膝关节单髁置换术胫骨假体术前定位的临床研究

Preoperative orientation of tibial prosthesis in unicompartmental knee arthroplasty

[目的]探究膝关节单髁置换术胫骨假体精准定位的方法及其对临床疗效的影响。[方法]2014年6月~2014年12月,116例膝关节内侧间室骨性关节炎患者,随机分成两组进行单髁置换术,术前定位组60膝,传统手术组56膝。术前定位组采用术前定位方法,即调整胫骨截骨导向器杆冠状面与胫骨嵴平行、矢状面远端距离皮肤1.80cm进行胫骨平台截骨;传统手术组采用牛津MP操作手册推荐的方法,即胫骨导向器在两个平面上均与胫骨长轴平行进行胫骨平台截骨。测量比较两组患者术后胫骨假体内外翻角(TCVA),胫骨假体后倾角(TCPSA)及HSS评分。[结果]术后平均随访12个月,术前定位组和传统手术组术后的胫骨假体内外翻角度分别为(0.92±1.81)°和(1.61±2.51)°(t=-1.072,P=0.288),胫骨假体后倾角度分别为(6.91±0.85)°和(7.32±1.73)°(t=-1.081,P=0.284),两组之间差异均无统计学意义,但术前定位组的胫骨假体内外翻角及后倾角更接近0°和7°,并且离散度小,更加精准。两组间术前、术后2周、6个月和1年的HSS评分差异均无统计学意义(P>0.05)。[结论]:本研究采用的术前定位方法能提高单髁置换术胫骨假体定位精确性,并取得了满意的临床效果。

[Objective] To explore the clinical outcome of preoperative precise orientating of tibial prosthesis in unicom- partmental knee arthroplasty （UKA） . [Methods] Between June 2014 and December 2014, 116 consecutive patients with unicompartmental osteoarthritis were treated with UKA. The patients were randomly divided into the trial group （preoperative precise orientating group, 60 knees） and the control group （56 knees） . In the trial group, the guide rod parallel was ad- justed to tibia crest in the coronal plane and the distal guide rod was regulated to 1.80cm far from skin in the sagittal plane. While in the control group, conventional Oxford MP process was used to ensure the tibia guide rod parallel to long axis of the tibia both in the coronal and sagittal plane. The postoperative tibial component vaigus/varus angle （TCVA）, tibial component posterior slope angle （TCPSA） and HSS scores were measured and compared between two groups. [Result] All patients were followed up for an average of 12 months. The postoperative tibial component valgus/varus angle （TCVA） were （0.92±1.81） ° in the trial group and （ 1.61＋2.51 ） ° in the control group respectively （t=-1.072, P=0.288） . Correspondingly, the tibial com- ponent posterior slope angle （TCPSA） were （6.91±0.85） ° and （7.32＋1.73） °respectively （t=-1.081. P=-0.284） . Although there was no significant difference between the two groups, the postoperative tibial component valgus/varus angle （TC- VA） and tibial component posterior slope angle （TCPSA） in the trial group were closer to 0 ° and 7 ° respectively, indicat- ing the position of tibial prosthesis was more precise. Preoperatively, and at 2 weeks, 6 months and one year postoperatively, no differences were found in HSS scores between the two groups （P 〉 0.05） . [ Conclusion] The preoperative precise orientating does improve the accuracy of tibial prosthesis position in UKA with satisfactory clinical outcome.