运动力学对线截骨对全膝关节置换术后运动学、生物力学及膝关节功能的影响

Effect of kinematic mechanics on kinematics,biomechanics and knee function after total knee arthroplasty

目的:探讨运动力学对线截骨对全膝关节置换术(TKA)后运动学、生物力学及膝关节功能的影响。方法:回顾性分析2019年12月至2020年6月收治的90例行TKA的患者,其中48例采用运动力学对线截骨,42例采用传统方法对线截骨。记录并比较两组患者术前、术后3 d力学对线,术前、术后3个月及术后6个月运动学指标(膝关节最大屈曲度、股骨内髁后移幅度、股骨外髁后移幅度)、生物力学指标(膝关节屈曲力矩峰值、伸展力矩峰值、外旋力矩峰值、内旋力矩峰值),以及术前、术后3个月、术后6个月美国膝关节外科学会膝关节功能评分(KSS)。结果:术后3 d两组患者下肢力线角度均小于术前,运动力学对线截骨组患者下肢力线、股骨假体力线、胫骨假体力线角度均小于传统方法对线截骨组患者,且差异均有统计学意义(P<0.05);术后3个月、术后6个月两组患者膝关节最大屈曲度、股骨内髁后移幅度、股骨外髁后移幅度、屈曲力矩峰值、伸展力矩峰值、外旋力矩峰值、内旋力矩峰值、膝关节KSS关节性评分、膝关节KSS功能性评分均高于术前,且差异均有统计学意义(P<0.05),术后6个月、术后3个月两组患者上述指标差异均无统计学意义(P>0.05),而运动力学对线截骨组患者术后3个月、术后6个月上述指标均高于传统方法对线截骨组患者,且差异均有统计学意义(P<0.05)。结论:在TKA中实施运动力学对线截骨可恢复下肢力线,显著提高患者膝关节运动学和生物力学参数,还可促进膝关节功能恢复,近期效果理想。

Objective:To investigate the effect of kinematic mechanics on kinematics,biomechanics and knee joint function after total knee arthroplasty(TKA).Methods:Ninety patients who underwent TKA from December 2019 to June 2020 were enrolled in this retrospective study.The osteotomy was performed by kinematic mechanics alignment in 48 patients(group A)and by traditional alignment in 42 patients(group B).Mechanical alignment,kinematic indexes(maximum knee flexion,medial femoral condyle and lateral femoral condyle),biomechanical indexes(peak flexion torque,extension torque,external rotation torque and internal rotation torque)and Knee Society Scoring(KSS)were recorded and compared between the two groups.Results:At 3 days after operation,the force line angles of lower limbs in both groups decreased(P<0.05),and the force line angles of lower limbs,femur prosthesis and tibia prosthesis in group A were significantly lower than those in group B(P<0.05).The maximum knee flexion,medial femoral condyle and lateral femoral condyle,peak flexion torque,extension torque,external rotation torque and internal rotation torque,KSS joint scores and KSS functional scores were significantly increased in both groups at 3 months and 6 months after operation(P<0.05),but there were no significant differences in the indexes between two time points(3 months and 6 months after operation,P>0.05).The above-mentioned indexes in group A were significantly higher than those in group B at 3 months and 6 months after operation(P<0.05).Conclusions:The application of kinematic mechanics alignment osteotomy in TKA can restore the force line of lower limbs,significantly improve the kinematic and biomechanical parameters of knee joint,promote the functional recovery of knee joint,and achieve good short-term effect.