Sohmiya Kazuki, Ogawa Hiroyasu, Nakamura Yutaka, Sengoku Masaya, Shimokawa Tetsuya, Ohnishi Kazuichiro, Akiyama Haruhiko
Department of Orthopaedic Surgery, Ogaki Tokushukai Hospital, Hayashi-machi 6-85-1, Ogaki, Gifu, 503-0015, Japan.
Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Yanagido 1-1, Gifu, 501-1194, Japan.
Knee Surg Sports Traumatol Arthrosc. 2023 Mar;31(3):963-968. doi: 10.1007/s00167-022-07107-y. Epub 2022 Aug 15.
This study aimed to retrospectively investigate (1) the reproducibility of gap measurements by manual stress using the Z-shaped retractor depending on the surgeon's experience with this maneuver and (2) the consistency of the gap distraction force produced by manual stress throughout the range of motion (ROM) in the robotic-assisted total knee arthroplasty (TKA). It was hypothesized that the joint gap produced by manual stress is not reproducible depending on the surgeon's experience, and the distraction force applied by manual stress throughout the ROM is not constant.
Medial and lateral joint gaps were obtained throughout the ROM by manual stress or a tensioner by two surgeons with different levels of experience in robotic-assisted TKA. The association between the differences in gap measurement by the two surgeons and the preoperative radiographic parameters, including the hip-knee-ankle (HKA) angle and absolute and relative varus/valgus laxities were analyzed.
The experienced surgeon produced significantly greater gaps than the inexperienced surgeon from 0° to 100° flexion, with a mean difference of 0.35 ± 0.12 mm in the medial gap (p < 0.0001), and from 10° to 120° flexion with a mean difference of 0.57 ± 0.13 mm in the lateral gap (p < 0.0001). The tensioner produced a significantly greater medial gap from 70° to 110° flexion with a mean difference of 0.32 ± 0.01 mm in the medial gap (p < 0.0001) and from 0° to 110° flexion with a mean difference of 1.12 ± 0.26 mm in the lateral gap (p < 0.0001). The differences in gap distance by manual stress between experienced and inexperienced surgeons were moderately correlated with the HKA angle in the lateral gap (r = 0.40, p = 0.01). The gap differences due to manual stress and a tensioner showed moderate negative correlation with the HKA angle in the medial gap (r = - 0.50, p = 0.001) and weak negative correlation with the absolute valgus laxity in the lateral gap (r = - 0.35, p = 0.03).
The joint distraction force by manual stress may differ depending on the surgeon's experience and tended to be smaller in deep flexion; therefore, the flexion gap may be underestimated. Surgeons should determine implant positioning considering gap balance by manual stress, taking into account these characteristics of the manual stress maneuver.
Level III, retrospective cohort study.
本研究旨在回顾性调查（1）使用Z形牵开器通过手动加压测量间隙的可重复性，该可重复性取决于外科医生进行此操作的经验，以及（2）在机器人辅助全膝关节置换术（TKA）中，手动加压在整个运动范围（ROM）内产生的间隙牵张力的一致性。研究假设是，手动加压产生的关节间隙根据外科医生的经验不可重复，并且在整个ROM内手动加压施加的牵张力并非恒定。
在机器人辅助TKA中，由两名经验水平不同的外科医生通过手动加压或张力器在整个ROM内获取内侧和外侧关节间隙。分析了两名外科医生在间隙测量上的差异与术前影像学参数之间的关联，这些参数包括髋-膝-踝（HKA）角以及绝对和相对内翻/外翻松弛度。
经验丰富的外科医生在0°至100°屈曲范围内产生的间隙明显大于经验不足的外科医生，内侧间隙平均差异为0.35±0.12毫米（p<0.0001），在10°至120°屈曲范围内，外侧间隙平均差异为0.57±0.13毫米（p<0.0001）。张力器在70°至110°屈曲范围内产生的内侧间隙明显更大，内侧间隙平均差异为0.32±0.01毫米（p<0.0001），在0°至110°屈曲范围内，外侧间隙平均差异为1.12±0.26毫米（p<0.0001）。经验丰富和经验不足的外科医生通过手动加压测量的间隙距离差异与外侧间隙的HKA角呈中度相关（r = 0.40，p = 0.01）。手动加压和张力器导致的间隙差异与内侧间隙的HKA角呈中度负相关（r = -0.50，p = 0.001），与外侧间隙的绝对外翻松弛度呈弱负相关（r = -0.35，p = 0.03）。
手动加压产生的关节牵张力可能因外科医生的经验而异，并且在深度屈曲时往往较小；因此，屈曲间隙可能被低估。外科医生在考虑通过手动加压实现间隙平衡来确定植入物位置时，应考虑手动加压操作的这些特点。
III级，回顾性队列研究。
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