Liu Kaiyuan, Liao Yuxin, Yang Dong, Xu Tianyang, Gao Qiuming, Jiang Wenwei, Fan Lin, Zan Pengfei, Li Guodong
Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
Department of Orthopedics, Shanghai First People's Hospital, Jiaotong University School of Medicine, Shanghai, China.
Front Surg. 2022 Feb 4;9:692072. doi: 10.3389/fsurg.2022.692072. eCollection 2022.
We hypothesized that subluxating patellar during minimally invasive total knee arthroplasty (MIS-TKA) would affect intraoperative soft tissue balance and postoperative clinical outcome.
From December 2018 to May 2020, 189 patients receiving primary MIS-TKA were enrolled. The gap-balance technique was used, with patients randomly assigned to undergo osteotomy and balance of soft tissue with patella reduced (group A; = 93) or subluxated (group B; = 96). The gap and varus?valgus angle were compared between groups in both extension and flexion position. The gap and varus?valgus angle were also compared before and after reducing patellar in group B. Femoral prosthesis rotation, mechanical femoral axis-to-tibial axis angle, Knee Society Score (KSS), visual analog scale (VAS), and range of motion (ROM) were compared postoperatively between two groups. Follow-up was 12 months.
The flexion gap and the varus angle were significantly greater (0.4 mm and 0.7 degree) after patella reduction than before reduction, but the extension joint gap and varus angle were comparable before and after patella reduction. The femoral prosthesis tended to be internally rotated (0.65 degree) in group B. ROM and VAS was better in the group A than in group B at 1 month after surgery, but the differences were not significant at 3, 6 and 12 months. KSS was comparable between the groups after surgery.
During MIS-TKA, as far as possible, soft tissue balance should be achieved with the patella reduced; otherwise, the femoral prosthesis may be installed more internally and, after patella reduction, the flexion gap and varus angle would increase.
Current Controlled Trials ChiCTR2000034106, https://www.chictr.org.cn/hvshowproject.aspx?id=39987.
我们假设在微创全膝关节置换术（MIS-TKA）过程中髌骨半脱位会影响术中软组织平衡及术后临床疗效。
2018年12月至2020年5月，纳入189例行初次MIS-TKA的患者。采用间隙平衡技术，患者随机分为两组，一组在髌骨复位状态下进行截骨和软组织平衡（A组，n = 93），另一组在髌骨半脱位状态下进行（B组，n = 96）。比较两组在伸直和屈曲位时的间隙及内外翻角度。同时比较B组髌骨复位前后的间隙及内外翻角度。术后比较两组的股骨假体旋转、机械股骨轴线与胫骨轴线夹角、膝关节协会评分（KSS）、视觉模拟评分（VAS）及活动度（ROM）。随访12个月。
髌骨复位后，屈曲间隙和内翻角度比复位前显著增大（分别为0.4 mm和0.7°），但伸直关节间隙和内翻角度在髌骨复位前后相当。B组股骨假体有内旋趋势（0.65°）。术后1个月时A组的ROM和VAS优于B组，但在3、6和12个月时差异无统计学意义。术后两组的KSS相当。
在MIS-TKA过程中，应尽可能在髌骨复位状态下实现软组织平衡；否则，股骨假体可能安装得更偏内，髌骨复位后，屈曲间隙和内翻角度会增大。
中国临床试验注册中心ChiCTR2000034106，https://www.chictr.org.cn/hvshowproject.aspx?id=39987 。
