Nakano Naoki, Matsumoto Tomoyuki, Muratsu Hirotsugu, Takayama Koji, Kuroda Ryosuke, Kurosaka Masahiro
Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
Department of Orthopaedic Surgery, Steel Memorial Hirohata Hospital, Himeji, Japan.
J Arthroplasty. 2016 Feb;31(2):401-5. doi: 10.1016/j.arth.2015.09.028. Epub 2015 Sep 26.
Although many studies have reported that postoperative knee flexion is influenced by preoperative conditions, the factors which affect postoperative knee flexion have not been fully elucidated. We tried to investigate the influence of intraoperative soft tissue balance on postoperative knee flexion angle after cruciate-retaining (CR) total knee arthroplasty (TKA) using a navigation and an offset-type tensor.
We retrospectively analyzed 55 patients with osteoarthritis who underwent TKA using e.motion-CR (B. Braun Aesculap, Germany) whose knee flexion angle could be measured at 2 years after operation. The exclusion criteria included valgus deformity, severe bony defect, infection, and bilateral TKA. Intraoperative varus ligament balance and joint component gap were measured with the navigation (Orthopilot 4.2; B. Braun Aesculap) while applying 40-lb joint distraction force at 0° to 120° of knee flexion using an offset-type tensor. Correlations between the soft tissue parameters and postoperative knee flexion angle were analyzed using simple linear regression models.
Varus ligament balance at 90° of flexion (R = 0.56; P < .001) and lateral compartment gap at 90° of flexion (R = 0.51; P < .001) were positively correlated with postoperative knee flexion angle. In addition, as with past studies, joint component gap at 90° of flexion (R = 0.30; P < .05) and preoperative knee flexion angle (R = 0.63; P < .001) were correlated with postoperative knee flexion angle.
Lateral laxity as well as joint component gap at 90° of flexion is one of the most important factors affecting postoperative knee flexion angle in CR-TKA.
尽管许多研究报告称术后膝关节屈曲受术前状况影响，但影响术后膝关节屈曲的因素尚未完全阐明。我们试图使用导航和偏置型张量研究在保留交叉韧带（CR）的全膝关节置换术（TKA）中，术中软组织平衡对术后膝关节屈曲角度的影响。
我们回顾性分析了55例行TKA的骨关节炎患者，这些患者使用e.motion-CR（德国贝朗蛇牌），术后2年可测量膝关节屈曲角度。排除标准包括外翻畸形、严重骨缺损、感染和双侧TKA。术中使用导航（Orthopilot 4.2；德国贝朗蛇牌）测量内翻韧带平衡和关节组件间隙，同时使用偏置型张量在膝关节屈曲0°至120°时施加40磅的关节牵张力。使用简单线性回归模型分析软组织参数与术后膝关节屈曲角度之间的相关性。
屈曲90°时的内翻韧带平衡（R = 0.56；P <.001）和屈曲90°时的外侧间室间隙（R = 0.51；P <.001）与术后膝关节屈曲角度呈正相关。此外，与既往研究一样，屈曲90°时的关节组件间隙（R = 0.30；P <.05）和术前膝关节屈曲角度（R = 0.63；P <.001）与术后膝关节屈曲角度相关。
外侧松弛以及屈曲90°时的关节组件间隙是影响CR-TKA术后膝关节屈曲角度的最重要因素之一。
