股骨远端形态对全膝关节置换术中标准截骨后屈伸间隙影响的研究

Effect of the shape of the femoral condyle on the gap of flexion and extension in knee arthroplasty

目的探讨股骨髁前后径与左右径比值对全膝关节置换术(total knee arthroplasty,TKA)中标准截骨后屈伸间隙的影响。方法筛选出在该院行TKA的患者76例,术前在膝关节X线片上测量股骨髁前后径及左右径,并在术中测量标准截骨后的屈伸间隙,其中屈曲间隙>伸直间隙的患者为A组,屈曲间隙=伸直间隙为B组,屈曲间隙<伸直间隙为C组,比较三组患者前后径与左右径比值、术后美国膝关节协会评分(KSS评分)及膝关节屈伸活动度。结果三组患者术前股骨髁前后径与左右径比值差异有统计学意义(P<0.05);术后膝关节KSS评分及膝关节活动度差异无统计学意义(P>0.05),同组术后KSS评分及膝关节活动度较术前均明显改善。结论股骨髁前后径与左右径比值的大小与术中标准截骨后屈伸间隙的大小有关,而且比值偏大的患者,截骨后可能出现屈曲间隙>伸直间隙,而比值偏小的患者,可能出现屈曲间隙<伸直间隙。但经过术中调整,术后均可获得良好的膝关节功能。

Objective To study the relationship between the shape of femoral condyle and the gap of flexion and extension after total knee arthroplasty（TKA） by standard osteotomy.Methods Seventy-six patients who were diagnosed as osteoarthritis and treated by TKA were enrolled in this study. The medial-lateral diameter and anteroposterior diameter of the femoral condyle were measured according to the preoperative knee X-ray radiographs. The gaps of flexion and extension were measured after TKA by standard osteotomy. The patients with flexion gap more than extension gap were taken as group A, those with flexion gap equal to extension gap as group B, and those with flexion gap less than extension gap as group C. The ratio of medial-lateral diameter to anteroposterior diameter of the femoral condyle, the KSS scores and knee flexion were compared among the three groups after surgery.Results There were significant differences in the ratio of medial-lateral diameter to anteroposterior diameter of the femoral condyle before surgery（P〈0.05）. There were no significant differences in the postoperative KSS scores and the knee joint activity among the three groups after surgery（P〉0.05）. Postoperative improvements of the KSS scores and knee activity degree were achieved in all groups.Conclusion The ratio between medial-lateral diameter and anteroposterior diameter is related to the size of the flexion and extension space. When the ratio is larger, the flexion gap will be more than extension gap, and when the ratio is smaller, the extension gap will be more than flexion gap. The knee function becomes better after intraoperative adjustment.