Matsui Yoshio, Matsuura Masanori, Minoda Yukihide, Nakagawa Sigeru, Okajima Yoshiaki, Kobayashi Akio, Inori Fumiaki
1 Osaka City General Hospital, Osaka, Japan.
2 Osaka City University, Osaka, Japan.
J Orthop Surg (Hong Kong). 2019 Jan-Apr;27(1):2309499019825574. doi: 10.1177/2309499019825574.
Joint gap unbalancing during total knee arthroplasty (TKA) induces flexion contracture. Flexion contracture is one of the most serious complications of TKA. When flexion contracture is found during surgery, intraoperative manipulation is often empirically performed. We evaluated the effects of intraoperative manipulation on joint gap and postoperative flexion contracture.
TKA was performed for 136 knees. Intraoperative manipulation was performed for flexion contracture in 61 knees. Joint gap changes before and after manipulation were measured at six positions from extension to 120° of flexion. Manipulation was not performed for 75 knees. The extension angle was measured radiographically immediately after surgery, at 3 months, and 6 months postoperatively. Extension angles with manipulation and without manipulation were compared.
Joint gap changes (mm) before and after manipulation were 0.1, 0.0, -0.2, -0.3, -0.1, and -0.3 at 0°, 30°, 45°, 60°, 90°, and 120° of flexion, respectively, indicating that manipulation could not change joint gaps significantly. Extension angles (°) with and without manipulation were -4.0 ± 4.6 and -3.8 ± 3.9 immediately after surgery, -5.3 ± 6.7 and -5.5 ± 6.2 at 3 months postoperatively, and -2.7 ± 6.0 and -3.8 ± 5.8 at 6 months postoperatively. No statistically significant difference existed between the values with or without manipulation during all periods.
Intraoperative manipulation does not enlarge the gap or resolve postoperative flexion contracture. Developing the new surgical technique is required to achieve perfect balance at TKA.
全膝关节置换术（TKA）期间关节间隙不平衡会导致屈曲挛缩。屈曲挛缩是TKA最严重的并发症之一。当在手术中发现屈曲挛缩时，通常凭经验进行术中手法操作。我们评估了术中手法操作对关节间隙和术后屈曲挛缩的影响。
对136个膝关节进行了TKA。61个膝关节因屈曲挛缩进行了术中手法操作。在从伸直位到屈曲120°的六个位置测量手法操作前后的关节间隙变化。75个膝关节未进行手法操作。术后立即、术后3个月和6个月通过X线测量伸直角度。比较有手法操作和无手法操作的伸直角度。
在屈曲0°、30°、45°、60°、90°和120°时，手法操作前后的关节间隙变化（mm）分别为0.1、0.0、-0.2、-0.3、-0.1和-0.3，表明手法操作不能显著改变关节间隙。有手法操作和无手法操作的术后立即伸直角度（°）分别为-4.0±4.6和-3.8±3.9，术后3个月分别为-5.3±6.7和-5.5±6.2，术后6个月分别为-2.7±6.0和-3.8±5.8。在所有时间段，有手法操作和无手法操作的值之间均无统计学显著差异。
术中手法操作不会扩大间隙或解决术后屈曲挛缩。需要开发新的手术技术以在TKA中实现完美平衡。
