Kim Chang-Wan, Lee Chang-Rack, Gwak Heui-Chul, Kim Jung-Han, Kwon Yong-Uk, Kim Doo-Yeol
Department of Orthopedic Surgery, Inje University Busan Paik Hospital, Busan, Republic of Korea.
J Knee Surg. 2020 Feb;33(2):144-151. doi: 10.1055/s-0038-1676766. Epub 2019 Jan 8.
Few studies have compared the accuracy of femoral component rotation in the measured resection technique according to the preoperative computed tomography (CT) and gap balancing technique. The aim of this study was to evaluate whether there is a difference in accuracy and outlier incidence of femoral component rotation between gap balancing and measured resection techniques with or without preoperative CT and to evaluate the difference in patellofemoral alignment on simple radiographs and clinical outcomes. In this retrospective study, we evaluated femoral component rotation angle on the clinical and surgical transepicondylar axis (FCRA-cTEA and FCRA-sTEA, respectively), patellar tilt angle, lateral patellar displacement, and patient-reported outcomes in the gap balancing technique (Group 1) and in the measured resection technique without (Group 2) and with (Group 3) preoperative CT. A total of 163 total knee arthoplasty (TKA) replacements were included in this study. Average FCRA-cTEA was -3.4 ± 2.6, -2.8 ± 2.1, and -1.8 ± 2.3 degrees in groups 1 to 3, respectively ( = 0.002). Average FCRA-sTEA was -0.2 ± 2.7, 0.5 ± 2.4, and 1.5 ± 2.1 degrees, respectively ( = 0.001). In an outlier analysis that evaluated femoral component rotation using cTEA as reference, no significant difference was observed between the three groups (40.8, 37.3, and 23.7%, respectively, = 0.133). When sTEA was used as a reference, groups 1 and 3 showed an outlier incidence of 8.2 and 8.5%, respectively, whereas this incidence was as high as 23.5% in group 2 ( = 0.030). No statistically significant group difference in patellofemoral alignment and patient-reported outcome was observed. In the measured resection technique with preoperative CT, the femoral component was externally rotated approximately 1 degree more than in the gap balancing or measured resection technique without preoperative CT. However, the difference in FCRA among the three techniques was not linked to the difference in patellofemoral alignment or patient-reported outcomes.
很少有研究比较过根据术前计算机断层扫描（CT）的测量截骨技术与间隙平衡技术中股骨组件旋转的准确性。本研究的目的是评估间隙平衡技术与有或没有术前CT的测量截骨技术在股骨组件旋转的准确性和异常值发生率上是否存在差异，并评估简单X线片上髌股关节对线情况及临床结果的差异。在这项回顾性研究中，我们评估了间隙平衡技术组（第1组）、无术前CT的测量截骨技术组（第2组）和有术前CT的测量截骨技术组（第3组）中股骨组件在临床和手术髁间轴上的旋转角度（分别为FCRA-cTEA和FCRA-sTEA）、髌骨倾斜角度、髌骨外侧移位以及患者报告的结果。本研究共纳入163例全膝关节置换术（TKA）病例。第1至3组的平均FCRA-cTEA分别为-3.4±2.6、-2.8±2.1和-1.8±2.3度（P=0.002）。平均FCRA-sTEA分别为-0.2±2.7、0.5±2.4和1.5±2.1度（P=0.
