全膝关节置换术中胫骨假体旋转对线新技术

A NEW TECHNIQUE DETERMINING TIBIAL ROTATIONAL ALIGNMENT IN TOTAL KNEE ARTHROPLASTY

目的比较全膝关节置换术中确定胫骨假体旋转对线的参照方法,以提高手术效果,减少术后并发症。方法2006年5月-2007年4月,对60例膝内翻患者行旋转平台全膝人工关节置换,其中男27例,女33例;年龄55～78岁。随机分为两组,每组30例。术中胫骨假体定位方法:A组采用胫骨结节中内1/3线作为解剖标志;B组膝内翻0～9°患者采用胫骨结节内侧缘作为解剖标志,10～19°患者以胫骨结节内侧缘至胫骨结节中内1/3线区间的中线为准,≥20°的患者以胫骨结节中内1/3线为准。测量术后两组聚乙烯半月板垫片的旋转角度。结果术后聚乙烯半月板垫片旋转角度测量,A组内旋(5.6±2.8)°,其中膝内翻0～9°患者为(8.4±3.8)°,10～19°患者为(3.5±2.7)°,≥20°患者为(0±2.4)°;B组内旋(0±1.9)°,其中膝内翻0～9°患者为(0±2.1)°,10～19°患者为(0±2.0)°,≥20°患者为(0±1.7)°。A组组内比较及与B组比较差异均有统计学意义(P<0.05),B组组内比较差异无统计学意义(P>0.05)。结论胫骨结节内侧缘至中内1/3线是较理想的胫骨假体旋转定位区间,线性的定位应根据患者膝关节内外翻畸形程度而定。

Objective To compare the two different techniques determining tibial rotational alignment in total knee arthroplasty（TKA） to enhance postoperative effect and reduce complications. Methods From May 2006 to April 2007, 60 patients（27 males, 33 females, aged 55-78 years ） received TKA and randomly divided into 2 groups（n=30）- tibial rotational alignment in TKA was determined by medical 1/3 of tibial tubercle in Group A, by medial border of tibial tubercle at 0-9°varus in Group B, by medical 1/3 of tibial tubercle at 20°or greater varus or by the mean line between medial border of tibial tubercle and medical 1/3 of tibial tubercle at 10-19°varus. The angle of rotation of polyethylene cushion was calculated. Results The angle of rotation of polyethylene cushion in Group A was （8.4±3.8）° at 0-9°varus, （3.5±2.7）° at 10-19°varus and （0 ±2.4）° at 20°varus or over, respectively, and there was significant difference （P 〈 0.05）. The angle of rotation of polyethylene cushion in Group B was （0±2.1）°at 0-9° varus, （0 ±2.0）° at 10-19°varus and （0 ±1.7）° at 20°varus or over, respectively, and there was no significant difference （P〉 0.05）. The angle of rotation of polyethylene cushion averaged （5.6±2.8）°in Group A and （0±1.9）° in Group B, showing significant difference （P〈 0.05）. Conclusion The range of ideal tibial rotational alignment in TKA was from medial border of the tibial tubercle to medical 1/3 of the tibial tubercle, and is decided by the degree of varus deformities and valgus deformities.