全膝关节置换术中胫骨假体旋转确定方法的比较研究

Comparison of Two Techniques Determining Rotation of Tibial Component at TKA

目的对目前全膝关节置换术(TKA)中常用的2种确定胫骨假体旋转位置的方法进行比较,以期为术中胫骨假体的正确旋转放置提供参考。方法连续行初次单侧TKA手术30例。术中于胫骨截骨面上标识出胫骨前后轴、后交叉韧带中点与胫骨结节中内1/3连线、后交叉韧带中点与ROM技术确定的胫骨前方标志点连线。数码相机垂直于截骨面进行图像摄取后转移至电脑,借助于软件系统分别测量胫骨前后轴与上述2条连线的夹角。结果胫骨结节中内1/3与后交叉韧带中点的连线同胫骨前后轴之间的平均夹角为(11.3±3.4)°,ROM技术获得的前方标记点基本位于髌腱内侧缘,其与后交叉韧带中点连线同胫骨AP轴之间的平均夹角为(0.8±2.2)°。结论国人TKA术中,当以胫骨结节中内1/3为标准行胫骨假体旋转放置时,有导致胫骨假体相对于股骨假体外旋过度的可能。当术中进行了正确的股骨假体旋转放置及软组织松解和平衡后,采用ROM技术能够获得更为正确的胫骨假体旋转放置。

Objective To compare two most commonly used techniques for deterrnination of the rotational alignment of tibial component during total knee arthroplasty. Methods Thirty patients who had unilateral TKA were enrolled. On proximal tibial cut surface, the rota- tional orientation of the tihial trial determined by the ROM technique was marked on the anterior tibial cortex as well as the medial 1/3 of tibial tubercle. The angles between the anteroposterior axis of tibia and lines connecting the middle of the posterior erueiate ligament and these 2 points were measured. Results On proximal tibial cut surface, the mean angle between the anteroposterior axis and a line connecting the middle of the posterior eruciate ligament and the medial 1/3 of tibial tubercle was （11.3±3.4）°.The mean angle between the anteroposterior axis and a line connecting the middle of the posterior cruciate ligament and the ROM mark was （0.8±2.2）°. Conclusion There is a tendency to align the tibial component in external rotation relative to the femoral component when the medial 1/3 of tibial tu- bercle is used. When the femoral component is set paralleling to the transepicondylar axis and correct soft tissue release has been done, the ROM technique can be used as a more reliable technique for correct rotational orientation of the tibial component.