比较保留和替代前交叉韧带的膝关节假体术后和术前的导航下膝关节运动学。
Comparing navigation-based in vivo knee kinematics pre- and postoperatively between a cruciate-retaining and a cruciate-substituting implant.
机构信息
University of Regensburg, Orthopaedic Surgery, Regensburg, Germany.
出版信息
Int Orthop. 2013 Mar;37(3):407-14. doi: 10.1007/s00264-013-1798-4. Epub 2013 Jan 30.
PURPOSE
Individual physiological knee kinematics are highly variable in normal knees and are altered following cruciate-substituting (PS) and cruciate-retaining (CR) total knee arthroplasty (TKA). We wanted to know whether knee kinematics are different choosing two different knee designs, CR and PS TKA, during surgery using computer navigation.
METHODS
For this purpose, 60 consecutive TKA were randomised, receiving either CR (37 patients) or PS TKA (23 patients). All patients underwent computer navigation, and kinematics were assessed prior to making any cuts or releases and after implantation. Outcome measures were relative rotation between femur and tibia, measured medial and lateral gaps and medial and lateral condylar lift-off.
RESULTS
We were not able to demonstrate a significant difference in femoral external rotation between either group prior to implantation (7.9° CR vs. 7.4° PS) or after implantation (9.0° CR vs. 11.3° PS), both groups showed femoral roll-back. It significantly increased pre- to postoperatively in PS TKA. In the CR group both gaps increased, the change of the medial gap was significantly attributable to medial release. In the PS group both gaps increased and the change of the medial and of the lateral gap was significant. Condylar lift-off was observed in the CR group during 20° and 60° of flexion.
CONCLUSION
This study did not reveal significant differences in navigation-based knee kinematics between CR and PS implants. Femoral roll-back was observed in both implant designs, but significantly increased pre- to postoperatively in PS TKA. A slight midflexion instability was observed in CR TKA. Intra-operative computer navigation can measure knee kinematics during surgery before and after TKR implantation and may assist surgeons to optimise knee kinematics or identify abnormal knee kinematics that could be corrected with ligament releases to improve the functional result of a TKR, whether it is a CR or PS design. Our intra-operative finding needs to be confirmed using fluoroscopic or radiographic 3D matching after complete recovery from surgery.
目的
正常膝关节的个体生理膝关节运动学变化很大，在交叉韧带替代（PS）和交叉韧带保留（CR）全膝关节置换（TKA）后会发生改变。我们想知道在使用计算机导航进行手术时，选择两种不同的膝关节设计（CR 和 PS TKA）是否会导致膝关节运动学发生变化。
方法
为此，将 60 例连续 TKA 随机分为 CR（37 例）或 PS TKA（23 例）组。所有患者均接受计算机导航，在进行任何切割或松解以及植入物植入后评估运动学。测量指标为股骨和胫骨之间的相对旋转、测量内侧和外侧间隙以及内侧和外侧髁间抬起。
结果
我们未能证明在植入前（CR 为 7.9°，PS 为 7.4°）或植入后（CR 为 9.0°，PS 为 11.3°）两组之间存在明显的股骨外旋差异，两组均显示股骨后滚。在 PS TKA 中，它在前到术后显著增加。在 CR 组中，两个间隙都增大，内侧间隙的变化主要归因于内侧松解。在 PS 组中，两个间隙都增大，内侧和外侧间隙的变化都有统计学意义。在 CR 组中，髁间抬起在 20°和 60°屈曲时观察到。
结论
本研究未发现 CR 和 PS 植入物之间基于导航的膝关节运动学存在显著差异。在两种植入物设计中都观察到股骨后滚，但在 PS TKA 中，术前到术后显著增加。在 CR TKA 中观察到轻微的中屈曲不稳定。术中计算机导航可在 TKR 植入前后测量膝关节运动学，并可帮助外科医生优化膝关节运动学或识别可能通过韧带松解纠正的异常膝关节运动学，以改善 TKR 的功能结果，无论是 CR 还是 PS 设计。我们的术中发现需要在手术完全恢复后使用荧光透视或放射学 3D 匹配来确认。
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