个体化股骨后髁旋转截骨在人工全膝关节置换中的应用

Individualized rotational osteotomy of the posterior femoral condyle in total knee arthroplasty

目的探讨个体化股骨后髁旋转截骨对优化人工全膝关节置换(total knee arthroplasty,TKA)术中股骨旋转力线的作用。方法将49例行TKA手术的患者按随机数表法分成A、B两组:A组患者根据术前CT测量规划,术中在股骨后髁添加截骨垫块后旋转截骨,B组患者均参照股骨后髁线(posterior femoral condyle axis,PCL)外旋3°旋转截骨。将CT扫描数据导入Carestream PACS软件,测量术中所需垫块厚度、手术前后股骨及假体后髁角(posterior condylar angle,PCA),术后收集两组患者股骨假体PCA绝对值、膝前疼痛发生率、膝关节KSS功能评分数据进行比较。结果 49例均获15~38个月的随访,平均26个月。术前股骨PCA或转化PCA值A组(4.60±1.06)°、B组(4.48±1.33)°,差异无统计学意义(P>0.05)。术后股骨PCA或转化PCA值绝对值A组(0.79±0.42)°、B组(2.07±0.85)°,差异有统计学意义(P<0.05);膝前疼痛发生率A组8.0%、B组20.8%,差异有统计学意义(P<0.05);膝关节KSS功能评分A组(88.64±7.54)分、B组(86.70±8.24)分,差异无统计学意义(P>0.05)。结论根据术前CT扫描数据,术中在股骨后髁添加截骨垫块个体化旋转截骨,能有效提高股骨旋转力线准确度,并减少术后膝前疼痛发生率,可用于指导TKA股骨旋转定位。

Objective To explore the effects of individualized posterior femoral rotational osteotomy on the femoral rotational alignment in total knee arthroplasty （ TKA ）. Methods Forty-nine patients undergoing TKA surgery were randomly divided into two groups： Group A patients were planned according to preoperative CT measurements, and the osteotomy of the posterior femoral condyle was performed by adding the osteotomy block; Patients in Group B were referred to the posterior femoral condyle line （ posterior femoral condyle axis, PCL ） for external rotation of 3° osteotomy. CT scan data were imported into Carestream PACS software to measure the required block thickness, posterior and condylar angle （ PCA ） before and after the operation. The PCA absolute value of the femoral prosthesis, incidence of anterior knee pain and the KSS function score of the knee joint were compared after operation in 2 groups. Results All the forty-nine patients were followed up for 15 - 38 months, with an average of 26 months. The preoperative PCA or converted PCA values were （ 4.60 ± 1.06 ） degrees in Group A and （ 4.48 ± 1.33 ） degrees in Group B, without statistical significance （ P 〉 0.05 ）. The absolute value of PCA or converted PCA value of the femoral prosthesis was （ 0.79 ± 0.42 ） degrees in Group A and （ 2.07 ± 0.85 ） degrees in Group B, with statistical significance （ P 〈 0.05 ）. The incidence of anterior knee pain was 8.0% in Group A and 20.8% in Group B, with statistical significance （ P 〈 0.05 ）. The knee joint KSS function score was （ 88.64 ± 7.54 ） points in Group A and （ 86.70 ± 8.24 ） points in Group B, without statistical significance （ P 〉 0.05 ）. Conelusions According to preoperative CT scan data, individualized rotation osteotomy added with osteotomy block can effectively improve the accuracy of the femoral rotation alignment, and reduce the incidence of anterior knee pain. This method can be used to guide the femoral rotational alignment in TKA.