Ferreira Marcio C, Franciozi Carlos Eduardo S, Kubota Marcelo S, Priore Ricardo D, Ingham Sheila J M, Abdalla Rene J
Department of Orthopedics and Traumatology, Knee Surgery, Heart Hospital, São Paulo, SP, Brazil.
Department of Orthopedics and Traumatology, Knee Surgery, Heart Hospital, São Paulo, SP, Brazil; Knee Surgery Department, Federal University of São Paulo, Medicine School, São Paulo, Brazil.
J Arthroplasty. 2017 Jul;32(7):2262-2267. doi: 10.1016/j.arth.2017.01.055. Epub 2017 Feb 7.
To analyze 2 methods of manual spreader gap assessment accuracy, visual vs blinded, compared with a controlled tensioner in total knee arthroplasty.
Twenty-two fresh frozen cadaver knees were used to perform total knee arthroplasty by 22 surgeons. Extension and flexion gaps were measured with empirical manual force application with spreaders in 2 different manners: (1) surgeons were blinded to gap geometry formation-blind method group (BM) and (2) surgeons viewed them-viewing method group (VM). A tensioner was used to measure the corresponding ligament tension applied during spreader measurements and to measure the extension and flexion gaps with standard force of 100 and 80 N (tensioner method [TM]) in each femorotibial compartment.
All measurements with spreaders (VM and BM) presented extension and flexion gaps oversized and asymmetric (P < .0001), when compared with the same gaps measured with the tensioner. Approximately 63% (P = <0.001) and 77.3% (P = .161) of the VM group and 68.2% (P = .018) and 77.3% (P = .161) of the BM group demonstrated asymmetry for extension and flexion gaps up to 3 mm to the TM. Gaps measured in the VM group presented results with slightly less oversizing and asymmetries than the measurements in the BM group compared with TM, although significantly different (P < .0001).
The assessment of extension and flexion gaps with empirical manual applied force spreaders produced oversized and asymmetric gaps compared with the use of tensioner. No visual influence was observed during the spreader applied empirical manual force compared with the blinded assessment.
分析在全膝关节置换术中，与可控张力器相比，视觉评估与盲法评估这两种手动撑开器间隙评估准确性的方法。
22名外科医生使用22个新鲜冷冻尸体膝关节进行全膝关节置换术。通过两种不同方式用撑开器施加经验性手动力量来测量伸直和屈曲间隙：（1）外科医生对间隙几何形状形成不知情——盲法组（BM）；（2）外科医生观察间隙——观察法组（VM）。使用张力器测量在撑开器测量过程中施加的相应韧带张力，并在每个股胫关节间室用100 N和80 N的标准力测量伸直和屈曲间隙（张力器法[TM]）。
与用张力器测量的相同间隙相比，所有使用撑开器的测量（VM和BM）均显示伸直和屈曲间隙过大且不对称（P < .0001）。VM组约63%（P = <0.001）和77.3%（P = .161）以及BM组68.2%（P = .018）和77.3%（P = .161）的伸直和屈曲间隙与TM相比不对称达3 mm。与TM相比，VM组测量的间隙显示出比BM组测量结果稍小的过大尺寸和不对称性，尽管差异显著（P < .0001）。
与使用张力器相比，用经验性手动施加力量的撑开器评估伸直和屈曲间隙会产生过大且不对称的间隙。与盲法评估相比，在撑开器施加经验性手动力量过程中未观察到视觉影响。
