在全膝关节置换翻修术中使用模块化假体柄优化机械对线
Optimizing Mechanical Alignment With Modular Stems in Revision TKA.
作者信息
Fleischman Andrew N, Azboy Ibrahim, Restrepo Camilo, Maltenfort Mitchell G, Parvizi Javad
机构信息
The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania.
出版信息
J Arthroplasty. 2017 Sep;32(9S):S209-S213. doi: 10.1016/j.arth.2017.05.039. Epub 2017 May 26.
BACKGROUND
Although mechanical alignment is critical for optimal function and long-term implant durability, the role of modular stems in achieving ideal alignment is unclear.
METHODS
We identified 319 revision total knee arthroplasty from 2003-2013, for which stem length, stem diameter, and stem fixation method were recorded prospectively. Three-dimensional canal-filling ratio, the product of canal-filling ratio at the stem tip in both the anteroposterior and lateral planes, and alignment were measured radiographically.
RESULTS
Ideal alignment of the femur was considered to be 95° in the anteroposterior (AP) plane and from 1° of extension to 4° of flexion in the lateral plane, and ideal tibial alignment was considered to be 90° in the AP plane. Even after accounting for difference in stem size and canal-fill, ideal AP alignment was more reliably achieved with press-fit stems.
CONCLUSION
Furthermore, increased engagement of the diaphysis and its anatomical axis with canal-filling stems facilitates accurate alignment.
背景
尽管机械对线对于最佳功能和植入物的长期耐用性至关重要，但模块化柄在实现理想对线中的作用尚不清楚。
方法
我们确定了2003年至2013年期间的319例翻修全膝关节置换术，前瞻性记录了柄的长度、直径和柄的固定方法。通过影像学测量三维髓腔填充率，即柄尖在前后位和侧位平面的髓腔填充率的乘积，以及对线情况。
结果
股骨的理想对线被认为是在前后位（AP）平面为95°，在侧位平面从伸直1°到屈曲4°，胫骨的理想对线被认为是在AP平面为90°。即使考虑到柄尺寸和髓腔填充的差异，压配柄更可靠地实现了理想的AP对线。
结论
此外，骨干与其解剖轴与髓腔填充柄的更大程度的贴合有助于精确对线。
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