Swank M, Romanowski J R, Korbee L L, Bignozzi S
Cincinnati Orthopaedic Research Institute, 9825 Kenwood Road, Suite 200, Cincinnati, Ohio, 45242, USA.
Proc Inst Mech Eng H. 2007 Oct;221(7):755-61. doi: 10.1243/09544119JEIM269.
Total knee arthroplasty (TKA) remains one of the most successful procedures in orthopaedic surgery. Complications certainly exist and are often related to failure of knee ligament balance. This asymmetry subsequently leads to component mal-alignment and loosening often secondary to deviation of the lower extremity mechanical axis. Understanding knee mechanics is essential, and recent technological advances have begun to minimize postoperative problems. A tensioning device that respects the native patellofemoral anatomy as well as the natural ligamentous strains has been developed. The surgical integration of computer-assisted navigation has allowed for enhanced accuracy and subsequently better results. The purpose of the current paper is to discuss the evolution of an improved ligament tensioning device, in the setting of classic mechanical guidance versus computer assistance and its postoperative impact on total knee outcomes in terms of manipulation rates and two-year radiographic alignment data. Based on a single surgeon series, mechanically guided arthroplasties resulted in a 16 per cent manipulation rate. Computer assistance with spacer blocks decreased the manipulation rate to 14 per cent, while using a novel tensioner device further decreased the manipulation rate to 7 per cent, a significant difference of p < 0.01. Radiographic data illustrate all TKAs with the tensioner to be within 4 degrees of the desired position.
全膝关节置换术（TKA）仍然是骨科手术中最成功的手术之一。并发症确实存在，且常常与膝关节韧带平衡失败有关。这种不对称随后会导致假体组件排列不齐和松动，这通常继发于下肢机械轴的偏差。了解膝关节力学至关重要，最近的技术进步已开始将术后问题降至最低。一种尊重天然髌股关节解剖结构以及自然韧带应变的张紧装置已经研发出来。计算机辅助导航的手术整合提高了准确性，进而带来了更好的效果。本文的目的是讨论一种改良韧带张紧装置的演变，即在传统机械引导与计算机辅助的背景下，以及其术后在手法调整率和两年影像学对线数据方面对全膝关节置换术结果的影响。基于单一外科医生的系列病例，机械引导的关节置换术手法调整率为16%。使用间隔块的计算机辅助将手法调整率降至14%，而使用一种新型张紧装置进一步将手法调整率降至7%，p<0.01，差异显著。影像学数据表明，所有使用该张紧装置的全膝关节置换术均在理想位置的4度范围内。
