全膝关节置换过程中的假体旋转对位

Prosthesis rotational alignment in total knee arthroplasty

背景:在全膝关节置换过程中对假体旋转对位争论的焦点目前仍集中在旋转对位的参照地标如何设定。目的:综述全膝关节置换手术中假体旋转对位的相关临床和基础研究进展。方法:广泛查阅全膝关节置换手术中假体旋转对位的解剖定位标志、定位方法、旋转对位的匹配、手术精确度等临床上遇到的相关文献。结果与结论:许多研究表明,旋转对位不良,会导致膝前痛,胫股骨和髌股关节间的稳定性失衡,髌骨的运动轨迹失调,步态异常,胫骨侧聚乙烯平台的磨损加速,假体过早松动,出现关节半脱位和脱位,甚至需进一步手术翻修等问题。术中胫股骨侧假体的旋转对位时要综合利用所获得的各种信息,个别校正,必要时结合置换前的CT扫描来进行,以改善全膝关节置换疗效和远期生存率。

BACKGROUND： Currently, studies about prosthesis rotational alignment of total knee arthroplasty （TKA） are focused on the rotational landmark location. OBJECTIVE： To summarize the clinical and basic research progress related to prosthesis rotational alignment in TKA. METHODS： Clinical articles related to anatomic landmark, location method, matching in rotational alignment and operational precision of prosthesis rotational alignment in TKA were extensively reviewed. RESULTS AND CONCLUSION： Many studies show that malrotation may lead to various complications, such as anterior knee pain, femoro-tibial and patellofemoral instability, maladjustment of patellar movement trajectory, abnormal gait, accelerated polyethylene wear, premature loosening, subluxation or dislocation, and even need for further revision. All derived data from various sources should be used in prosthesis rotational alignment at tibial and femoral side when operation, individual corrections should be made appropriately, and preoperative CT scan can be used if necessary, so as to improve the TKA outcome and longevity.