胫骨假体放置位置与人工膝关节置换后的稳定性

Effect of setting position of tibial prosthesis on the stability after total knee replacement

背景:目前关于在全膝置换中针对选择何种参照方法和技术来确定胫骨假体放置位置或参数尚报道较少。目的:分析人工膝关节置换过程中胫骨假体放置的位置对其置换后稳定性及相容性的的影响。方法:通过检索选择文章内容与人工膝关节置换过程中胫骨假体或角度相关的文章,同一领域文献则选择近期发表或发表在权威杂志文章。结果和结论:初检得到132篇文献,根据纳入标准选择关于胫骨假体放置的27篇文章进行综合分析。由于胫骨上端几何结构的个体差异以及手术操作等原因,假体与胫骨上端切面有时不能良好匹配。全膝关节置换中,胫骨假体各面的角度、对线、对位对置换后膝关节的稳定性、屈伸功能和假体使用寿命均有重要影响;胫骨假体的放置直接关系到人工膝关节置换后假体的松动、下沉及术后关节感等。因此选用适合患者型号的假体,使假体与胫骨上端切面能良好匹配的同时,还要提高假体植入技巧,以增强假体的稳定性。

BACKGROUND： Choice of reference methods and techniques to determine the setting position or parameters of the tibial prosthesis in total knee arthroplasty is still rarely reported. OBJECTIVE： To analyze the effect of setting position of tibial prosthesis on its stability and compatibility in total knee replacement. METHODS： The articles that related to the tibial prosthesis or angle in the process of total knee replacement were selected through search. For the articles in the same field, those published recently or in the authorized journals were included. RESULTS AND CONCLUSION： After preliminary retrieval, 132 articles were screened out and 27 of them were involved in the retrospective analysis according to inclusion criteria. Due to individual differences of the geometry of the proximal tibia and surgical operation, the prosthesis and the proximal tibia section sometimes cannot show a good match. During total knee arthroplasty, the tibial surface angles, alignment and apposition have an important impact on the stability, flexion and extension functions of knee joint and life of the prosthesis; tibial prosthesis placement is directly related to the prosthesis loosening, subsidence and postoperative joint flu after total knee replacement. Therefore, selecting a suitable type of prosthesis for the patients and make a good match between the prosthesis and the proximal tibia section, the prosthesis implantation techniques are also needed to be improved in order to enhance the stability of the prosthesis.