人工全膝关节置换后股骨假体角度的CT影像学评估:股骨外上髁线参照与间隙平衡技术的对比研究(英文)

Computed tomographic evaluation of femoral component rotation in total knee arthroplasty: a comparison between trans-epicondylar and balanced gap techniques

[目的]虽然人工全膝关节置换术中假体旋转定位的重要性已得到公认,但术中以哪条轴线为参照能够更加精确的保证股骨假体的旋转定位,目前尚存争议。研究表明股骨外上髁线(TEA)与膝关节屈曲轴线平行,但这一轴线术中难以精确确定。本文采用间隙平衡技术(BG),对比TEA技术在股骨假体实际旋转角度测量的差异。[方法]30例人工全膝关节置换分为2组(每组15膝),分别采用TEA和BG技术,术后行CT扫描测量股骨假体旋转角度并行膝关节学会评分(KSS)。[结果]BG组中股骨假体平均外旋角度为2.7°±1.1°,TEA组为5.6°±1.6°(P=0.001)。术后KSS功能评分改善BG组高于TEA组(P=0.002),但两组的KSS膝评分无显著性差异(P=0.39)。[结论]研究表明,与BG技术相比,术中应用TEA参照确定股骨假体的旋转定位可导致股骨假体的过度外旋,其术后KSS功能评分亦较差。

[ Objective] To compare the actual femoral component rotation obtained by the TEA and BG techniques. [ Methods] Thirty TKAs performed by TEA and BG techniques （15 each） were evaluated prospectively by CT scan for femoral component rotation as well as the Knee Society Scores （KSS）. [ Result ] The mean rotation in BG group was 2.7°±1.1° and 5.6°±1.6° in the TEA group （P = 0. 001 ）. The improvement in KSS for function was significantly greater in the BG group than in the TEA group （P = 0.002）, but there was no difference in the KSS for knee （P = 0.39）. [ Conclusion] This study demonstrates that the use of the TEA technique for determining rotational alignment in TKA results in excessive external rotation of the femoral component and poorer KSS for function compared to the BG technique.