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一种无需计算机辅助设备的受限运动学对线全膝关节置换新技术。

A Novel Technique for Restricted Kinematic Alignment Total Knee Arthroplasty Without Computer-Assisted Devices.

作者信息

Sakakibara Yuzuru, Yasutani Yusuke, Oyama Akimitsu, Teramoto Atsushi

机构信息

Orthopedic Surgery, Muroran City General Hospital, Muroran, JPN.

Orthopedic Surgery, Sapporo Medical University School of Medicine, Sapporo, JPN.

出版信息

Cureus. 2024 Aug 19;16(8):e67233. doi: 10.7759/cureus.67233. eCollection 2024 Aug.

DOI:10.7759/cureus.67233
PMID:39301339
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11412279/
Abstract

Kinematic-alignment total knee arthroplasty (KA-TKA) aims to restore natural limb alignment and joint line obliquity, thereby improving patient satisfaction. Restricted KA-TKA (rKA-TKA) addresses abnormal knee anatomies and seeks to replicate natural anatomical structures within safe alignment boundaries. This study introduces a novel device and technique that enables rKA-TKA without computer-assisted surgery (CAS). The new device allows for precise cartilage thickness measurement and adjustment of osteotomy angles, facilitating accurate alignment. A heel-lift technique for tibial osteotomy is presented, offering a reproducible method for determining the osteotomy volume and angle. These innovations make KA and rKA-TKA feasible in any surgical setting, avoiding the high costs and limited availability associated with CAS.

摘要

运动学对线全膝关节置换术（KA-TKA）旨在恢复肢体自然对线和关节线倾斜度，从而提高患者满意度。受限KA-TKA（rKA-TKA）针对异常膝关节解剖结构，力求在安全对线边界内复制自然解剖结构。本研究介绍了一种无需计算机辅助手术（CAS）即可实现rKA-TKA的新型设备和技术。这种新设备可精确测量软骨厚度并调整截骨角度，有助于实现精确对线。文中介绍了一种用于胫骨截骨的足跟抬高技术，为确定截骨量和角度提供了一种可重复的方法。这些创新使KA和rKA-TKA在任何手术环境中都可行，避免了与CAS相关的高成本和可用性受限问题。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dac3/11412279/bbfacd641d1b/cureus-0016-00000067233-i09.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dac3/11412279/fcc47e3b63f0/cureus-0016-00000067233-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dac3/11412279/4cbf623696fb/cureus-0016-00000067233-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dac3/11412279/ec61ca59dce9/cureus-0016-00000067233-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dac3/11412279/28bd9ba517d6/cureus-0016-00000067233-i04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dac3/11412279/e2b46020a3a4/cureus-0016-00000067233-i05.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dac3/11412279/8652e687a61a/cureus-0016-00000067233-i06.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dac3/11412279/b8c3a851edee/cureus-0016-00000067233-i07.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dac3/11412279/3fee0c622897/cureus-0016-00000067233-i08.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dac3/11412279/bbfacd641d1b/cureus-0016-00000067233-i09.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dac3/11412279/fcc47e3b63f0/cureus-0016-00000067233-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dac3/11412279/4cbf623696fb/cureus-0016-00000067233-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dac3/11412279/ec61ca59dce9/cureus-0016-00000067233-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dac3/11412279/28bd9ba517d6/cureus-0016-00000067233-i04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dac3/11412279/e2b46020a3a4/cureus-0016-00000067233-i05.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dac3/11412279/8652e687a61a/cureus-0016-00000067233-i06.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dac3/11412279/b8c3a851edee/cureus-0016-00000067233-i07.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dac3/11412279/3fee0c622897/cureus-0016-00000067233-i08.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dac3/11412279/bbfacd641d1b/cureus-0016-00000067233-i09.jpg

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本文引用的文献

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Arthroplasty Surgeons Differ in Their Intraoperative Soft Tissue Assessments: A Study in Human Cadavers to Quantify Surgical Decision-making in TKA.关节置换外科医生在术中软组织评估方面存在差异：一项在人体尸体上研究全膝关节置换术中手术决策的定量研究。
Clin Orthop Relat Res. 2022 Aug 1;480(8):1604-1615. doi: 10.1097/CORR.0000000000002184. Epub 2022 Mar 24.
2
Restricted Kinematic Alignment, the Fundamentals, and Clinical Applications.受限运动学对线、基本原理及临床应用
Front Surg. 2021 Jul 20;8:697020. doi: 10.3389/fsurg.2021.697020. eCollection 2021.
3
Navigation and robotics improved alignment compared with PSI and conventional instrument, while clinical outcomes were similar in TKA: a network meta-analysis.
导航和机器人技术与 PSI 和传统器械相比，可改善 TKA 的对线，且临床结果相似：网状 Meta 分析。
Knee Surg Sports Traumatol Arthrosc. 2022 Feb;30(2):721-733. doi: 10.1007/s00167-021-06436-8. Epub 2021 Jan 25.
4
Kinematic alignment in total knee arthroplasty.全膝关节置换术中的运动学对线
EFORT Open Rev. 2020 Aug 1;5(7):380-390. doi: 10.1302/2058-5241.5.200010. eCollection 2020 Jul.
5
In Kinematically Aligned Total Knee Arthroplasty, Failure to Recreate Native Tibial Alignment Is Associated With Early Revision.在运动学对线全膝关节置换术中，未能重建原生胫骨对线与早期翻修有关。
J Arthroplasty. 2020 Nov;35(11):3166-3171. doi: 10.1016/j.arth.2020.06.029. Epub 2020 Jun 17.
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Restoring the constitutional alignment with a restrictive kinematic protocol improves quantitative soft-tissue balance in total knee arthroplasty: a randomized controlled trial.采用限制性运动学方案恢复与解剖学一致的膝关节对线可改善全膝关节置换术后的定量软组织平衡：一项随机对照试验。
Bone Joint J. 2020 Jan;102-B(1):117-124. doi: 10.1302/0301-620X.102B1.BJJ-2019-0674.R2.
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Orthop Traumatol Surg Res. 2019 Nov;105(7):1223-1226. doi: 10.1016/j.otsr.2019.07.005. Epub 2019 Aug 1.
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