Wang Z W, Wen L, Yu Y, Ma D S, Zhou L, Zhang B, Ren S X, Lin Y, Pan J, Qu T B
Department of Orthopaedic Surgery, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing 100020, China.
Center of Diagnosis and Treatment for Joint Disease, Beijing Charity Hospital, Capital Medical University, Beijing 100068, China.
Zhonghua Wai Ke Za Zhi. 2020 Jun 1;58(6):457-463. doi: 10.3760/cma.j.cn112139-20200103-00007.
To examine the clinical effects of the treatment of knee osteoarthritis patients with kinematic alignment technique of total knee replacement (KA-TKA) assisted by patient-specific instrumentation (PSI). The clinical data of 14 patients with knee osteoarthritis treated with unilateral KA-TKA assisted by PSI at Department of Orthopaedic Surgery, Beijing Chaoyang Hospital Affiliated to Capital Medical University from May 2018 to August 2019 were analyzed retrospectively. There were 6 males and 8 females, aged 66.6 years (range: 56 to 79 years), 9 left knees and 5 right knees. The operation time, soft tissue release and extra varus or valgus osteotomy were recorded. The data of osteotomy blocks were measured and compared with the corresponding position of the prostheses. The hip knee ankle angle (HKA), the mechanical distal femoral lateral angle (mLDFA) and the proximal tibial medial angle (MPTA) were measured before and 3 months after the operation. The knee joint functional score (KS-F) , knee joint clinical score (KS-C) and the Western Ontario McMaster (WOMAC) Osteoarthritis Index were recorded and compared by paired test or Wilcoxon non-parametric test. The operation time was (81.8±16.9) minutes (range: 60 to 115 minutes), 2 cases were manually increased varus osteotomy by 2 mm and 1 patient received lateral retinaculum release. There was no extra medial or lateral soft tissue release. Intraoperative measurement of the resection showed that the femoral side mismatch was within 2 mm. The medial and lateral condyle, the medial and lateral posterior condyles were relatively overcut by 0.50 mm, 0.21 mm, 0.93 mm, and 0.71 mm, respectively. The tibial side mismatch was within 1.5 mm, the medial and lateral plateau were relatively undercut by 0.43 mm and 0.32 mm. HKA was corrected from (8.8±5.6) ° to (1.6±4.3) ° (20.723, 0.000) .KS-C improved from 28.21±13.47 preoperative to 78.07±8.01 postoperative (-16.570, 0.000); KS-F improved from 41.00±15.25 preoperative to 84.93±10.85 postoperative (-14.675, 0.000).WOMAC Osteoarthritis Index decreased from 53.5 (25.75) ((())) preoperative to 5.5 (5.25) postoperative (-3.297, 0.001) .No statistically significant difference was found in mLDFA and MPTA before and after surgery. No significant patellofemoral complication was recorded during follow-up time. PSI assisted TKA resection has high accuracy. KA-TKA aims to restore the native anatomy of the knee joint, only corrects the malalignment of lower extremities caused by articular cartilage wear, with less interference to soft tissues, easy to obtain satisfactory knee joint laxity and has a promising early clinical effect.
探讨患者特异性器械(PSI)辅助下全膝关节置换运动学对线技术(KA-TKA)治疗膝关节骨关节炎患者的临床效果。回顾性分析2018年5月至2019年8月在首都医科大学附属北京朝阳医院骨科接受单侧PSI辅助KA-TKA治疗的14例膝关节骨关节炎患者的临床资料。其中男性6例,女性8例,年龄66.6岁(范围:56至79岁),左膝9例,右膝5例。记录手术时间、软组织松解及额外的内翻或外翻截骨情况。测量截骨块数据并与假体相应位置进行比较。于术前及术后3个月测量髋膝踝角(HKA)、机械性股骨远端外侧角(mLDFA)及胫骨近端内侧角(MPTA)。记录膝关节功能评分(KS-F)、膝关节临床评分(KS-C)及西安大略和麦克马斯特大学(WOMAC)骨关节炎指数,并采用配对检验或Wilcoxon非参数检验进行比较。手术时间为(81.8±16.9)分钟(范围:60至115分钟),2例手动增加内翻截骨2 mm,1例患者行外侧支持带松解。无额外的内侧或外侧软组织松解。术中测量截骨显示股骨侧不匹配在2 mm以内。内侧髁、外侧髁、内侧后髁及外侧后髁分别相对多截骨0.50 mm、0.21 mm、0.93 mm及0.71 mm。胫骨侧不匹配在1.5 mm以内,内侧平台及外侧平台分别相对少截骨0.43 mm及0.32 mm。HKA从(8.8±5.6)°矫正至(1.6±4.3)°(t = 20.723,P = 0.000)。KS-C从术前的28.21±13.47提高至术后的78.07±8.01(t = -16.570,P = 0.000);KS-F从术前的41.00±15.25提高至术后的84.93±10.85(t = -14.675,P = 0.000)。WOMAC骨关节炎指数从术前的53.5(25.75)降至术后的5.5(5.25)(Z = -3.297,P = 0.001)。术前及术后mLDFA和MPTA差异无统计学意义。随访期间未记录到明显的髌股并发症。PSI辅助TKA截骨准确性高。KA-TKA旨在恢复膝关节的自然解剖结构,仅纠正关节软骨磨损导致的下肢力线不良,对软组织干扰小,易于获得满意的膝关节松弛度,早期临床效果良好。