Kamei Goki, Ishibashi Shigeki, Yoshioka Koki, Sakurai Satoru, Inoue Hiroyuki, Ishikawa Masakazu, Mochizuki Yu, Adachi Nobuo
Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, Japan.
Department of Orthopaedic Surgery, Hiroshima Prefectural Hospital, 1-5-54, Ujinakanda, Minami-ku, Hiroshima, Japan.
Arthroplasty. 2021 Apr 5;3(1):17. doi: 10.1186/s42836-021-00072-w.
In total knee arthroplasty (TKA) using the modified gap technique, the soft-tissue balance is measured after osteotomy of the distal femur and proximal tibia (conventional bone gap). However, after osteotomy, the flexion gap size during 90° knee flexion may be larger than that observed after implantation. The tension of the lateral compartment during 90° flexion may also be reduced after osteotomy of the distal femur. We manufactured a distal femoral trial component to reproduce the condition after implantation and prior to posterior condyle osteotomy. This study aimed to evaluate the effect of the trial component on the flexion gap.
This prospective study included 21 consecutive patients aged 78 years with medial osteoarthritis who underwent cruciate-retaining TKA between February 2017 and March 2018. The postoperative flexion gap size and inclination during 90° flexion were compared between cases with and without the trial component.
The mean joint gap size with the trial component (13.4 ± 0.80 mm) was significantly smaller than that without the trial component (14.7 ± 0.84 mm). The mean gap inclination angle with the trial component (3.7° ± 0.62°) was significantly smaller than that without the trial component (5.5° ± 0.78°).
In the present study, the joint gap size and medial tension were significantly reduced after the trial component had been set. Accurate measurement of the soft-tissue balance is an important factor in the modified gap technique, and this method using a distal femoral trial component can offer better outcomes than those achieved with conventional methods.
在采用改良间隙技术的全膝关节置换术（TKA）中，在股骨远端和胫骨近端截骨后（传统骨间隙）测量软组织平衡。然而，截骨后，膝关节90°屈曲时的屈曲间隙大小可能大于植入后观察到的大小。股骨远端截骨后，90°屈曲时外侧间室的张力也可能降低。我们制造了一种股骨远端试验部件，以重现植入后和后髁截骨前的情况。本研究旨在评估试验部件对屈曲间隙的影响。
这项前瞻性研究纳入了2017年2月至2018年3月期间连续21例年龄78岁的内侧骨关节炎患者，他们接受了保留交叉韧带的TKA。比较了使用和未使用试验部件的病例术后90°屈曲时的屈曲间隙大小和倾斜度。
使用试验部件时的平均关节间隙大小（13.4±0.80mm）显著小于未使用试验部件时的大小（14.7±0.84mm）。使用试验部件时的平均间隙倾斜角度（3.7°±0.62°）显著小于未使用试验部件时的角度（5.5°±0.78°）。
在本研究中，设置试验部件后关节间隙大小和内侧张力显著降低。准确测量软组织平衡是改良间隙技术中的一个重要因素，这种使用股骨远端试验部件的方法比传统方法能提供更好的结果。
