Kanamiya Takeshi, Whiteside Leo A, Nakamura Takashi, Mihalko William M, Steiger Jerry, Naito Masatoshi
Missouri Bone and Joint Center Research Laboratory, St. Louis, MO 63141, USA.
Clin Orthop Relat Res. 2002 Nov(404):24-31. doi: 10.1097/00003086-200211000-00005.
The current authors evaluated a fundamental approach to balancing the lateral ligaments of the knee that begins with aligning the implants correctly in flexion and extension, proceeds to assessing stability in flexion and extension, and concludes with releasing tight structures based on their function throughout the arc of flexion. Seventeen knees from cadavers were used to evaluate stability at various degrees of flexion after total knee arthroplasty, and then stability was reevaluated after release of selected ligaments. The iliotibial band and posterior capsule were effective lateral stabilizers only in full extension. The lateral collateral ligament had a major stabilizing effect throughout the arc from 0 degrees to 90 degrees flexion. The iliotibial band and popliteus tendon and posterolateral corner capsule had little effect when the other ligaments were intact. When tested in the absence of the other lateral ligaments, the popliteus tendon and posterolateral corner capsule had significant stabilizing effects throughout the flexion arc. The popliteus tendon exerted its effect mostly from 60 degrees to 90 degrees flexion. The posterolateral corner capsule was effective mostly at 0 degrees to 30 degrees flexion. The iliotibial band had a significant stabilizing effect from 0 degrees to 30 degrees flexion.
当前作者评估了一种平衡膝关节外侧韧带的基本方法，该方法首先在屈伸过程中正确对齐植入物，接着评估屈伸时的稳定性，最后根据其在整个屈曲弧度中的功能来松解紧张的结构。使用来自尸体的17个膝关节来评估全膝关节置换术后不同屈曲程度的稳定性，然后在松解选定韧带后重新评估稳定性。髂胫束和后关节囊仅在完全伸展时是有效的外侧稳定结构。外侧副韧带在从0度到90度屈曲的整个弧度中具有主要的稳定作用。当其他韧带完整时，髂胫束、腘肌腱和后外侧角关节囊作用很小。在没有其他外侧韧带的情况下进行测试时，腘肌腱和后外侧角关节囊在整个屈曲弧度中具有显著的稳定作用。腘肌腱的作用主要在60度到90度屈曲时发挥。后外侧角关节囊主要在0度到30度屈曲时有效。髂胫束在0度到30度屈曲时具有显著的稳定作用。
