Risitano Salvatore, Karamian Brian, Indelli Pier Francesco
Department of Orthopaedic Surgery and Bioengineering, Stanford University School of Medicine and the Palo Alto Veterans Affairs Health Care System (PAVAHCS), Palo Alto, CA, USA.
J Clin Orthop Trauma. 2017 Jul-Sep;8(3):265-269. doi: 10.1016/j.jcot.2017.06.004. Epub 2017 Jun 2.
Total knee arthroplasty is a traditional surgical procedure aimed to restore function and relief pain in patients with severe knee osteoarthritis. Recently, many medial pivot knee systems were deigned to replicate the normal knee kinematic: a highly congruent medial compartment and a less conforming lateral tibial plateau characterize these devices. A slightly asymmetric soft tissue balancing is mandatory using medial pivot designs to obtain a correct and physiological knee biomechanics leading good outcomes and long survival rates. This article describes a new surgical technique using a modern third generation TKA design combined with wireless load-sensor tibial trials to improve the correct knee load balancing with a minimal conformity of the polyethylene insert. The use of wireless load-sensing tibial trials has several benefits: it is an intraoperative, objective and dynamic tool allowing surgeons to optimize in real time soft tissue balancing. The meaning of a "truly balanced knee" is still a controversial issue in the current literature.
全膝关节置换术是一种传统的外科手术，旨在恢复重度膝关节骨关节炎患者的功能并缓解疼痛。近来，许多内侧旋转铰链膝关节系统被设计用于复制正常膝关节的运动学：这些装置的特点是内侧间室高度匹配，而外侧胫骨平台匹配度较低。使用内侧旋转铰链设计时，必须进行轻微不对称的软组织平衡，以获得正确且符合生理的膝关节生物力学，从而取得良好的效果和较长的生存率。本文介绍了一种新的手术技术，该技术使用现代第三代全膝关节置换设计并结合无线负载传感器胫骨试模，以在聚乙烯衬垫匹配度最小的情况下改善膝关节负载的正确平衡。无线负载传感胫骨试模的使用有诸多益处：它是一种术中使用的、客观且动态的工具，可让外科医生实时优化软组织平衡。在当前文献中，“真正平衡的膝关节”的含义仍是一个有争议的问题。
