National University Health System, University Orthopaedics, Hand and Reconstructive Microsurgery Cluster, 1E Kent Ridge Road, 119228, Singapore.
Bone Joint J. 2013 Oct;95-B(10):1354-8. doi: 10.1302/0301-620X.95B10.31477.
The optimal management of the tibial slope in achieving a high flexion angle in posterior-stabilised (PS) total knee replacement (TKR) is not well understood, and most studies evaluating the posterior tibial slope have been conducted on cruciate-retaining TKRs. We analysed pre- and post-operative tibial slope differences, pre- and post-operative coronal knee alignment and post-operative maximum flexion angle in 167 patients undergoing 209 TKRs. The mean pre-operative posterior tibial slope was 8.6° (1.3° to 17°) and post-operatively it was 8.0° (0.1° to 16.7°). Multiple linear regression analysis showed that the absolute difference between pre- and post-operative tibial slope (p < 0.001), post-operative coronal alignment (p = 0.02) and pre-operative range of movement (p < 0.001) predicted post-operative flexion. The variance of change in tibial slope became larger as the post-operative maximum flexion angle decreased. The odds ratio of having a post-operative flexion angle < 100° was 17.6 if the slope change was > 2°. Our data suggest that recreation of the anatomical tibial slope appears to improve maximum flexion after posterior-stabilised TKR, provided coronal alignment has been restored.
在实现后稳定型（PS）全膝关节置换术（TKR）高屈曲角度中，胫骨斜率的最佳管理尚不清楚，并且大多数评估胫骨后斜率的研究都是在交叉韧带保留型 TKR 上进行的。我们分析了 167 例接受 209 例 TKR 手术的患者的术前和术后胫骨斜率差异、术前和术后冠状位膝关节对线以及术后最大屈曲角度。平均术前胫骨后斜率为 8.6°（1.3°至 17°），术后为 8.0°（0.1°至 16.7°）。多元线性回归分析显示，术前和术后胫骨斜率的绝对差值（p<0.001）、术后冠状对线（p=0.02）和术前活动范围（p<0.001）均预测术后屈曲。胫骨斜率变化的方差随着术后最大屈曲角度的降低而增大。如果斜率变化>2°，术后屈曲角度<100°的可能性是 17.6。我们的数据表明，在恢复冠状对线的前提下，重建解剖学胫骨斜率似乎可以改善后稳定型 TKR 后的最大屈曲。
