全膝关节置换术中下肢机械轴的研究进展

Progress on femorotibial mechanical axis of total knee arthroplasty

下肢机械轴(femorotibial mechanical axis,FTMA)是影响全膝关节置换术(total knee arthroplasty,TKA)后临床疗效的重要因素之一。通常认为TKA后下肢力线对准范围控制在中性FTMA±3°之内,在改善关节功能、延长假体生存率及降低翻修率等更具优势,可获得到更好的临床效果。因此,中性FTMA也被认为是TKA的金标准。然而,随着计算机辅助手术等技术的应用,FTMA对准较前更加精确,而术后临床效果却并未明显提升。部分学者开始质疑FTMA中性对准的必要性,提出运动学、保留残余畸形等对线方法,认为这些对线方式可以得到更佳的临床效果。近年来有文献报道认为FTMA可能不是影响术后临床效果的最重要因素,提出下肢的排列及测量方式,对相邻关节功能的影响等均可影响TKA后临床效果。本文研究认为中性FTMA对准仍是TKA成功的重要因素,其他对准方式可根据患者情况进行评估后,以中性FTMA对准为标准的情况下适当应用;术者应当探究其他因素对TKA后临床效果的影响,并对其加以改进从而达到最佳的治疗效果。

Femorotibial mechanical axis(FTMA)is one of important factors influencing clinical effect after total knee arthroplasty(TKA).It is generally believed that the range of lower limb alignment after TKA is controlled within neutral FTMA±3°,which has more advantages in improving joint function,prolonging prosthesis survival rate and reducing revision rate,and obtain better clinical results.Therefore,neutral FTMA is also considered to be the gold standard for TKA.However,with the application of computer-assisted surgery and other technologies,the alignment of FTMA is more accurate than before,but the clinical effect after surgery has not significantly improved.Some scholars have begun to question the necessity of neutral alignment of FTMA,and proposed alignment methods such as kinematics and retained residual deformity,which could achieve better clinical effects.In recent years,it has been reported that FTMA might not be the most important factor influencing postoperative clinical effects,and it is suggested that the arrangement and measurement of lower limbs and the effects on adjacent joint functions could affect clinical effect after TKA.The paper reviews neutral FTMA alignment is still an important factor for success of TKA.After a thorough evaluation according to the patient's condition,it should be appropriately applied in the case of neutral FTMA alignment;the operator should explore other factors which affect clinical outcome after TKA,and improve it to achieve the best therapeutic effect.