Tsukiyama Hiroyuki, Kuriyama Shinichi, Kobayashi Masahiko, Nakamura Shinichiro, Furu Moritoshi, Ito Hiromu, Matsuda Shuichi
Department of Orthopaedic Surgery, Hyogo Prefectural Amagasaki Hospital, Hyogo, Japan.
Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Knee. 2017 Dec;24(6):1478-1484. doi: 10.1016/j.knee.2017.09.004. Epub 2017 Sep 29.
It is commonly thought that balanced medial and lateral tibiofemoral joint gaps are essential, but the effect of joint laxity on clinical outcome after total knee arthroplasty (TKA) is unclear. It was hypothesised that medial joint laxity correlates with inferior patient satisfaction and knee function, although lateral joint laxity is allowed to a certain degree in TKA.
This study included 50 knees that underwent primary TKA. Knee laxity was measured with postoperative stress radiographs in flexion and extension, and patient satisfaction and knee function were evaluated by the 2011 Knee Society Knee Scoring System.
In a comparison of medially tight and medially loose knees in flexion, the scores for satisfaction, symptoms, standard activity, and advanced activity were significantly better in medially tight than in medially loose knees (satisfaction: 29.8, 22.2; symptoms: 20.3, 15.9; standard activities: 24.2, 19.1; and advanced activities: 15.3, 8.7, in the tight and loose knees, respectively). Neither lateral joint laxity during knee flexion nor medial joint laxity during knee extension was associated with a poor postoperative clinical outcome, whereas lateral joint laxity and the standard activity score in extension had a moderate positive correlation.
Knees with medial joint laxity during flexion resulted in an inferior postoperative outcome, and lateral joint laxity did not influence patient satisfaction or function. Care should be taken to maintain medial joint stability during the TKA procedure.
人们普遍认为，胫股关节内外侧间隙平衡至关重要，但关节松弛对全膝关节置换术（TKA）后临床结局的影响尚不清楚。研究假设，内侧关节松弛与患者满意度及膝关节功能较差相关，尽管在TKA中允许一定程度的外侧关节松弛。
本研究纳入50例行初次TKA的膝关节。术后通过应力位X线片测量膝关节屈伸时的松弛度，并采用2011年膝关节协会膝关节评分系统评估患者满意度和膝关节功能。
在比较屈膝时内侧紧张和内侧松弛的膝关节时，内侧紧张的膝关节在满意度、症状、标准活动和高级活动方面的评分明显优于内侧松弛的膝关节（满意度：内侧紧张膝关节为29.8，内侧松弛膝关节为22.2；症状：20.3，15.9；标准活动：24.2，19.1；高级活动：15.3，8.7）。屈膝时的外侧关节松弛和伸膝时的内侧关节松弛均与术后临床结局不佳无关，而伸膝时的外侧关节松弛与标准活动评分呈中度正相关。
屈膝时内侧关节松弛的膝关节术后结局较差，外侧关节松弛不影响患者满意度或功能。在TKA手术过程中应注意保持内侧关节稳定性。
