Chanalithichai Nuttawut, Tammachote Nattapol, Jitapunkul Chane, Kanitnate Supakit
Department of Orthopaedics, Thammasat University, 99 Moo 18, Khlong Nueng, Khlong Luang, Pathumthani, 12120, Thailand.
Eur J Orthop Surg Traumatol. 2019 Aug;29(6):1297-1304. doi: 10.1007/s00590-019-02423-5. Epub 2019 Mar 28.
Although many studies investigated the accuracy of customized cutting block (CCB), the data on rotational alignment are still lacking. The study aimed to assess whether CCB improved the component rotational position compared with conventional cutting instrument (CCI) using computed tomography scanning.
Eighty-six of 102 total knee arthroplasties from the previous randomized study were analyzed. The outcomes were rotational position of the femoral and tibial components, frequency of outliers and intra-class correlation coefficient.
The mean femoral component rotation was not different between CCB versus CCI: 0.9° ± 0.8° versus 1.1° ± 1.1° (P = 0.29). Both groups had similar outlier frequencies: 2% (CCB) versus 2% (CCI) (P = 0.74). CCB had nearly 1° less mean tibial component deviation compared with CCI (P < 0.001): (1) dorsal tangent reference (DTR): 0.7° ± 0.8° versus 1.5° ± 1.0°, and (2) tibial trans-epicondylar reference (TTR): 0.5° ± 0.9° versus 1.4° ± 1.1°. Outlier frequencies were similar: (1) DTR: 0% CCB versus 5% CCI (P = 0.24), and (2) TTR: 5% in CCB versus 12% CCI (P = 0.20). Measurements based on tibial tubercle showed that CCB had ~ 1.4° less mean tibial component deviation compared with CCI: 0.3° ± 1.4° versus 1.7° ± 1.6° (P < 0.001) with a corresponding, less frequency of outliers: 0% versus 19% (P = 0.002). However, there was poor intra-observer reproducibility (0.61).
CCB did not improve femoral component rotational alignment compared with CCI nor affect outlier frequency, but it marginally improved the accuracy of tibial rotational alignment. The tibial tubercle reference point had poor intra-observer reproducibility.
尽管许多研究调查了定制截骨导板（CCB）的准确性，但关于旋转对线的数据仍然缺乏。本研究旨在通过计算机断层扫描评估与传统截骨器械（CCI）相比，CCB是否能改善假体组件的旋转位置。
对先前随机研究中的102例全膝关节置换术患者中的86例进行分析。观察指标为股骨和胫骨组件的旋转位置、异常值频率和组内相关系数。
CCB组与CCI组的股骨组件平均旋转角度无差异：分别为0.9°±0.8°和1.1°±1.1°（P = 0.29）。两组的异常值频率相似：分别为2%（CCB组）和2%（CCI组）（P = 0.74）。与CCI组相比，CCB组的胫骨组件平均偏差近1°（P < 0.001）：（1）背侧切线参考（DTR）：0.7°±0.8°和1.5°±1.0°，以及（2）胫骨髁上参考（TTR）：0.5°±0.9°和1.4°±1.1°。异常值频率相似：（1）DTR：CCB组为0%，CCI组为5%（P = 0.24），以及（2）TTR：CCB组为5%，CCI组为12%（P = 0.20）。基于胫骨结节的测量显示，与CCI组相比，CCB组的胫骨组件平均偏差小约1.4°：分别为0.3°±1.4°和1.7°±1.6°（P < 0.001），相应的异常值频率更低：分别为0%和19%（P = 0.002）。然而，观察者内的可重复性较差（0.61）。
与CCI相比，CCB并未改善股骨组件的旋转对线，也未影响异常值频率，但它略微提高了胫骨旋转对线的准确性。胫骨结节参考点的观察者内可重复性较差。
