导航辅助下全膝关节置换术的力线重建选择研究进展

Progress of alignment techniques in computer navigation assisted total knee arthroplasty

全膝关节置换术(TKA)中的力线重建是影响TKA手术疗效的重要因素。目前共有5种对线技术,传统器械下TKA选择最多的是机械轴对线。因徒手操作精度不足,难以准确控制1°以内的角度改变,所以垂直截骨的机械轴对线最容易实现。随着计算机导航辅助技术的发展,利用实时数字化数据反馈的优势,术者能够在术中规划时将下肢力线与软组织平衡有机结合,并且有意识地选择适合患者的个性化下肢对线,包括调整的机械轴对线、运动学对线、限制性运动学对线和解剖轴对线。本文对目前导航辅助下TKA的5种力线重建技术的临床疗效进行讨论,探讨下肢力线的理论安全范围,总结计算机导航辅助技术在TKA力线重建中的作用和优势。

Alignment reconstruction is an important factor for successful total knee arthroplasty(TKA).There are currently five alignment techniques.Neutral mechanical alignment is the most common used technique in conventional TKA.Mechanical alignment is most easily achieved by perpendicular cuts because bone resection is difficult to accurate to 1°by hand.With the development of computer navigation assisted systems,there are more options of alternative alignment techniques.Taking advantage of real-time digitizing feedback,surgeons can choose suitable alignment technique for patients consciously,such as adjusted mechanical alignment,kinematic alignment,restricted kinematic alignment and anatomic alignment.This article reviewed the progress of five alignment techniques in computer navigation assisted TKA.We discussed the clinical efficacy of different alignment techniques and theoretical safe zones for lower limb alignment,and summarized the role and advantage of computer navigation in alignment reconstruction in TKA.