人工膝关节表面置换术中胫骨髓内与髓外定位的临床效果比较

Comparison of Clinical Influence of Intramedullary versus Extramedullary Alignment Guides on Total Knee Arthroplasty

目的比较髓内定位与髓外定位对全膝关节置换术下肢力线、术中止血带时间、术后并发症的影响。方法回顾性分析2012年2月至2013年11月105例行全膝关节置换术的患者(210膝),根据术中胫骨截骨定位方法将其分为髓内定位和髓外定位,其中髓内定位组40例(80膝),平均年龄(66.65±9.57)岁;髓外定位组65例(130膝),平均年龄(65.29±9.27)岁,观察术后下肢力线改变、胫骨平台后倾角、术中止血带时间、术后并发症等。结果两组患者性别、年龄、身高、体质量、体质量指数、术前下肢力线方面差异均无统计学意义(P>0.05)。术后髓内定位组下肢力线为(179.69±2.91)°,髓外定位组为(178.26±3.38)°,两组比较差异有统计学意义(P=0.002),其中髓内定位组患者术后中立位及外翻位的患者共68例,占85.00%,髓外定位组共94例,占72.31%,两组比较差异有统计学意义(P=0.033)。髓内定位组术中止血带时间(79.46±12.06)min,髓外定位组术中止血带时间(84.68±8.02)min,两组比较差异有统计学意义(P=0.001);术后并发症发生率髓内定位组为6.25%,髓外定位组为3.07%,两组比较差异无统计学意义(P=0.279)。结论髓内定位法在下肢力线改善、术中止血带时间方面优于髓外定位法,但相关并发症发生率较髓外定位高。

Objective To compare the clinical influence of intramedullary versus extramedullary alignment guides on total knee arthroplasty（ TKA） in terms of alignment of the lower limbs,intraoperative tourniquet time,and postoperative complications. Methods We retrospectively analyzed the clinical data of 105 patients（ 210 knees） undergoing bilateral TKA from February 2012 to November 2013. All patients were divided to two groups： 40 [age：（ 66. 65 ± 9. 57） years] were implanted using intramedullary guides on the tibia and 65[age：（ 65. 29 ± 9. 27） years] were implanted using extramedullary guides on the tibia. Alignment of lower limb,tibial component angle in the sagittal plane,tourniquet time,and postoperative complications were compared. Results The gender ratio,age,height,weight,body mass index,and preoperative alignment of lower limbs were not significantly different between these two groups（ all P〉0. 05）. The average coronal alignment of lower extremity was（ 179. 69 ± 2. 91） ° in the intramedullary guides group and（ 178. 26 ± 3. 38） ° in the extramedullary guides group（ P = 0. 002）. The alignment of lower limbs on neutral and valgus position were foundin 68 cases（ 85. 00%） in the intramedullary group and in 94 cases（ 72. 31%） in extramedullary group（ P =0. 033）; the tourniquet time was（ 79. 46 ± 12. 06） min in the intramedullary group and（ 84. 68 ± 8. 02） min in the extramedullary group（ P = 0. 001）; the postoperative complication rate was 6. 25% in intramedullary group and 3. 07% in extramedullary group（ P = 0. 279）. Conclusion Alignment and tourniquet time can be significantly improved by the intramedullary instrumentation,while the incidence of complications associated with intramedullary instrumentation is higher than extramedullary instrumentation.