在导航全膝关节置换术中，屈膝90°时基于导航的胫骨旋转与更好的活动范围相关。
Navigation-based tibial rotation at 90° of flexion is associated with better range of motion in navigated total knee arthroplasty.
作者信息
Ishida Kazunari, Shibanuma Nao, Matsumoto Tomoyuki, Sasaki Hiroshi, Takayama Koji, Hiroshima Yuji, Kuroda Ryosuke, Kurosaka Masahiro
机构信息
Department of Orthopedic Surgery, Kobe Kaisei Hospital, 3-11-15, Shinohara-Kita, Nada, Kobe, 657-0068, Japan.
Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki, Chuo, Kobe, 650-0017, Japan.
出版信息
Knee Surg Sports Traumatol Arthrosc. 2016 Aug;24(8):2447-52. doi: 10.1007/s00167-016-4008-2. Epub 2016 Feb 4.
PURPOSE
In clinical practice, people with better femorotibial rotation in the flexed position often achieve a favourable postoperative maximum flexion angle (MFA). However, no objective data have been reported to support this clinical observation. In the present study, we aimed to investigate the correlation between the amount of intraoperative rotation and the pre- and postoperative flexion angles.
METHODS
Fifty-five patients with varus osteoarthritis undergoing computer-assisted posterior-stabilized total knee arthroplasty (TKA) were enrolled. After registration, rotational stress was applied towards the knee joint, and the rotational angles were recorded by using a navigation system at maximum extension and 90° of flexion. After implantation, rotational stress was applied for a second time, and the angles were recorded once more. The MFA was measured before surgery and 1 month after surgery, and the correlation between the amount of femorotibial rotation during surgery and the MFA was statistically evaluated.
RESULTS
Although the amount of tibial rotation at maximum extension was not correlated with the MFA, the amount of tibial rotation at 90° of flexion after registration was positively correlated with the pre- and postoperative MFA (both p < 0.005). However, no significant relationship was observed between the amount of tibial rotation after implantation and the postoperative MFA (n.s.).
CONCLUSION
The results showed that better femorotibial rotation at 90° of flexion is associated with a favourable postoperative MFA, suggesting that the flexibility of the surrounding soft tissues is an important factor for obtaining a better MFA, which has important clinical relevance. Hence, further evaluation of navigation-based kinematics during TKA may provide useful information on MFA.
LEVEL OF EVIDENCE
Diagnostic studies, development of diagnostic criteria in a consecutive series of patients, and a universally applied "gold" standard, Level II.
目的
在临床实践中，屈膝位时股骨胫骨旋转较好的患者术后常能获得良好的最大屈曲角度（MFA）。然而，尚无客观数据支持这一临床观察结果。在本研究中，我们旨在探讨术中旋转量与术前及术后屈曲角度之间的相关性。
方法
纳入55例接受计算机辅助后稳定型全膝关节置换术（TKA）的内翻性骨关节炎患者。注册后，向膝关节施加旋转应力，并使用导航系统在最大伸展位和屈曲90°时记录旋转角度。植入后，再次施加旋转应力，并再次记录角度。在手术前和手术后1个月测量MFA，并对手术期间股骨胫骨旋转量与MFA之间的相关性进行统计学评估。
结果
尽管最大伸展位时胫骨旋转量与MFA无关，但注册后屈曲90°时胫骨旋转量与术前及术后MFA呈正相关（均p < 0.005）。然而，植入后胫骨旋转量与术后MFA之间未观察到显著关系（无统计学意义）。
结论
结果表明，屈曲90°时较好的股骨胫骨旋转与良好的术后MFA相关，提示周围软组织的柔韧性是获得更好MFA的重要因素，具有重要的临床意义。因此，TKA期间基于导航的运动学的进一步评估可能为MFA提供有用信息。
证据水平
诊断性研究，在一系列连续患者中制定诊断标准，以及普遍应用的“金”标准，二级。
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