全膝关节置换个性化联合间隙平衡△

Personalized combined gap balancing technique in total knee arthroplasty

摘要:

［目的］ 探讨个性化测量截骨联合间隙平衡技术在全膝关节置换 （total knee arthroplasty, TKA） 中的应用价值。［方法］回顾性分析 2019 年 7 月—2019 年 11 月本科行 TKA 治疗膝关节骨性关节炎的 68 例患者的临床资料，依据医患沟通结果， 34 例采用个性化测量截骨联合间隙平衡技术完成 TKA（联合组）；34 例常规采用股骨后髁外旋 3°截骨完成 TKA（常规组）。比较两组围手术期、随访及影像资料。［结果］所有患者均顺利完成手术，无明显并发症。术中出现初始屈曲间隙不平衡联合组为 3 例，而常规组为 11 例，差异有统计学意义 （P<0.05）。联合组患者出血量显著少于常规组 （P<0.05），两组手术时间、切口总长度、术中透视次数、下地行走时间、切口愈合等级以及住院时间的差异均无统计学意义 （P>0.05）。两组患者均获随访，平均随访时间 （25.91±1.20） 个月，随时间推移，两组 VAS 评分显著降低 （P<0.05），而 KSS 评分和 ROM 显著增加 （P< 0.05）。术前两组间上述指标的差异均无统计学意义 （P>0.05）；但是，术后 12 个月和末次随访时联合组 VAS 评分显著低于常规组（P<0.05）；术后各时间点联合组 KSS 评分和 ROM 均优于常规组（P<0.05）。 影像方面，与术前相比，术后两组 FTA 角和 MPTA 角均显著改善 （P<0.05），术后相应时间点两组间 FTA、MPTA 、α 角、β 角、SFA、STA 的差异均无统计学意义 （P> 0.05）。［结论］个性化测量截骨联合间隙平衡技术行全膝关节置换术有利于获得膝关节屈曲间隙平衡，近期临床疗效优于常规测量截骨技术。

Abstract:

[Objective] To evaluate the significance of personalized combined gap balancing technique in total knee arthroplasty (TKA) . [Methods] A retrospective study was done on 68 patients who received TKA for knee osteoarthritis in our department from July 2019 to November 2019. According to the doctor-patient communication, 34 patients underwent TKA with personalized external rotation re- section of posterior femoral condyle combined with gap balancing technique (combined group) , while the remaining 34 patients had conven- tional posterior femoral condyle cutting at 3° external rotation (conventional group) . The perioperative, follow-up and imaging data of the two groups were compared. [Results] All patients in both groups were successfully operated on without obvious complications. The initial flexion gap imbalance was found in 3 cases of the combined group, whereas 11 cases in the conventional group, which proved statistically significant (P＜0.05) . The combined group had significantly less perioperative blood loss than the conventional group (P＜0.05) , although there were no significant differences in operative time, total incision length, intraoperative fluoroscopy times, ambulation time, incision heal- ing grade and hospital stay between the two groups (P＞0.05) . With the follow-up time of (25.91±1.20) months, the VAS significantly de- creased (P＜0.05) , while KSS score and ROM significantly increased in both groups (P＜0.05) . There were no statistically significant differ- ences in the abovementioned indexes between the two groups preoperatively (P＞0.05) . However, the combined group proved significantly superior to the conventional group in term of VAS score at 12 months after surgery and the last follow-up (P＜0.05) , whereas KSS score and knee range of motion (ROM) at all matching time points postoperatively (P＜0.05) . Radiographically, the femorotibial angle (FTA) and medi- al proximal tibial angle (MPTA) significantly improved in both groups postoperatively compared with those preoperatively (P＜0.05) . Howev- er, there were no statistically significant differences in FTA, MPTA, α angle, β angle, sagittal femoral angle (SFA) and sagittal tibial angle (STA) between the two groups at any corresponding postoperative time points (P＞0.05) . [Conclusion] The personalized external rotation re-section of posterior femoral condyle combined with gap balancing technique in total knee arthroplasty is beneficial to achieve gap balance of knee flexion, with better short-term clinical outcomes over the conventional posterior condyle resection in fixed 3° of external rotation.