股骨和胫骨的关节外因素对机械对线全膝关节置换术后膝关节平衡的影响。
Extra-articular factors of the femur and tibia affecting knee balance in mechanically aligned total knee arthroplasty.
机构信息
Department of Orthopaedic Surgery, Ogaki-Tokushukai Hospital, Hayashi-machi 6-85-1, 503-0015 Ogaki, Gifu, Japan; Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Yanagido 1-1, 501-1194 Gifu, Japan.
Department of Orthopaedic Surgery, Ogaki-Tokushukai Hospital, Hayashi-machi 6-85-1, 503-0015 Ogaki, Gifu, Japan.
出版信息
Orthop Traumatol Surg Res. 2022 Dec;108(8):103297. doi: 10.1016/j.otsr.2022.103297. Epub 2022 May 1.
PURPOSE
Although the joint gap distance and compartment loading of the knee are different parameters for obtaining balanced knees in patients with total knee arthroplasty (TKA), the extent to which a balanced knee is achieved in patients with mechanically aligned TKA (MA-TKA) is unclear. This study aimed to investigate the anatomical factors that affect the ligament balancing in MA-TKA according to a gap balancing technique by measured resection technique.
METHODS
The relationship between compartment loading, gap distance, and lower limb alignment was analysed in forty-three patients who underwent navigation-assisted MA-TKA with the minimum soft-tissue release. Radiographic parameters included hip-knee-ankle (HKA) angle, femorotibial angle, mechanical lateral distal femoral angle (mLDFA), medial proximal tibial angle, posterior tibial slope, varus and valgus joint line convergence angle, femoral valgus angle, femoral shaft curve, and tibial shaft curve (TSC).
RESULTS
The postoperative HKA angle was 0.4±1.5°, with one coronal alignment outlier (2.3%). The gap distance showed four unbalanced knees for extension (9.3%) and flexion (9.3%), whereas the compartment loading identified 17 unbalanced knees (39.5%) at extension, 8 (18.6%) at 45° flexion, 7 (16.2%) at 90° flexion, and 10 (23.2%) at full flexion in MA-TKA. Mediolateral differentials of compartment loading correlated with femoral valgus angle (0°, 45°, and 90° flexion), mLDFA (45° and 90° flexion), and TSC (45° and 90° flexion). Femoral valgus angle and TSC were risk factors of the mediolateral differentials of compartment loading.
CONCLUSION
Extra-articular factors of femoral valgus angle, mLDFA, and TSC were associated with the mediolateral imbalance of compartmental loading, suggesting there is a limit to obtaining balanced knees in MA-TKA due to these unadjustable extra-articular factors.
LEVEL OF EVIDENCE
IV, therapeutic case series.
目的
尽管膝关节间隙距离和关节腔压力是全膝关节置换术（TKA）中获得平衡膝关节的不同参数，但机械对线 TKA（MA-TKA）患者达到平衡膝关节的程度尚不清楚。本研究旨在通过测量截骨技术研究间隙平衡技术中影响 MA-TKA 韧带平衡的解剖学因素。
方法
分析 43 例接受导航辅助 MA-TKA 治疗且软组织松解最少的患者的关节腔压力、间隙距离与下肢对线之间的关系。影像学参数包括髋膝踝角（HKA）、股胫角、机械性外侧远端股骨角（mLDFA）、胫骨近端内侧角、胫骨后倾角、内翻和外翻关节线会聚角、股骨外翻角、股骨干曲线和胫骨骨干曲线（TSC）。
结果
术后 HKA 角为 0.4±1.5°，有 1 例冠状面对线偏差（2.3%）。间隙距离显示 4 例伸直位（9.3%）和 4 例屈膝位（9.3%）存在不平衡，而关节腔压力在伸展位识别出 17 例（39.5%）、45°屈膝位 8 例（18.6%）、90°屈膝位 7 例（16.2%）和全屈膝位 10 例（23.2%）存在不平衡。关节腔压力的内外侧差异与股骨外翻角（0°、45°和 90°屈曲位）、mLDFA（45°和 90°屈曲位）和 TSC（45°和 90°屈曲位）相关。股骨外翻角和 TSC 是关节腔压力内外侧差异的危险因素。
结论
股骨外翻角、mLDFA 和 TSC 的关节外因素与关节腔压力的内外侧失衡相关，这表明由于这些不可调节的关节外因素，MA-TKA 获得平衡膝关节存在局限性。
证据等级
IV，治疗性病例系列研究。
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