Ji Song-Jie, Zhou Yi-Xin, Jiang Xu, Cheng Zhi-Yuan, Wang Guang-Zhi, Ding Hui, Yang Ming-Lei, Zhu Zhong-Lin
Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing 100035, China.
Chin Med J (Engl). 2015 Nov 5;128(21):2866-72. doi: 10.4103/0366-6999.168043.
Joint line (JL) is a very important factor for total knee arthroplasty (TKA) to restore. The objective of this study was to evaluate the early clinical and kinematic results of TKAs with posterior-stabilized (PS) or cruciate retaining (CR) implants in which the JL was elevated postoperatively.
Data were collected from patients who underwent TKA in our department between April 2011 and April 2014. The patients were divided into two groups based on the prosthesis they received (PS or CR). At 1-year postoperatively, clinical outcomes were evaluated by the American Knee Society (AKS) knee score, AKS function score, and patella score. In vivo kinematic analysis after TKA was performed on all patients and a previously validated three-dimensional to two-dimensional image registration technique was used to obtain the kinematic data. Anteroposterior (AP) translation of the medial and lateral femoral condyles, and axial rotation relative to the tibial plateau, were analyzed. The data were assessed using the Mann-Whitney test.
At time of follow-up, there were differences in the AKS knee scores (P = 0.005), AKS function scores (P = 0.025), patella scores (P = 0.015), and postoperative range of motions (P = 0.004) between the PS group and the CR group. In the PS group, the magnitude of AP translation for the medial and lateral condyle was 4.9 ± 3.0 mm and 12.8 ± 3.3 mm, respectively. Axial rotation of the tibial component relative to the femoral component was 12.9 ± 4.5°. In the CR group, the magnitude of AP translation for the medial and lateral condyle was 4.3 ± 3.5 mm and 7.9 ± 4.2 mm, respectively. The axial rotation was 6.7 ± 5.9°. There were statistically different between PS group and CR group in kinematics postoperatively.
Our results demonstrate that postoperative JL elevation had more adverse effects on the clinical and kinematic outcomes of CR TKAs than PS TKAs.
关节线（JL）是全膝关节置换术（TKA）中需要恢复的一个非常重要的因素。本研究的目的是评估采用后稳定型（PS）或保留交叉韧带型（CR）假体且术后关节线升高的TKA的早期临床和运动学结果。
收集2011年4月至2014年4月在我科接受TKA的患者的数据。根据患者接受的假体类型（PS或CR）将其分为两组。术后1年，采用美国膝关节协会（AKS）膝关节评分、AKS功能评分和髌骨评分评估临床结果。对所有患者进行TKA后的体内运动学分析，并使用先前验证的三维到二维图像配准技术获取运动学数据。分析股骨内外侧髁的前后（AP）平移以及相对于胫骨平台的轴向旋转。使用Mann-Whitney检验评估数据。
随访时，PS组和CR组在AKS膝关节评分（P = 0.005）、AKS功能评分（P = 0.025）、髌骨评分（P = 0.015）和术后活动范围（P = 0.004）方面存在差异。在PS组中，内侧和外侧髁的AP平移幅度分别为4.9±3.0 mm和12.8±3.3 mm。胫骨组件相对于股骨组件的轴向旋转为12.9±4.5°。在CR组中，内侧和外侧髁的AP平移幅度分别为4.3±3.5 mm和7.9±4.2 mm。轴向旋转为6.7±5.9°。术后PS组和CR组在运动学方面存在统计学差异。
我们的结果表明，术后关节线升高对CR TKA的临床和运动学结果的不良影响大于PS TKA。
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