Hino Kazunori, Kutsuna Tatsuhiko, Watamori Kunihiko, Ishimaru Yasumitsu, Kiyomatsu Hiroshi, Shiraishi Yoshitaka, Miura Hiromasa
Department of Orthopedic Surgery, Ehime University Graduate School of Medicine, Ehime, Japan.
Department of Orthopedic Surgery, Ehime University Graduate School of Medicine, Ehime, Japan.
Knee. 2018 Oct;25(5):897-902. doi: 10.1016/j.knee.2018.06.006. Epub 2018 Jun 21.
Proper soft tissue balance is crucial for a successful clinical outcome after total knee arthroplasty (TKA). Bi-cruciate substituting (BCS)-TKA has been developed to more closely approximate normal knee characteristics. The purpose of the present study was to evaluate midflexion laxity before and after BCS-TKA using a navigation system, and assess the correlation between intraoperative laxity and the maximum flexion angle after surgery.
Fifty-one knees in 46 patients with osteoarthritis replaced with BCS prosthesis were assessed. Manual mild passive internal-external rotational and varus-valgus stress was applied to the knees, and the maximum total laxity was measured automatically by a navigation system before and after TKA. The correlations with the range of motion (ROM) were evaluated using Spearman's correlation coefficients (ρ).
Internal-external stress assessment revealed no statistically significant difference at each flexion angle before and after BCS-TKA. In contrast, the varus-valgus stress assessment revealed that BCS-TKA had significantly decreased varus-valgus laxity from preoperative levels at 20-120° flexion angles. Furthermore, the maximum flexion angle at six months after surgery significantly correlated with the intraoperative laxity at deep flexion range.
BCS-TKA stabilized varus-valgus laxity to better than preoperative levels at midflexion range.
合适的软组织平衡对于全膝关节置换术（TKA）后的成功临床结果至关重要。双交叉替代（BCS）-TKA已被开发出来，以更接近正常膝关节的特征。本研究的目的是使用导航系统评估BCS-TKA前后的屈膝松弛度，并评估术中松弛度与术后最大屈曲角度之间的相关性。
对46例骨关节炎患者的51个膝关节进行BCS假体置换评估。对膝关节施加手动轻度被动内外旋转和内翻-外翻应力，并在TKA前后通过导航系统自动测量最大总松弛度。使用Spearman相关系数（ρ）评估与运动范围（ROM）的相关性。
内外应力评估显示，BCS-TKA前后各屈曲角度无统计学显著差异。相比之下，内翻-外翻应力评估显示，BCS-TKA在20-120°屈曲角度时，内翻-外翻松弛度较术前水平显著降低。此外，术后6个月的最大屈曲角度与深屈曲范围内的术中松弛度显著相关。
BCS-TKA在屈膝范围内将内翻-外翻松弛度稳定在优于术前水平。
