全膝关节置换术中股骨假体旋转对线的比较研究

Rotational alignment of femoral prosthesis in total knee arthroplasty

目的比较全膝关节置换术（TKA）中以经上髁轴和股骨后髁轴外旋3。置放股骨假体外侧支持带的松解率。方法150例膝关节骨性关节炎患者随机分成两组，一组采用股骨上髁轴确定股骨假体的旋转对线（股骨上髁组），另一组参照股骨后髁连线外旋3。确定股骨假体旋转对线（股骨向髁组）。假体安装完毕后以“无拇指”技术评价髌骨轨迹，决定是否需要做外侧支持带松解。结果股骨上髁轴组外侧支持带松解率为6．3％，股骨后髁轴组外侧支持带松解率为15．8％（P〈0．05）。结论TKA中股骨假体旋转对线对于髌股轨迹的优劣有着显著影响，股骨上髁轴作为旋转对线的参照可以显著改善髌股轨迹，降低外侧支持带松解率。

Objective To compare the lateral retinacular release rate of placing femoral prosthesis via transepicondylar axis and hypocondyle axis at 3° outward rotation in total knee arthroplasty （TKA）. Methods A total of 150 patients with osteoarthritis undergone primary TKA divided into two groups. The femoral prosthesis was set by 3° outward rotation via the transepicondylar axis in Group A, but via the hypocondyle axis in Group B. A lateral refinacular release was performed when lateral tracking persisted during trial range of motion using the ＂no thumb＂ technique. Results The lateral release incidence rate was 6.3% in Group A and 15.8% in Group B （ P 〈 0.05 ）. Conclusions Rotational alignment of femoral prosthesis exerts a great influence on patella femoral tracking in TKA. It is reliable for surgeons to adopt the transepicondylar axis as the reference axis to rotate femoral components so as to improve patellofemoral tracking, and decrease the release rate of lateral retinaculum.