Luring C, Hüfner T, Kendoff D, Perlick L, Bäthis H, Grifka J, Krettek C
Department of Trauma Surgery, Medical School Hannover, Germany.
Knee. 2006 Jan;13(1):15-8. doi: 10.1016/j.knee.2004.09.007. Epub 2005 Jun 24.
Correct postoperative leg alignment and stability of total knee prosthesis over the full range of movement are critical factors for successful TKA. This is achieved by correct implantation of prosthesis and soft tissue handling. However, the surgical approach and how to displace the patella are still controversial. We have carried out a cadaver study looking at the effect of patella eversion or subluxation on limb axis alignment during balancing of the knee in three different standard surgical approaches; subvastus, midvastus, or medial parapatellar. For each approach, five knees were studied. Leg alignment was visualised by the Ci CT-free DePuy/BrainLAB navigation system. Using a navigation system alignment was determined in the AP axis in both extension and 90 flexion, with the patella everted as well as subluxated. Eversion of the patella gave a more valgus axis reading than subluxation in both extension 0.58 (SD: 0.03, range 0.54 -0.60 ) and 90 flexion 0.48 (SD: 0.11, range 0.38 -0.60 ). The effect was greatest using the medial paraptellar approach. Surgeons should be aware that everting the patella influences the AP alignment when soft tissue balancing in total knee replacement.
全膝关节置换术（TKA）成功的关键因素是术后腿部正确对线以及全膝关节假体在整个运动范围内的稳定性。这通过正确植入假体和处理软组织来实现。然而，手术入路以及如何移动髌骨仍存在争议。我们进行了一项尸体研究，观察在三种不同的标准手术入路（股直肌下、股直肌中、内侧髌旁）中，膝关节平衡时髌骨外翻或半脱位对肢体轴线对线的影响。对于每种入路，研究了五个膝关节。通过Ci CT-free DePuy/BrainLAB导航系统观察腿部对线情况。使用导航系统，在伸直位和90°屈曲位的前后轴线上确定对线情况，同时使髌骨外翻和半脱位。在伸直位（0.58，标准差：0.03，范围0.54 - 0.60）和90°屈曲位（0.48，标准差：0.11，范围0.38 - 0.60），髌骨外翻比半脱位产生的外翻轴线读数更大。在内侧髌旁入路中这种影响最大。外科医生应意识到，在全膝关节置换术中进行软组织平衡时，髌骨外翻会影响前后轴线对线。
