功能对线与限制性运动对线机器人辅助全膝关节置换术短期临床研究

Short-term outcomes of functional alignment and restricted kinematic alignment used in robot-assisted total knee arthroplasty

目的:比较功能对线(FA)与限制性运动对线(rKA)机器人辅助全膝关节置换术(RTKA)短期临床效果差异。方法:回顾性分析2021年10月至2022年4月因膝骨关节炎行RTKA的37例(39膝)患者资料,根据术中膝关节对线指导方法将患者分为FA组19例(20膝)和rKA组18例(19膝)。对两组患者一般资料、手术资料、手术前后髋膝踝角(HKA)、股骨远端外侧角(LDFA)、胫骨近端内侧角(MPTA)、股骨假体外旋角度、术后3个月膝关节协会评分(KSS)、并发症发生情况进行统计分析。结果:两组平均年龄,体重指数(BMI),手术前后HKA、LDFA、MPTA比较,差异无统计学意义(P>0.05)。FA组股骨假体外旋角度2.05°±0.41°,rKA组股骨假体外旋角度-1.11°±0.39°,两组比较差异有统计学意义(P<0.05)。FA组术后3个月膝关节协会评分膝评分(KSS-K)为(88.50±1.67)分,膝关节协会评分功能评分(KSS-F)为(88.60±1.14)分,rKA组术后3个月KSS-K为(89.47±1.62)分,KSS-F为(89.95±1.26)分,两组比较差异无统计学意义(P>0.05)。两组均无髌前疼痛、髌骨轨迹不良及其他严重并发症发生。结论:rKA-RTKA患者股骨假体较FA-RTKA患者明显内旋,未发现股骨假体内旋与髌前疼痛、髌骨轨迹不良和膝关节功能相关。FA-RTKA与rKA-RTKA术后短期效果无明显差异。

Objective:To compare the short-term clinical outcomes between functional alignment(FA)and restricted kinematic alignment(rKA)used in robot-assisted total knee arthroplasty(RTKA).Methods:Patients who underwent RTKA for knee osteoarthritis in our hospital from October 2021 to April 2022 were retrospectively analyzed and divided into FA group and rKA group according to the operator and intraoperative knee alignment guidance method.The general data,surgical data,pre and post-operative hip-knee-ankle angle(HKA),lateral distal femoral angle(LDFA),proximal medial tibial angle(MPTA),external rotation angle of the femoral prosthesis,Knee Society score(KSS)of the knee at 3 months postoperatively,and complications were statistically analyzed in both groups.Results:A total of 37 patients(39 knees)were included in this study,there were 19 patients(20 knees)in the FA group and 18 patients(19 knees)in the rKA group.There was no significant difference in average age,body mass index(BMI),pre and postoperative HKA,LDFA and MPTA between the two groups(P>0.05).The external rotation angle of femoral prosthesis was 2.05°±0.41°in the FA group and−1.11°±0.39°in the rKA group,and the difference between the two groups was statistically significant(P<0.05).The postoperative Knee Society score-the knee score(KSS-K)and Knee Society score-the function score(KSS-F)were 88.50±1.67 and 88.60±1.14 respectively in the FA group,and 89.47±1.62 and 89.95±1.26 respectively in the rKA group,and no statistical significance was found between the two groups(P>0.05).There was no anterior knee pain,patellar maltracking,or other serious complications occurred in either of the groups.Conclusions:The femoral prosthesis of robot-assisted rKA-aligned TKA patients have more internal rotation than that of FA-aligned TKA patients.There is no evidence showed that femoral prosthesis internal rotation has an effect on the occurrence of anterior knee pain and patellar maltracking and knee function.There is no significant difference in short-term outcomes between robot-assisted FA aligned and rKA aligned TKAs.