标尺测量截骨法在全膝关节置换胫骨平台截骨中的应用

Application of tape measurement in tibial plateau leveling osteotomy in total knee arthroplasty

目的观察标尺测量截骨法在全膝关节置换术中获得胫骨平台的解剖后倾角(PTS)的应用效果。方法回顾性选取京清华长庚医院收治的40例全膝关节置换术患者,根据调整胫骨平台解剖后倾的方法不同分为实验组及对照组,试验组采用标尺测量法行胫骨平台截骨,对照组根据术前患者后倾角调整抱踝器后倾角度后截骨。所有患者均于术前、术后拍摄胫骨全长正侧位X线片,测量胫骨平台后倾角。结果试验组患者PTS与术前相比,无显著差异;对照组患者PTS与术前相比,明显升高,试验组患者PTS明显低于对照组;术中根据术前测量的PTS调整抱踝器后倾角平均为9.6°±1.8°,术后为12.0°±1.4°,两者比较差异具有统计学意义(P<0.05);术中抱踝测得的PTS与术后实际获得的PTS呈正相关关系,相关系数为0.88,两者呈较强相关性。结论全膝关节置换术中,采用标尺测量截骨可基本还原患者解剖后倾角,而胫骨截骨板及抱踝器所读得的角度与实际获得的胫骨平台后倾角有明显差异。采用的标尺测量截骨较传统抱踝器测量截骨可获得更好的解剖后倾角。

Objective To observe the effect of tape measurement in obtaining the anatomical posterior tibial slope(PTS)of tibial plateau in total knee arthroplasty.Method A total of 40 patients undergoing total knee arthroplasty admitted to Beijing Tsing Hua Changgung Hospital were retrospectively selected and divided into the experimental group and the control group according to different methods of adjusting anatomic posterior tibial slope.The experimental group performed tibial plateau osteotomy using tape measurement method,while the control group adjusted the PTS of the holding-ankle plate according to the pre-operative PTS.The PTS of all the patients was measured on the tibial full length X-ray before and after the operation.Results There was no significant difference in PTS between before and after the operation in the experimental group;the PTS of the control group after the operation was significantly higher than that before the operation,and the PTS of the experimental group was significantly lower than that of the control group.The average PTS of the holding-ankle plate during the operation according to the pre-operative PTS is 9.6°±1.8°,and the PTS after the operation was 12.0°±1.4°,the difference was statistically significant(P<0.05);the PTS of the ankle-holding device during the operation had a strong positive correlation with the actual PTS obtained after the operation,and the correlation coefficient was 0.88.Conclusion In total knee arthroplasty,tibial plateau osteotomy using tape measurement method can basically obtain anatomical PTS,but using holding-ankle plate reduced the angle significantly.Therefore,tape measurement method osteotomy can obtain a better anatomical PTS than the traditional holding-ankle plate measuring osteotomy.