCA value was measured and clinically applied；61 patients with knee osteoarthritis who underwent the initial TKA treatment were randomly divided into two groups，and the clinical effects of the two groups were compared at 6 months after surgery.There were 30 cases in the 3° PCL osteotomy group，including 6 males and 24 females；aged 57~79 years old，with an average age of(68.2±5.2)years；31 cases in the individualized PCA value group，including 9 males and 22 females；The age ranged from 56 to 78 years，with an average of(67.9±5.5)years old.The American Knee Society score (KSS)，visual analogue scale (VAS) of pain，and range of motion (ROM) of knee joints were compared between the two groups at 6 months after operation.Results After ultra-thin CT scan of 6 knee joint specimens，the 4“true” anatomical landmarks of the posterior condyle angle of the distal femur were clearly distinguishable，and the results of image overlap technology were the same in imaging and anatomical measurement.KSS score at 6 months after operation：the score of the individualized osteotomy group (81.9±8.8) was better than that of the 3° PCL osteotomy group (77.5±6.9).The difference between the two groups was statistically significant (P＜0.05)；There was no statistically significant difference in functional scores between groups (P＞0.05).VAS：The score of the individualized osteotomy group (2.1±0.7) was lower than that of the 3°PCL osteotomy group (2.6±0.9).The difference between the two groups was statistically significant (P＜0.05).ROM：The postoperative flexion mobility of the individualized measurement group (106.8±15.6)° is better than that of the 3°PCL osteotomy group (102.1±16.2)°，but the difference between the groups is not statistically significant (P＞0.05)；individualized The postoperative extensional lag angle (1.4±2.4)° in the measurement group was significantly smaller than (3.0±3.3)° in the 3°PCL osteotomy group，and the difference between the two groups was statistically significant (P＜0.05).Conclusion Image overlay technology can accurately measure the PCA angle and improve the accuracy of rotational osteotomy in total knee arthroplasty.The preoperatively planned individualized posterior condylar femoral rotation osteotomy group is significantly better than the traditional reference PCL external rotation 3° osteotomy group in terms of postoperative knee function recovery.The image overlap individualized measurement PCA method is worthy of promotion.

Key words： total knee arthroplasty rotational osteotomy surgical transepicondylar axis posterior femoral condylar line posterior condylar angle

	Service

	E-mail this article
	Add to my bookshelf
	Add to citation manager
	E-mail Alert
	RSS
	Articles by authors

Cite this article:

URL:

http://www.sygkzz.com/EN/ OR http://www.sygkzz.com/EN/Y2021/V27/I1/14

［1］Tolk JJ，Janssen RPA，Prinsen CAC，et al.The OARSI core set of performance-based measures for knee osteoarthritis is reliable but not valid and responsive［J］.Knee Surg Sports Traumatol Arthrosc，2019，27(9)：2898-2909.
［2］Cacciola G，De Martino I，De Meo F.Does the medial pivot knee improve the clinical and radiographic outcome of total knee arthroplasty?A single centre study on two hundred and ninety seven patients［J］.Int Orthop，2020，44(2)：291-299.
［3］Dunbar MJ，Richardson G，Robertsson O.I can't get no satisfaction after my total knee replacement：rhymes and reasons［J］.Bone Joint J，2013，95B(11)：148-152.
［4］Valkering KP，Breugem SJ，van den Bekerom MP，et al.Effect of rotational alignment on outcome of total knee arthroplasty：A systematic review of the literature and correlation analysis［J］.Acta Orthopaedica，2015，86(4)：432-439.
［5］Merican AM，Ghosh KM，Iranpour F，et al.The effect of femoral component rotation on the kinematics of the tibiofemoral and patellofemoral joints after total knee arthroplasty［J］.Knee Surg Sports Traumatol Arthrosc，2011，19(9)：1479-1487.
［6］Churchill DL，Incavo SJ，Johnson CC，et al.The Transepicondylar Axis Approximates the Optimal Flexion Axis of the Knee［J］.Clin Orthop Relat Res，1998(356)：111-118.
［7］Jabloński J，Sibiński M，Polguj M，et al.The influence of lmplant position on final clinical outcome and gait analysis after total knee arthroplasty［J］.J Knee Surg，2019，32(9)：891-896.
［8］Ding L，Liu X，Liu C，et al.A clinical study of the rotational alignment of the femoral component in total knee arthroplasty［J］.J Phys Ther Sci，2015，27(7)：2077-2081.
［9］Fehring TK.Rotational malalignment of the femoral component in total knee arthroplasty［J］.Clin Orthop Relat Res，2000(380)：72-79.
［10］Hanada H，Whiteside LA，Steiger J，et al.Bone landmarks are more reliable than tensioned gaps in TKA component alignment［J］.Clin Orthop Relat Res，2007(462)：137-142.
［11］Jones C，Nawaz Z，Hassan A，et al.The variability in the external rotation axis of the distal femur：an MRI-based anatomical study［J］.Eur J Orthop Surg Traumatol，2016，26(2)：199-203.
［12］Tan H，Wang Y，Long T，et al.How to accurately determine the distal femoral valgus cut angle in the valgus knee arthroplasty［J］.Int Orthop，2018，42 (3)：537-542.
［13］Yoshino N，Takai S，Ohtsuki Y，et al.Computed tomography measurement of the surgical and clinical transepicondylar axis of the distal femur in osteoarthritic knees［J］.J Arthrop，2001，16(4)：493-497.
［14］Hirschmann MT，Konala P，Amsler F，et al.The position and orientation of total knee replacement components：a comparison of conventional radiographs，transverse 2D-CT slices and 3DCT reconstruction［J］.J Bone Joint Surg(Br)，2011，93(5)：629-633.
［15］Prassas D，Stunneck D，Rolfs T M，et al.Coronal correction for severe deformity using robotic-assisted total knee arthroplasty［J］.J Knee Surg，2018，31(1)：2-5.
［16］Zambianchi F，Luyckx T，Victor J，et al.How to improve femoral component rotational alignment［J］.Knee Surg Sports Traumatol Arthrosc，2014，22(8)：1805-1811.
［17］van der List JP，Chawla H，Joskowicz L，et al.Current state of computer navigation and robotics in unicompartmental and total knee arthroplasty：a systematic review with meta-analysis［J］.Knee Surg Sports Traumatol Arthrosc，2016，24(11)：3482-3495.

[1]	. [J]. sygkzz, 2021, 27(3): 272-276.