Department of Physical Medicine and Orthopaedic Surgery, Department of Electrical Energy, Metal, Mechanical Construction and Systems, Ghent University, Ghent, Belgium.
Department of Physical Medicine and Orthopaedic Surgery, Ghent University, Ghent, Belgium.
Bone Joint J. 2020 Oct;102-B(10):1324-1330. doi: 10.1302/0301-620X.102B10.BJJ-2019-1602.R2.
Inadvertent soft tissue damage caused by the oscillating saw during total knee arthroplasty (TKA) occurs when the sawblade passes beyond the bony boundaries into the soft tissue. The primary objective of this study is to assess the risk of inadvertent soft tissue damage during jig-based TKA by evaluating the excursion of the oscillating saw past the bony boundaries. The second objective is the investigation of the relation between this excursion and the surgeon's experience level.
A conventional jig-based TKA procedure with medial parapatellar approach was performed on 12 cadaveric knees by three experienced surgeons and three residents. During the proximal tibial resection, the motion of the oscillating saw with respect to the tibia was recorded. The distance of the outer point of this cutting portion to the edge of the bone was defined as the excursion of the oscillating saw. The excursion of the sawblade was evaluated in six zones containing the following structures: medial collateral ligament (MCL), posteromedial corner (PMC), iliotibial band (ITB), lateral collateral ligament (LCL), popliteus tendon (PopT), and neurovascular bundle (NVB).
The mean 75 percentile value of the excursion of all cases was mean 2.8 mm (SD 2.9) for the MCL zone, mean 4.8 mm (SD 5.9) for the PMC zone, mean 3.4 mm (SD 2.0) for the ITB zone, mean 6.3 mm (SD 4.8) for the LCL zone, mean 4.9 mm (SD 5.7) for the PopT zone, and mean 6.1 mm (SD 3.9) for the NVB zone. Experienced surgeons had a significantly lower excursion than residents.
This study showed that the oscillating saw significantly passes the edge of the bone during the tibial resection in TKA, even in experienced hands. While reported neurovascular complications in TKA are rare, direct injury to the capsule and stabilizing structures around the knee is a consequence of the use of a hand-held oscillating saw when making the tibial cut. Cite this article: 2020;102-B(10):1324-1330.
在全膝关节置换术（TKA）中，当摆动锯片超出骨边界进入软组织时，会导致软组织的意外损伤。本研究的主要目的是通过评估摆动锯片超出骨边界的偏移量来评估基于导向器的 TKA 过程中软组织意外损伤的风险。第二个目的是研究这种偏移量与外科医生经验水平之间的关系。
对 12 具尸体膝关节进行了常规基于导向器的髌旁内侧入路 TKA 手术，由 3 名经验丰富的外科医生和 3 名住院医生完成。在胫骨近端截骨过程中，记录摆动锯相对于胫骨的运动。将该切割部分的外点到骨边缘的距离定义为摆动锯的偏移量。评估了锯片在包含以下结构的六个区域中的偏移量：内侧副韧带（MCL）、后内侧角（PMC）、髂胫束（ITB）、外侧副韧带（LCL）、腘肌腱（PopT）和神经血管束（NVB）。
所有病例的平均 75 百分位数偏移量值分别为：MCL 区的平均 2.8mm（SD 2.9），PMC 区的平均 4.8mm（SD 5.9），ITB 区的平均 3.4mm（SD 2.0），LCL 区的平均 6.3mm（SD 4.8），PopT 区的平均 4.9mm（SD 5.7），NVB 区的平均 6.1mm（SD 3.9）。经验丰富的外科医生的偏移量明显低于住院医生。
本研究表明，即使在经验丰富的手中，摆动锯在 TKA 胫骨截骨过程中也会明显超出骨边缘。虽然 TKA 中报道的神经血管并发症很少，但当使用手持摆动锯进行胫骨切割时，直接损伤膝关节周围的囊和稳定结构是不可避免的。
[doi:10.1016/j.arth.2020.03.004] 2020;102-B(10):1324-1330.
