个体化导板辅助全膝关节置换运动学对线技术

Kinematic alignment in total knee arthroplasty with patient-specific instrumentation

大部分自然人群膝关节存在不同程度的生理内翻或外翻,而目前广泛应用的全膝关节置换机械学对线技术并没有充分尊重这种生理变异,而把下肢中立位对线作为对线目标。有学者认为这可能与膝关节置换较低的术后满意率相关。在此背景下出现了一种更为尊重自然膝关节解剖形态的对线方式——运动学对线,由于该方法可能有助于减少术中软组织松解,改善膝关节术后功能并提高病人的满意率,所以近年来受到广泛关注。作者医院是国内最早使用个体化截骨导板进行运动学对线膝关节置换的单位之一。本文总结了该技术的术前规划、手术技巧和陷阱、相关理论以及临床和实验室证据等方面内容,以帮助读者全面理解运动学对线技术。

Most of the population has different degrees of natural varus or valgus knee.Mechanical alignment,the most widely used in total knee arthroplasty,however,does not fully follow this physiological variation.Neutral alignment in coronal plane is considered as goal in mechanical alignment.Some authors speculated that this may have something to do with the lower satisfaction rate after total knee replacement.Kinematic alignment,which focuses more on the articular topography of the natural knee joint,emerged in this context.As this method may reduce soft tissue release,improve knee function and patient satisfaction.Therefore,it has received widespread attention in recent years.The author’s hospital is one of the earliestinstitutions in China to perform kinematic alignment in total knee replacement using patient-specific instrumentation.This review summarized the technology’s preoperative planning,pearls and pitfalls in surgical techniques,relevant basic theories,and clinical evidences,so as to help readers fully understand kinematic alignment.