胫骨优先、间隙平衡的个体化对线可使绝大多数内翻和直膝畸形恢复正常的骨表型和关节线倾斜度，并使外翻和严重内翻畸形正常化。

Tibia-first, gap-balanced patient-specific alignment restores bony phenotypes and joint line obliquity in a great majority of varus and straight knees and normalises valgus and severe varus deformities.

机构信息

Department for Arthroplasty, Sports-Traumatology and General Orthopaedics, Asklepios Orthopaedic Hospital Lindenlohe, Schwandorf, Germany.

Department of Orthopedic Surgery and Traumatology, Kantonsspital Baselland, Bruderholz, Switzerland.

出版信息

Knee Surg Sports Traumatol Arthrosc. 2024 May;32(5):1287-1297. doi: 10.1002/ksa.12145. Epub 2024 Mar 19.

DOI:10.1002/ksa.12145

PMID:38504509

Abstract

PURPOSE

The present study focuses on testing the capability of a restricted tibia-first, gap-balanced patient-specific alignment technique (PSA) to restore bony morphology and phenotypes.

METHODS

Three-hundred and sixty-seven patients were treated with navigated total knee arthroplasty and tibia-first gap-balanced PSA technique. Boundaries for medial proximal tibial angle were 86°-92°, mechanical lateral distal femoral angle 86°-92°, and hip-knee-ankle angle 175°-183°. Knees were classified by coronal plane alignment of the knee (CPAK), with subsequent analyses comparing pre- and postoperative distributions. Phenotype classification within CPAK groups assessed pre- and postoperative distributions.

RESULTS

Preoperatively, the largest CPAK group was type II (30.8%), followed by type I (20.5%) and type V (17.8%). Postoperatively, type II remained the largest group (39%), followed by type V (30%). All groups with varus/valgus deformities (I, III, IV and VI) became smaller. While in straight legs (II, IV), the CPAK was restored in more than 70%-75%, in varus groups (I, IV) in 40%-50% and in valgus (III and VI) in 5%-18%. The joint line obliquity remained the same in the majority of knees (straight >75%; varus 63%-80%; valgus VI 95%), with the exception of CPAK III (40%). The phenotype analysis showed for straight legs a phenotype restoration of 85%, for varus 94% and for valgus 37%. Joint line convergence angle was reduced significantly in all groups from 1.8°-4.3° preoperatively to 0.6°-1.2° postoperatively.

CONCLUSION

PSA restores bony phenotypes and joint line obliquity in the majority of straight and varus knees, while most of the valgus and extreme varus knees are normalised.

LEVEL OF EVIDENCE

Level III, retrospective cohort study.

摘要

目的

本研究旨在测试受限的胫骨优先、间隙平衡的个体化假体定位技术（PSA）在恢复骨骼形态和表型方面的能力。

方法

对 367 例接受导航全膝关节置换术和胫骨优先间隙平衡 PSA 技术治疗的患者进行了研究。内侧胫骨近端角的边界为 86°-92°，机械性外侧股骨远端角为 86°-92°，髋膝踝角为 175°-183°。膝关节根据冠状面对线（CPAK）进行分类，随后分析比较术前和术后的分布情况。在 CPAK 组内进行表型分类，评估术前和术后的分布情况。

结果

术前，最大的 CPAK 组为 II 型（30.8%），其次是 I 型（20.5%）和 V 型（17.8%）。术后，II 型仍然是最大的组（39%），其次是 V 型（30%）。所有存在内翻/外翻畸形的组（I、III、IV 和 VI）均减小。在直腿（II、IV）中，CPAK 的恢复超过 70%-75%，在内翻组（I、IV）中为 40%-50%，在外翻组（III 和 VI）中为 5%-18%。大多数膝关节（直腿>75%；内翻 63%-80%；外翻 VI 95%）的关节线倾斜度保持不变，除了 CPAK III（40%）。表型分析显示，直腿的表型恢复率为 85%，内翻为 94%，外翻为 37%。所有组的关节线会聚角均从术前的 1.8°-4.3°显著降低至术后的 0.6°-1.2°。