Department of Mechanical Engineering, University of California at Davis, Davis, CA, USA,
Knee Surg Sports Traumatol Arthrosc. 2013 Oct;21(10):2271-80. doi: 10.1007/s00167-013-2621-x. Epub 2013 Aug 15.
Performing kinematically aligned total knee arthroplasty (TKA) with generic instruments is less costly than patient-specific instrumentation; however, the alignment and function with this new technique are unknown.
One hundred and one consecutive patients (101 knees) treated with kinematically aligned TKA, implanted with use of generic instruments, were prospectively followed. The medial collateral ligament was not released. The lateral collateral ligament was released in the 17 % of patients with a fixed valgus deformity. Six measures of alignment were categorized from a scanogram of the extremity, an axial scan of the knee, and an intraoperative measurement. Both the Oxford Knee and WOMAC™ scores were assessed as function. High function was a mean Oxford Knee score >41.
The frequency that patients were categorized as in-range was 93 % for the mechanical alignment of the limb (0° ± 3°), 94 % for the joint line (-3° ± 3°), 57 % for the anatomic axis of the knee (-2.5° ± -7.4° valgus), 4 % for the varus-valgus rotation of the tibial component (≤0° valgus), 98 % for the rotation of the tibial component with respect to the femoral component (0° ± 10°), and 94 % for the intraoperative change in the anterior-posterior distance of the tibia with respect to the femur at 90° of flexion (0 ± 2 mm). The mean OKS score was 42, and WOMAC™ score was 89. For each alignment, the function was the same for patients categorized as an outlier or in-range.
The authors prefer the use of generic instruments to perform kinematically aligned TKA in place of mechanically aligned TKA because five of six alignments were accurate and because high function was restored regardless of whether patients had an alignment categorized as an outlier or in-range.
IV.
使用通用器械进行运动学对线全膝关节置换术（TKA）比使用患者特异性器械的成本更低；然而，这种新技术的对线和功能尚不清楚。
前瞻性随访了 101 例（101 膝）接受运动学对线 TKA 治疗、使用通用器械植入的连续患者。未松解内侧副韧带。外侧副韧带在 17%存在固定外翻畸形的患者中松解。通过肢体扫描、膝关节轴位扫描和术中测量对 6 项对线指标进行分类。Oxford 膝关节评分和 WOMAC™评分均用于评估功能。高功能定义为平均 Oxford 膝关节评分＞41 分。
患者在肢体机械对线（0°±3°）、关节线（-3°±3°）、膝关节解剖轴（-2.5°±-7.4°外翻）、胫骨组件的内翻-外翻旋转（≤0°外翻）、胫骨组件相对于股骨组件的旋转（0°±10°）和膝关节屈曲 90°时胫骨相对于股骨前后距离的术中变化（0±2mm）方面的分类为在范围内的频率分别为 93%、94%、57%、4%、98%和 94%。平均 OKS 评分为 42 分，WOMAC™评分为 89 分。对于每种对线情况，分类为离群值或在范围内的患者的功能相同。
作者倾向于使用通用器械进行运动学对线 TKA，而不是机械对线 TKA，因为在 6 项对线指标中有 5 项是准确的，并且无论患者的对线是否被归类为离群值或在范围内，都可以恢复高功能。
IV。
