Stucinskas Justinas, Robertsson Otto, Lebedev Aleksej, Wingstrand Hans, Smailys Alfredas, Tarasevicius Sarunas
Department of Orthopaedics, Lithuanian University of Health Sciences, Eiveniu 2, 50009, Kaunas, Lithuania.
Department of Clinical Sciences, Lund University, Lund, Sweden.
Arch Orthop Trauma Surg. 2016 May;136(5):693-700. doi: 10.1007/s00402-016-2434-8. Epub 2016 Mar 12.
The aim of this study was to investigate if preoperative measurements of the femoral valgus angle (FVA) affected the mechanical alignment, individual component positions and clinical outcome in total knee arthroplasty (TKA).
120 patients were randomized into two groups. In one group (control), a fixed FVA for the intramedullary femoral guide was set at 7°, whereas in the other group (measured) FVA was measured preoperatively on long hip-knee-ankle radiographs, and the angle for the distal femoral cut was set accordingly. Preoperatively and 1 year after TKA, range of motion (ROM) and Knee Society Score (KSS) were assessed. Postoperatively, the coronal alignments of the components and the mechanical alignment were measured comparing the rate of outliers which deviated more than 3° from the neutral mechanical axis.
104 patients remained for the radiological analysis (52 in each group). There were no significant differences either in the mean preoperative or postoperative mechanical alignment, or femoral or tibial component alignment; also, there were no differences in the number of postoperative mechanical axis or tibial component alignment outliers. However, the number of femoral component alignment outliers was significantly higher in the control group. 97 patients were available for clinical outcome analysis. Preoperatively, the groups did not differ significantly with respect to KSS or ROM. The postoperative ROM and KSS functional subscale scores were similar between the groups. However, there was slightly but significantly better postoperative KSS objective subscale score in the measured group.
Preoperative FVA measurement and following femoral distal cut adjustments did not affect overall leg alignment postoperatively, while positioning of femoral component was improved together with minor improvements in objective KSS subscale scores.
本研究旨在调查股骨外翻角（FVA）的术前测量是否会影响全膝关节置换术（TKA）中的机械对线、各个组件位置及临床结果。
120例患者被随机分为两组。一组（对照组）将髓内股骨导向器的固定FVA设定为7°，而另一组（测量组）术前在长的髋-膝-踝X线片上测量FVA，并据此设定股骨远端截骨的角度。在TKA术前及术后1年评估活动范围（ROM）和膝关节协会评分（KSS）。术后，测量组件的冠状面对线和机械对线，比较偏离中立机械轴超过3°的异常值发生率。
104例患者纳入影像学分析（每组52例）。术前或术后的平均机械对线、股骨或胫骨组件对线均无显著差异；术后机械轴或胫骨组件对线异常值的数量也无差异。然而，对照组中股骨组件对线异常值的数量显著更高。97例患者可进行临床结果分析。术前，两组在KSS或ROM方面无显著差异。两组术后的ROM和KSS功能亚量表评分相似。然而，测量组术后的KSS客观亚量表评分略有但显著更好。
术前FVA测量及随后的股骨远端截骨调整并未影响术后的整体下肢对线，同时股骨组件的定位得到改善，客观KSS亚量表评分也有轻微改善。
Zotero 插件