Orthopedic Department, Center for Musculoskeletal Surgery, Charité, Universitätsmedizin Berlin, Chariteplatz 1, 10117, Berlin, Germany,
Arch Orthop Trauma Surg. 2014 Apr;134(4):459-65. doi: 10.1007/s00402-014-1934-7. Epub 2014 Feb 2.
There is still a relevant rate of outliers in coronal alignment >3° when the conventional technique is used, potentially accompanied by a poorer long-term clinical outcome and a reduced longevity of the implant. Intraoperative implementation of preoperative planning and above all checking of the bone resections carried out are decisive for reinstating a straight leg axis. Intramedullary control of femoral resection has not been described to date. The objective of this study was to present a new technique for the intramedullary control of femoral resection and the results obtained using this method.
All patients who underwent primary total knee arthroplasty with the new intramedullary control of femoral resection were included in this retrospective study. The frequency of the need for correction of the saw cuts was documented. The radiological assessment included pre- and postoperative whole-leg standing radiographs. In the process, the whole-leg axis, AMA, entry point, LDFA and MPTA were evaluated preoperatively. On the postoperative radiographs, the whole-leg axis and the alignment of the femoral and tibial components were evaluated.
One hundred and sixty-two total knee arthroplasties (TKAs) were included in the study. The average age was 68.7 years. The preoperative malalignment was on the average 8.2° ± 4.7° (23.8° varus to 17.3° valgus). The postoperative whole-leg axis was on the average 1.3° ± 1.1° (5.5° varus to 4.3° valgus). The femoral component showed a deviation from the mechanical axis of 0.1° ± 1.2° (4.3° varus to 3.7° valgus) and the tibial component a deviation from the mechanical tibial axis of 0.3° ± 1.2° (4.2° varus to 2.5° valgus).
The new technique of intramedullary control of distal femoral resection, together with preoperative planning, leads to a precise alignment of the femoral component in the coronal plane. Thus, for the first time, a simple and effective tool for checking distal femoral resection is available for standardized use.
当使用传统技术时，冠状面对线仍有较大的离群率>3°，这可能伴随着较差的长期临床结果和植入物寿命的降低。术中实施术前规划，尤其是检查所进行的骨切除，对于恢复直腿轴至关重要。目前尚未描述股骨切除的髓内控制。本研究旨在介绍一种新的股骨切除髓内控制技术及其应用结果。
本回顾性研究纳入了所有接受新型股骨切除髓内控制的初次全膝关节置换术患者。记录了需要纠正锯切的频率。影像学评估包括术前和术后的下肢全长站立位 X 线片。在这个过程中，术前评估下肢全长轴线、AMA、入点、LDFA 和 MPTA。术后 X 线片评估下肢全长轴线和股骨及胫骨组件的对线情况。
研究共纳入 162 例全膝关节置换术。平均年龄为 68.7 岁。术前对线不良平均为 8.2°±4.7°（23.8°内翻至 17.3°外翻）。术后下肢全长轴线平均为 1.3°±1.1°（5.5°内翻至 4.3°外翻）。股骨组件偏离机械轴 0.1°±1.2°（4.3°内翻至 3.7°外翻），胫骨组件偏离机械胫骨轴 0.3°±1.2°（4.2°内翻至 2.5°外翻）。
新型股骨远端切除髓内控制技术与术前规划相结合，可使股骨组件在冠状面精确对线。因此，首次为标准化应用提供了一种简单有效的检查股骨远端切除的工具。
