Tsubosaka Masanori, Ishida Kazunari, Sasaki Hiroshi, Shibanuma Nao, Kuroda Ryosuke, Matsumoto Tomoyuki
Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
Department of Orthopaedic Surgery, Kobe Kaisei Hospital, Kobe, Japan.
J Arthroplasty. 2017 Jun;32(6):1824-1828. doi: 10.1016/j.arth.2017.01.033. Epub 2017 Jan 30.
To investigate the effects of suture (soft tissue closure) and air tourniquet use on intraoperative kinematics in navigated total knee arthroplasty.
The study included 20 patients with varus-type knee osteoarthritis who underwent primary posterior-stabilized total knee arthroplasty using computed tomography (CT)-based navigation. Intraoperative tibiofemoral kinematics from maximum extension to maximum flexion were measured using the computed tomography-based navigation. The measurements were performed 3 times as follows: measurement 1: before suture (tourniquet on), measurement 2: after suture (tourniquet on), and measurement 3: after tourniquet removal. Details of kinematics including knee joint gap, tibiofemoral rotational angles, and anteroposterior (AP) distance between the femur and tibia were compared among the 3 measurements and statistically evaluated.
On the medial side, there was no significant difference among the 3 measurements in the extension gap, but measurement 1 showed a significantly larger flexion gap compared with the other 2 measurements. On the lateral side, there was no significant difference between the extension and flexion gaps in all measurements. The anteroposterior distance in measurement 1 showed that the femur was positioned significantly more anterior to the tibia at 10° and 20° of flexion compared with the other 2 measurements after suture. There was no significant difference among the 3 measurements in the tibiofemoral rotation angles.
These results found that the effect of suture and tourniquet was minimal, and that intraoperative kinematics can effectively evaluate postoperative passive kinematic conditions.
探讨缝合（软组织闭合）和使用气压止血带对导航全膝关节置换术中术中运动学的影响。
本研究纳入20例内翻型膝骨关节炎患者，这些患者接受了基于计算机断层扫描（CT）导航的初次后稳定型全膝关节置换术。使用基于CT的导航测量术中从最大伸展到最大屈曲的胫股运动学。测量按以下3次进行：测量1：缝合前（止血带在位），测量2：缝合后（止血带在位），测量3：止血带移除后。比较3次测量中包括膝关节间隙、胫股旋转角度以及股骨和胫骨之间前后（AP）距离在内的运动学细节，并进行统计学评估。
在内侧，3次测量的伸展间隙无显著差异，但测量1显示与其他2次测量相比，屈曲间隙显著更大。在外侧，所有测量的伸展和屈曲间隙之间无显著差异。测量1中的前后距离显示，与缝合后的其他2次测量相比，在屈曲10°和20°时，股骨相对于胫骨显著更靠前。3次测量的胫股旋转角度之间无显著差异。
这些结果发现缝合和止血带的影响最小，并且术中运动学可以有效地评估术后被动运动状况。
