Dorr L D, Boiardo R A
Clin Orthop Relat Res. 1986 Apr(205):5-11.
Results with total knee arthroplasty as published in this issue show few mechanical failures in knees correctly aligned. If the principles of technique are respected, the narrow limits for margin of error can be met. To provide optimal results, the following measures are recommended. The tibia should be cut no more than 5 mm from the medial subchondral bone, if the posterior cruciate ligament is sacrificed, and between 5 mm and 8 mm, if the posterior cruciate is saved. Fill a defect as necessary with bone graft. The tibia should be cut 90 degrees to its axis in the medial-lateral plane and with 5 degrees posterior tilt. Maintain the anterior-posterior height of the femur to ensure flexion stability. Use the distal femur as the "adjustment cut" even if the joint line is elevated. If the posterior cruciate ligament tension is tight, lengthen the ligament or convert to a sacrificing design. Deformity should be corrected with soft tissue release and not angular bone cuts. The patella cut should be performed so that the result is a symmetrical patella that is not increased from its anatomic height. If these principles are followed, the instrumentation use and order of osteotomy of the distal femur or tibia do not matter.
本期发表的全膝关节置换术结果显示，正确对线的膝关节机械故障很少。如果遵循技术原则，就可以达到误差范围的狭窄界限。为了获得最佳结果，建议采取以下措施。如果牺牲后交叉韧带，胫骨截骨应距内侧软骨下骨不超过5毫米；如果保留后交叉韧带，则截骨距离在5毫米至8毫米之间。必要时用骨移植填充缺损。胫骨应在内外侧平面与胫骨轴呈90度截骨，并向后倾斜5度。保持股骨的前后高度以确保屈曲稳定性。即使关节线升高，也应使用股骨远端进行“调整截骨”。如果后交叉韧带张力过紧，可延长韧带或改为牺牲性设计。畸形应通过软组织松解矫正，而不是进行角向截骨。髌骨截骨应使结果为对称的髌骨，且不超过其解剖高度。如果遵循这些原则，股骨远端或胫骨截骨时器械的使用和顺序并不重要。
