全膝关节置换前侧皮质切割的相关因素△

Factors related to anterior femoral notching in total knee arthroplasty

摘要:

[目的]探讨前参考系统全膝关节置换术(total knee arthroplasty, TKA)前侧皮质切割发生的相关因素。[方法]回顾性分析 2015 年 10 月—2020 年 12 月在本院因原发性膝关节骨关节炎行前参考系统 TKA 的 86 例患者 (105 膝) 连续病例资料。根据术后膝关节侧位 X 线片是否有前皮质切割表现，将患者分为切割组和未切割组。采用单因素分析和多因素逻辑回归分析前皮质切割发生的相关因素。[结果]105 膝中，术后影像显示共 28 膝发生前皮质切割，占 26.7%；77 例未发生前皮质切割， 占 73.3%。前侧皮质切割者按 Tayside 分级，I 级 13 膝(12.4%)，II 级 10 膝(9.5%)，III 级 5 膝(4.8%)，无 IV 级发生。单项因素比较，两组年龄、BMI、性别、侧别、前髁厚度、LDFA、MAD、前皮质屈曲角、髁间窝形态、前髁骨赘量、开髓点位置、股骨远端截骨量、后髁截骨量、通髁线辨认情况的差异均无统计学意义 (P＞0.05)。但是切割组术前后髁厚度显著大于未切割组 (P＜0.05)；切割组股骨假体选择偏小的比率显著高于未切割组 (P＜0.05)。多因素逻辑回归分析显示，术前影像测量后髁厚度大 (OR=1.124；P＜0.05) 是前皮质切割的危险因素，术中股骨假体选择偏大 (OR=0.375；P＜0.05) 是前皮质切割保护因素。 [结论] 在前参考系统 TKA 中，较大术前测量后髁厚度是前皮质切割的危险因素，而术中偏大的股骨假体选择是前皮质切割保护因素。

Abstract:

[Objective] To explore the factors related to anterior femoral cortical notching in total knee arthroplasty (TKA) with anterior referencing (AR) system. [Methods] A retrospective study was conducted on 86 consecutive patients (105 knees) who underwent TKA with AR for primary knee osteoarthritis in our hospital from October 2015 to December 2020. The patients were divided into notching group (the NT) and non-notching group (the NNT) according to whether anterior femoral cortical notching was seen on postoperative lateral X-ray of the knee. Univariate comparison and multivariate logistic regression analysis were performed to analyze the factors related to the anterior femoral cortical notching. [Results] Among 105 knees, 28 knees had anterior femoral cortical notching, accounting for 26.7%, while the re- maining 77 knee had non-notching of the femoral anterior cortex, accounting for 73.3%. Of the NT group, 13 knees (12.4%) were of grade I, 10 knees (9.5%) of grade II, 5 knees (4.8%) of grade III, and no grade IV according to Tayside classification. In term of univariate compari- son, there were no significant differences in age, BMI, gender, side, anterior condylar thickness, lateral distal femoral angle (LDFA) , mechan- ical axis deviation (MAD) , anterior cortical flexion angle, intercondylar fossa shape, anterior condylar osteophyte, opening point position, dis- tal femoral osteotomy, posterior condylar osteotomy, and condylar line identification between the two groups (P＞0.05) . However, the NT group had significantly greater posterior condylar thickness measured on the preoperative radiographs (P＜0.05) , in addition, the significant- ly higher ratio of smaller femoral component used intraoperatively than NNT group (P＜0.05) . In term of multivariate logistic regression analy- sis, the larger posterior condyle thickness measured on preoperative image (OR=1.124; P＜0.05) was a risk factor for anterior femoral cortical notching, whereas the larger femoral component selected during operation (OR=0.375; P＜0.05) was a protective factor for anterior femoral cortical notching. [Conclusion] In anterior referencing TKA, larger preoperative posterior condyle thickness is a risk factor for anterior corti- cal notching, while larger femoral prosthesis used intraoperatively is a protective factor for anterior cortical notching.