改良的初次限制型全膝关节置换术手术方法，可使用股骨干直型延长柄。
Improved surgical procedure of primary constrained total knee arthroplasty which enables use of the femoral diaphyseal straight extension stem.
机构信息
Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
Department of Orthopaedic Surgery, Hamanomachi Hospital, 3-3-1 Nagahama, Chuo-ku, Fukuoka, 810-8539, Japan.
出版信息
BMC Musculoskelet Disord. 2022 May 2;23(1):408. doi: 10.1186/s12891-022-05367-w.
BACKGROUND
In performing primary constrained total knee arthroplasties (TKA) to imbalanced knees, the offset stem is sometimes compelled to use, although this is associated with surgical difficulties. We developed a modified procedure which might be able to fit the anteroposterior (AP) and mediolateral (ML) position of the femoral component simultaneously with the straight stem. Purposes of this study were to evaluate usefulness of the modified procedure both in computer simulations and actual surgeries.
METHODS
We included 32 knees that had undergone primary TKA using constrained implants because of the coronal imbalance. In the component-first procedure, the distal femur was prepared to fit the AP and ML position of the femoral component simultaneously at first, as in primary TKA. Finally, the stem hole is created based on the femoral component position (the component-first procedure). The femoral component and extension stem were simulated using the three-dimensional planning software (ZedKnee) following the component-first procedure. We investigated the suitability of the straight stem through computer simulation and evaluation of actual surgeries. Clinical and radiographical outcomes were also evaluated at the latest follow-up.
RESULTS
The component-first procedure enabled the AP and ML position of the femoral component to be fitted simultaneously with the straight stem in simulations and actual surgeries in all cases. The stem diameter was not significantly different between simulations and actual surgeries (13.9 and 13.7 mm on average, respectively, p = 0.479) and almost similar from intraclass correlation coefficient analysis (kappa value 0.790). Clinical and radiographical outcomes were almost similar to primary TKA cases and there was no case of component loosening, cortical bone hypertrophy around the stem and stem-tip pain.
CONCLUSIONS
Our improved surgical procedure may facilitate use of the constrained implant for more cases of primary TKA in imbalanced knees without the usual surgical difficulties.
TRIAL REGISTRATION
Retrospectively registered.
背景
在为不平衡的膝关节进行初次约束性全膝关节置换术（TKA）时，有时会被迫使用偏心距柄，尽管这与手术难度相关。我们开发了一种改良的手术方法，该方法可能能够同时用直柄使股骨部件的前后（AP）和内外（ML）位置相匹配。本研究的目的是评估改良手术在计算机模拟和实际手术中的有效性。
方法
我们纳入了 32 例因冠状面失衡而接受约束性植入物初次 TKA 的膝关节。在初次组件法中，首先准备股骨远端以同时适应股骨组件的 AP 和 ML 位置，与初次 TKA 相同。最后，根据股骨组件位置（初次组件法）创建柄孔。使用三维规划软件（ZedKnee）对股骨组件和延伸柄进行模拟，遵循初次组件法。我们通过计算机模拟和实际手术评估来研究直柄的适用性。并在最新随访时评估临床和影像学结果。
结果
初次组件法在所有情况下均能使直柄在模拟和实际手术中同时适应股骨组件的 AP 和 ML 位置。在模拟和实际手术中，柄直径无显著差异（分别平均为 13.9 和 13.7mm，p=0.479），且内类相关系数分析（kappa 值为 0.790）几乎相似。临床和影像学结果与初次 TKA 几乎相似，无组件松动、柄周围皮质骨增生和柄尖痛病例。
结论
我们的改良手术方法可能有助于在不平衡的膝关节中为更多初次 TKA 病例使用约束性植入物，而不会遇到通常的手术困难。
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