Shetty Gautam M, Mullaji Arun, Khalifa Ahmed Adel, Ray Abhik, Nikumbha Vivek
Department of Orthopaedic Surgery, Breach Candy Hospital & Mullaji Knee Clinic, Mumbai, India.
Department of Orthopaedic Surgery, Qena University Hospital, Qena, Egypt.
Knee Surg Relat Res. 2017 Jun 1;29(2):110-114. doi: 10.5792/ksrr.17.003.
The purpose of this prospective study was to determine correlation between coronal mechanical alignment measured on preoperative standing full-length radiographs and navigation during total knee arthroplasty (TKA) in the presence of an associated sagittal deformity (hyperextension and flexion deformity).
Coronal mechanical alignment measured on preoperative, standing, full-length, hip-to-ankle anteroposterior radiographs was compared with intraoperative measurements recorded with computer navigation in 200 primary navigated TKAs.
The mean difference in mechanical alignment between the two techniques was significantly greater (p=0.001) in patients with an associated flexion deformity >10° when compared to knees with associated flexion deformity ≤10°; 48% of knees with a flexion deformity >10° had a difference of ≥3° between the full-length radiograph and navigation alignment measurements. There was a strong correlation between the radiographic and navigation measurement techniques.
The mean difference in coronal mechanical alignment between the two techniques was significantly higher in patients with an associated flexion deformity >10°. Hence, surgeons should take caution when relying on preoperative full-length radiographs for determining coronal mechanical alignment in patients with an associated flexion deformity >10° where using navigation may be more reliable.
本前瞻性研究的目的是确定在存在矢状面畸形（过伸和屈曲畸形）的情况下，术前站立位全长X线片测量的冠状面机械对线与全膝关节置换术（TKA）中导航之间的相关性。
在200例采用导航技术的初次TKA手术中，将术前站立位全长髋至踝前后位X线片测量的冠状面机械对线与术中计算机导航记录的测量结果进行比较。
与伴有≤10°屈曲畸形的膝关节相比，伴有>10°屈曲畸形的患者，两种技术在机械对线方面的平均差异显著更大（p = 0.001）；48%伴有>10°屈曲畸形的膝关节，其全长X线片与导航对线测量结果之间的差异≥3°。X线片测量技术与导航测量技术之间存在很强的相关性。
伴有>10°屈曲畸形的患者，两种技术在冠状面机械对线方面的平均差异明显更高。因此，对于伴有>10°屈曲畸形的患者，外科医生在依靠术前全长X线片确定冠状面机械对线时应谨慎，此时使用导航可能更可靠。
