Ho Jade Pei Yuik, Park Seong Yun, Nam Hee Seung, Cho Joon Hee, Lee Yong Seuk
Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, South Korea; Department of Orthopaedic Surgery, Kuala Lumpur General Hospital, Malaysia.
Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, South Korea.
Knee. 2023 Dec;45:35-45. doi: 10.1016/j.knee.2023.09.003. Epub 2023 Sep 27.
The aims of this study were (1) to compare in vivo coverage and rotational alignment of 2 tibial component designs: anatomic and symmetrical; and (2) to determine if coronal deformity and tibial torsion were related to rotation and coverage.
Postoperative CT scans of 200 propensity score-matched patients who underwent TKA with either an anatomic (ATC) or symmetrical tibia component (STC) were analyzed. Rotation was measured using four axes: surgical transepicondylar axis (sTEA), Berger's protocol, medio-lateral (ML) axis and posterior borders of the tibial plateau, while coverage was assessed by measuring fit and surface area. The relationship between coronal deformity, tibial torsion, rotation, and coverage was investigated.
Overall, STCs had more internal rotation when measured using the sTEA (-0.6° ± 3.5 vs 0.5° ± 3.6, p = 0.03), Berger's protocol (-21.6° ± 7.1 vs -17.9° ± 6.2, p = 0.000) and ML axes (2.9° ± 3.9 vs 8.1° ± 5.1, p = 0.000) compared to ATCs. STCs also had more posteromedial underhang (-3.3 mm ± 2.4 mm vs -1.7 mm ± 2.5 mm, p = 0.000) but smaller change in tibial torsion postoperatively (-18.4° ± 9.9° vs -13.1° ± 9.4°, p = 0.000). Tibial torsion was more pronounced in valgus than varus knees both preoperative (-25.4° ± 6.5° vs -20.2° ± 9.3°, p = 0.02) and postoperatively (-19.7° ± 7.2° vs -14.7° ± 10.3°, p = 0.04), but there was no difference in postoperative tibial torsion between ATCs and STCs in this subgroup.
The use of an anatomic tibial baseplate optimizes coverage by reducing posterolateral overhang and posteromedial underhang. It also achieved better rotational profiles compared to STCs. However, it resulted in a larger change in tibial torsion after TKA.
本研究的目的是：（1）比较两种胫骨假体设计（解剖型和对称型）在体内的覆盖情况和旋转对线；（2）确定冠状面畸形和胫骨扭转是否与旋转和覆盖相关。
对200例接受全膝关节置换术（TKA）且倾向得分匹配的患者进行术后CT扫描分析，这些患者使用的是解剖型胫骨假体（ATC）或对称型胫骨假体（STC）。使用四个轴测量旋转：手术经髁轴（sTEA）、伯杰法、内外侧（ML）轴和胫骨平台后缘，同时通过测量贴合度和表面积评估覆盖情况。研究冠状面畸形、胫骨扭转、旋转和覆盖之间的关系。
总体而言，与ATC相比，使用sTEA测量时STC的内旋更多（-0.6°±3.5°对0.5°±3.6°，p = 0.03），采用伯杰法测量时也是如此（-21.6°±7.1°对-17.9°±6.2°，p = 0.000），以及使用ML轴测量时（2.9°±3.9°对8.1°±5.1°，p = 0.000）。STC的后内侧悬垂也更多（-3.3 mm±2.4 mm对-1.7 mm±2.5 mm，p = 0.000），但术后胫骨扭转变化较小（-18.4°±9.9°对-13.1°±9.4°，p = 0.000）。术前（-25.4°±6.5°对-20.2°±9.3°，p = 0.02）和术后（-19.7°±7.2°对-14.7°±10.3°，p = 0.04），外翻膝的胫骨扭转比内翻膝更明显，但在该亚组中，ATC和STC术后胫骨扭转无差异。
使用解剖型胫骨基板可通过减少后外侧悬垂和后内侧悬垂来优化覆盖。与STC相比，它还能实现更好的旋转轮廓。然而，它导致TKA后胫骨扭转变化更大。
