Department of Joint Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China.
Orthop Surg. 2023 Jan;15(1):93-102. doi: 10.1111/os.13525. Epub 2022 Nov 15.
Although many studies have compared the measured resection (MR) technique to the gap balancing (GB) technique, few studies have investigated the hybrid technique. In this study, we compared imaging and clinical outcomes of the MR, GB, and hybrid techniques in primary total knee arthroplasty (TKA).
From January 2016 to January 2019, we conducted a retrospective study on 90 patients who underwent unilateral primary TKA; 30 received the MR technique, 30 received the GB technique, and 30 received the hybrid technique. Radiological outcomes, including joint line level, mechanical alignment of the lower limb, positions of the femoral and tibial components, and rotation of the femoral component, and clinical outcomes, including the visual analog scale score for pain, the Knee Society Score, and the range of motion, were assessed among the three groups. One-way analysis of variance and Dunnett's test were performed for normally distributed data. Kruskal-Wallis H test and Dunn-Bonferroni test were conducted for non-normally distributed data.
No significant difference in the mechanical alignment (p = 0.151) and the positions of the tibial and femoral components (p = 0.230 for α angle, p = 0.517 for β angle, p = 0.686 for femoral flexion angle, and p = 0.918 for tibial slope angle) was found among the three groups. No significant difference in the elevation of the joint line between the MR and the hybrid groups was found (2.1 ± 0.3 mm vs 2.1 ± 0.1 mm, p = 0.627), but the GB group (2.8 ± 0.2 mm) differed significantly from the other two groups (p < 0.001). Although rotation of the femoral component in the GB group was larger than that of the MR and hybrid groups, the difference was not significant (1.8° ± 0.2° vs 1.7° ± 0.3° vs. 1.7° ± 0.2°, p = 0.101). The clinical outcomes were not significantly different (p > 0.05), although the results in the hybrid group were slightly higher.
The hybrid technique helped to restore the mechanical alignment of the lower limb and realize optimal positions of the femoral and tibial components without significant differences relative to the MR and GB techniques. The hybrid technique was more helpful for maintaining the original height of the joint line, which was similar to the MR technique. Additionally, although the improvement in the clinical outcomes in the hybrid group was slightly higher, it was not significantly different among the three groups.
尽管许多研究已经比较了测量截骨（MR）技术和间隙平衡（GB）技术，但很少有研究调查混合技术。本研究比较了原发性全膝关节置换术（TKA）中 MR、GB 和混合技术的影像学和临床结果。
本研究为回顾性研究，自 2016 年 1 月至 2019 年 1 月，共纳入 90 例接受单侧原发性 TKA 的患者，30 例接受 MR 技术，30 例接受 GB 技术，30 例接受混合技术。评估三组患者的影像学结果，包括关节线水平、下肢机械对线、股骨和胫骨组件的位置以及股骨组件的旋转，以及临床结果，包括疼痛视觉模拟评分、膝关节协会评分和运动范围。正态分布数据采用单因素方差分析和 Dunnett 检验，非正态分布数据采用 Kruskal-Wallis H 检验和 Dunn-Bonferroni 检验。
三组患者的机械对线（p=0.151）和胫骨及股骨组件位置（α角 p=0.230，β角 p=0.517，股骨屈曲角 p=0.686，胫骨倾斜角 p=0.918）无显著差异。MR 组和混合组关节线抬高无显著差异（2.1±0.3mm 比 2.1±0.1mm，p=0.627），但 GB 组（2.8±0.2mm）与其他两组有显著差异（p<0.001）。GB 组股骨组件旋转大于 MR 组和混合组，但差异无统计学意义（1.8°±0.2°比 1.7°±0.3°比 1.7°±0.2°，p=0.101）。临床结果无显著差异（p>0.05），但混合组结果略高。
混合技术有助于恢复下肢机械对线，实现股骨和胫骨组件的最佳位置，与 MR 和 GB 技术相比无显著差异。混合技术更有助于维持关节线的原始高度，与 MR 技术相似。此外，混合组临床结果的改善略高，但三组间无显著差异。
