不同运动学和功能性对线技术中股骨关节线重建的可比准确性。
Comparable accuracy of femoral joint line reconstruction in different kinematic and functional alignment techniques.
机构信息
Department of Orthopaedic Surgery, Hannover Medical School, Diakovere Annastift, Anna Von Borries Str. 1-6, 30625, Hannover, Germany.
Department of Orthopaedic and Trauma Surgery, Pius Hospital, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany.
出版信息
Knee Surg Sports Traumatol Arthrosc. 2023 Sep;31(9):3871-3879. doi: 10.1007/s00167-023-07360-9. Epub 2023 Mar 14.
PURPOSE
A key part of kinematic alignment (KA) and functional alignment (FA) is to restore the natural femoral joint line, in particular the medial joint line. KA is known to reproduce the femoral joint line accurately; however, direct comparisons with other surgical techniques such as FA are currently lacking. The purpose of this study was to evaluate differences of alignment parameters in KA and FA techniques with a special focus given to the femoral joint line.
METHODS
We performed a retrospective radiological analysis of pre- and postoperative long leg radiographs of 221 consecutive patients with varus or neutral leg alignment, who underwent primary total knee arthroplasty (TKA) procedures from 2018 to 2020. Patients were assigned to one of four groups: (1) FA: image-based robotic-assisted TKA, (2) FA: imageless robotic-assisted TKA, (3): restricted KA: 3D cutting block-assisted (patient-specific instruments, PSI) TKA, (4): unrestricted KA: calipered technique. Patients' radiographs were (re)-analyzed for overall limb alignment, medial proximal tibial angle (MPTA), lateral distal femoral angle (LDFA), as well as medial and lateral femoral joint line alteration. Statistical significance was determined using unpaired t testing (FA vs. KA group) and one-way ANOVA (subgroup analyses).
RESULTS
Comparisons of KA vs. FA, as well as individual subgroups of KA and FA did not show any differences in the accuracy of medial joint line reconstruction (< 2 mm, p = 0.384, p = 0.744, respectively) and LDFA alteration (< 2°, p = 0.997, 0.921, respectively). Correction of MPTA (3.4° vs. 2.2°) and lateral femoral joint line (2.1 mm vs. 1.5 mm) was higher for FA and FA subgroups compared to KA and KA subgroups (both p < 0.001).
CONCLUSION
Kinematic and functional alignments showed a comparable accuracy in reconstruction of the medial femoral joint line and femoral joint line orientation. Increased correction of MPTA and lateral femoral joint line was recorded with FA techniques.
LEVEL OF EVIDENCE
III.
目的
运动学对线（KA）和功能对线（FA）的一个关键部分是恢复自然的股骨关节线，特别是内侧关节线。KA 已知能够准确地复制股骨关节线；然而，目前还缺乏与 FA 等其他手术技术的直接比较。本研究的目的是评估 KA 和 FA 技术在对线参数方面的差异，特别关注股骨关节线。
方法
我们对 2018 年至 2020 年期间接受初次全膝关节置换术（TKA）的 221 例内翻或中立位患者的术前和术后长腿 X 线片进行了回顾性放射学分析。患者被分为四组之一：（1）FA：基于图像的机器人辅助 TKA，（2）FA：无图像的机器人辅助 TKA，（3）限制 KA：3D 切割块辅助（患者特定器械，PSI）TKA，（4）不受限制 KA：卡尺技术。对患者的 X 线片进行了（重新）分析，以评估整体肢体对线、内侧胫骨近端角（MPTA）、外侧股骨远端角（LDFA）以及内侧和外侧股骨关节线的改变。使用配对 t 检验（FA 与 KA 组）和单因素方差分析（亚组分析）确定统计学意义。
结果
KA 与 FA 以及 KA 和 FA 的各个亚组之间的比较显示，内侧关节线重建的准确性（<2mm，p=0.384，p=0.744）和 LDFA 改变（<2°，p=0.997，0.921）没有差异。FA 和 FA 亚组的 MPTA（3.4°与 2.2°）和外侧股骨关节线（2.1mm 与 1.5mm）的校正更高，而 KA 和 KA 亚组则更低（均 p<0.001）。
结论
运动学和功能对线在重建内侧股骨关节线和股骨关节线方向方面具有相似的准确性。FA 技术可记录到 MPTA 和外侧股骨关节线的校正增加。
证据水平
III 级。
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