Department of Surgery, CIUSSS-de-L'Est-de-L'Ile-de-Montréal, Université de Montréal, Hôpital Maisonneuve Rosemont, 5415 Boulevard de l'Assomption, Montréal, QC, H1T 2M4, Canada.
Department of Surgery, Albany Health Campus, Albany, Australia.
Knee Surg Sports Traumatol Arthrosc. 2020 May;28(5):1532-1541. doi: 10.1007/s00167-019-05562-8. Epub 2019 Jun 14.
The objective of this study was to calculate bone resection thicknesses and resulting gap sizes, simulating a measured resection mechanical alignment (MA) technique for total knee arthroplasty (TKA).
MA bone resections were simulated on 1000 consecutive lower limb CT scans from patients undergoing TKA. Femoral rotation was aligned with either the surgical trans-epicondylar axis (TEA) or with 3° of external rotation to the posterior condyles (PC). Imbalances in the extension space, flexion space, medial compartment and lateral compartment were calculated.
Extension space imbalances (≥ 3 mm) occurred in 25% of varus and 54% of valgus knees and severe imbalances (≥ 5 mm) were present in up to 8% of varus and 19% of valgus knees. Higher flexion space imbalance rates were created with TEA versus PC (p < 0.001). Using TEA, only 49% of varus and 18% of valgus knees had < 3 mm of imbalance throughout the extension and flexion spaces, and medial and lateral compartments.
A systematic use of the simulated measured resection MA technique for TKA leads to many cases with imbalance. Some imbalances may not be correctable surgically and may result in TKA instability. Modified versions of the MA technique or other alignment methods that better reproduce knee anatomies should be explored.
本研究旨在计算截骨厚度和由此产生的间隙大小，模拟测量截骨机械对线（MA）技术在全膝关节置换术（TKA）中的应用。
对 1000 例接受 TKA 的患者的下肢 CT 扫描进行 MA 截骨模拟。股骨旋转与手术髁间轴（TEA）或后髁 3°外旋对齐。计算伸展间隙、屈曲间隙、内侧间室和外侧间室的不平衡。
25%的内翻膝和 54%的外翻膝存在伸展间隙不平衡（≥3mm），高达 8%的内翻膝和 19%的外翻膝存在严重的不平衡（≥5mm）。与 PC 相比，TEA 产生更高的屈曲间隙不平衡率（p<0.001）。使用 TEA，只有 49%的内翻膝和 18%的外翻膝在伸展和屈曲间隙以及内侧和外侧间室中存在<3mm 的不平衡。
系统使用模拟测量截骨 MA 技术进行 TKA 会导致许多不平衡的情况。一些不平衡可能无法通过手术纠正，可能导致 TKA 不稳定。应探索 MA 技术的修改版本或其他更好地模拟膝关节解剖结构的对线方法。
2 级
