在全髁置换全膝关节置换术中，深陷且高度匹配的胫骨假体衬垫并不能防止髌腱角增大和髌骨向前移位。
Deep-dished highly congruent tibial insert in CR-TKA does not prevent patellar tendon angle increase and patellar anterior translation.
作者信息
Akkawi Ibrahim, Colle Francesca, Bruni Danilo, Raspugli Giovanni Francesco, Bignozzi Simone, Zaffagnini Stefano, Iacono Francesco, Marcacci Maurilio
机构信息
Biomechanics and Technological Innovation Laboratory, Codivilla-Putti Research Center, Bologna University, Via Di Barbiano 1-10, 40136, Bologna, Italy,
出版信息
Knee Surg Sports Traumatol Arthrosc. 2015 Jun;23(6):1622-30. doi: 10.1007/s00167-014-2889-5. Epub 2014 Feb 12.
PURPOSE
Starting from the hypothesis that a deep-dished highly congruent tibial insert in cruciate-retaining total knee arthroplasty would prevent the increase in patellar tendon angle and anterior patellar translation by reducing the paradoxical anterior femoral translation, the main purpose of the present study was to investigate the effect of this prosthesis design, and secondary to assess the clinical outcomes at 6-month follow-up.
METHODS
Twenty patients treated with cruciate-retaining total knee arthroplasty with navigation technique were enrolled and prospectively followed up at 6 months. The median value of age was 71 years (57-83). Before and after surgery, the following parameters were calculated: patellar tendon angle, anterior-posterior and medio-lateral patellar translation, patellar height and range of motion. All patients were assessed with the SF-36 Physical Functioning and the Knee injury and Osteoarthritis Outcome Score ADL scores.
RESULTS
Patellar tendon angle and anterior patellar translation significantly increased in post-operative conditions (p < 0.0001); a statistically significant medial patellar translation was found (p < 0.0001), while patellar height did not show any difference between pre- and post-operative conditions (n.s). A significant correlation was found between patellar tendon angle and anterior patellar translation and the clinical scores (p < 0.0417). There was a significant post-operative decrease (p < 0.0033) in the range of motion.
CONCLUSIONS
The present study failed to demonstrate that deep-dished highly congruent tibial insert prevents the anterior translation of the patella in cruciate-retaining total knee arthroplasty, thus causing inferior clinical scores. It provided useful information about the biomechanical role of the patella in total knee arthroplasty, allowing to choose the most appropriate surgical approach.
LEVEL OF EVIDENCE
Case series, Level IV.
目的
基于保留交叉韧带的全膝关节置换术中，深凹且高度匹配的胫骨假体可通过减少股骨异常前向平移来防止髌腱角增大和髌骨前移的假设，本研究的主要目的是探讨这种假体设计的效果，其次是评估6个月随访时的临床结果。
方法
纳入20例行保留交叉韧带全膝关节置换术并采用导航技术治疗的患者，并对其进行6个月的前瞻性随访。年龄中位数为71岁（57 - 83岁）。手术前后计算以下参数：髌腱角、髌骨前后向和内外侧平移、髌骨高度及活动范围。所有患者均采用SF - 36身体功能量表以及膝关节损伤和骨关节炎疗效评分中的日常生活活动（ADL）评分进行评估。
结果
术后髌腱角和髌骨前移显著增加（p < 0.0001）；发现髌骨有统计学意义的内侧平移（p < 0.0001），而髌骨高度在术前和术后情况之间未显示出任何差异（无统计学意义）。髌腱角和髌骨前移与临床评分之间存在显著相关性（p < 0.0417）。活动范围术后显著下降（p < 0.0033）。
结论
本研究未能证明深凹且高度匹配的胫骨假体在保留交叉韧带的全膝关节置换术中可防止髌骨前移，从而导致临床评分较低。它提供了有关髌骨在全膝关节置换术中生物力学作用的有用信息，有助于选择最合适的手术方法。
证据水平
病例系列，IV级。
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