Department of Orthopaedic Surgery, Kobe Kaisei Hospital, 3-11-15, Shinohara-Kita, Nada, Kobe, 657-0068, Japan.
Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki, Chuo, Kobe, 650-0017, Japan.
Knee Surg Sports Traumatol Arthrosc. 2018 May;26(5):1532-1539. doi: 10.1007/s00167-017-4557-z. Epub 2017 Apr 24.
To investigate the tibiofemoral rotational profiles during navigated posterior-stabilized (PS) total knee arthroplasty (TKA) and investigate the effect on post-operative maximum flexion angles.
Twenty-five subjects, treated with navigated PS TKA, were enrolled, and the effect of posterior cruciate ligament (PCL) resection and component implantation on tibiofemoral rotational kinematics was statistically evaluated. Then, the effect of rotational alignment changes on the post-operative maximum angles was retrospectively examined in 96 subjects using the multiple regression analysis.
Tibial internal rotation was significantly increased in full extension (p < 0.01 and <0.001, respectively) and at 60° and 90° flexion (p < 0.05) after PCL resection, which further increased after implantation, compared with that before resection. The amount of tibial internal rotation from 90° flexion to maximum flexion was significantly decreased after PCL resection and implantation, compared with that before resection (p < 0.05). The internal changes in the rotational alignment were independent factors for the minimal improvement in the post-operative maximum flexion angles (R = 0.078, p = 0.0067).
PCL resection changed the tibial rotational alignment and decreased the amount of tibial internal rotation. The implantation of PS components further increased the internal rotational alignment and could not compensate for the tibiofemoral rotation. Finally, the internal changes in rotational alignment affected the improvement of the maximum flexion angles, suggesting that rotational alignment is an important factor for improving post-operative maximum flexion angles.
II.
研究导航后稳定型（PS）全膝关节置换术（TKA）中胫骨股骨的旋转形态，并探讨其对术后最大屈曲角度的影响。
共纳入 25 例接受导航 PS TKA 治疗的患者，对后交叉韧带（PCL）切除和假体植入对胫骨股骨旋转运动学的影响进行统计学评估。然后，使用多元回归分析回顾性检查 96 例患者旋转对线变化对术后最大角度的影响。
PCL 切除后，在完全伸展（p<0.01 和 <0.001）以及 60°和 90°屈曲时，胫骨内旋显著增加（p<0.05），与切除前相比，在假体植入后进一步增加。与切除前相比，PCL 切除和植入后从 90°屈曲到最大屈曲的胫骨内旋量显著减少（p<0.05）。旋转对线的内变化是术后最大屈曲角度最小改善的独立因素（R=0.078，p=0.0067）。
PCL 切除改变了胫骨的旋转对线，减少了胫骨的内旋量。PS 组件的植入进一步增加了胫骨的内旋转对线，但不能补偿胫骨股骨的旋转。最终，旋转对线的内变化影响了最大屈曲角度的改善，提示旋转对线是改善术后最大屈曲角度的一个重要因素。
II 级。
