全膝关节置换术中测量截骨与间隙平衡截骨的疗效比较

Comparison of measured resection and gap balancing in total knee arthroplasty

目的探讨在全膝关节置换术(TKA)中测量截骨与间隙平衡截骨的临床效果。方法笔者自2008-01-2013-06行人工全膝关节置换术诊治126例(130膝)骨性关节炎,测量组76例,平衡组50例,比较2组的手术情况、影像学、膝关节功能恢复情况。结果 126例均获随访2~5年,平均3.4年。测量组与平衡组单膝手术时间比较差异无统计学意义(P>0.05),但术中2钉孔连线与股骨通髁线夹角<2°,测量组外旋角度(1.04±0.62)°,平衡组内旋角度(1.24±0.57)°,术后患膝伸直应力位X线片示内外侧股胫关节角2组间差异无统计学意义(P>0.05)。但屈膝90°应力下X线片示内外侧股胫关节角2组间差异有统计学意义(P<0.05)。术后下肢力线与小腿解剖轴线夹角2组间比较差异有统计学意义(P<0.05)。术后膝关节KSS评分及并发症发生率2组比较差异均无统计学意义(P>0.05)。结论间隙平衡截骨技术在保证下肢力线及屈伸间隙平衡方面优于测量截骨技术,但易导致股骨假体内旋,术中要注意调整两钉孔连线与股骨通髁线夹角。

Objective To evaluate the efficiency of measured resection and gap balancing used in total knee arthroplasty （TKA）. Methods One hundred and twenty six cases （130 knees） receiving TKA in our hospital for osteoarthritis from January 2008 to June 2013 were retrospectively analyzed. The measured resection technology was used in 76 patients while the gap balancing technique was used in another 50 cases. The data of surgery, imaging and knee function were compared. Results All patients were followed up for 2-5 years, average 3.4 years. The one side knee surgery time of the two groups showed no significant difference （P 〉0.05）, but the angle between the line of two pinholes and the femoral condyle line was 〈2°, external rotation angle of measured resection groups was （1.04±0.62）~, internal rotation angle of gap balancing groups was （1.24±0.57）°. Postoperative knee straight stress X-ray showed that there was no significant difference in lateral tibiofemoral joint angle between the two groups （P 〉0.05）, but bent-knee 90° stress was greater in the measured resection groups （P 〈0.05）. After operation, the difference was statistically significant in limb alignment and erns anatomic axis angle between the two groups（P 〈 0.05）. KSS scores and complication rate of the two groups showed no significant difference （P 〉0.05）. Conclusion Gap balancing technique in limb alignment and flexion and straight gap balance is better than measured resection technique, but it can cause femoral prosthesis internal rotation. Attention should be paid in operation to adjust two pinholes of attachment and femoral condyle line angle.