全膝关节置换术中关节线重建方法的研究进展

Research progress on joint line reconstruction methods in total knee arthroplasty

目的总结全膝关节置换术中有关关节线重建方法的研究进展。方法在中国知网、万方数据、PubMed等数据库,以“关节线”“膝”“置换”以及“joint line”“knee”“replacement”等为中、英文关键词,检索2008年1月—2022年8月关于全膝关节置换术中重建关节线方法的相关文献,共检索到711篇,剔除内容不符、质量较低、重复研究、证据等级不高、无法获取全文者,最终纳入53篇文献,对其进行归纳总结。结果常见的重建关节线倾斜度的方法有机械对线技术、解剖对线技术、动力对线技术、限制性动力对线技术;常见的重建关节线高度的解剖标志有内收肌结节、腓骨头、胫骨结节、内外侧髁等。采用计算机辅助导航系统建立膝关节三维骨骼模型,确定假体尺寸并制定手术方案,应用示踪器技术可以指导股骨、胫骨的精确截骨,可以更好地重建关节线。机器人辅助全膝关节置换术系统使用计算机软件,术中机器人设备精准地执行个体化手术计划,可提高重建关节线的精度。通过3D打印技术打印个体化的膝关节模型、制作截骨槽导板和定位钉导板、带有标记的间隔块工具,指导术中关节线的重建,使手术更加精确化和个体化。结论全膝关节置换术中,针对患者膝关节解剖结构形态特点,选择合适的解剖学标志及对线技术,结合计算机辅助导航技术、骨科机器人手术系统、3D打印技术等数字化技术,可以实现关节线更为准确地重建。

Objective This study aimed to summarize the research progress on joint line reconstruction methods in total knee arthroplasty.Methods In the CNKI,Wanfang Data,and PubMed database,“关节线”“膝”“置换”and“knee”“replacement”and“joint line”were used as Chinese and English keywords to search for related studies from January 2008 to August 2022.A total of 711 articles were retrieved,and those with inconsistent content,low quality,duplication,low evidence level,and unavailable full text were excluded.In total,53 articles were finally included and summarized.Results The common methods for the reconstruction of joint line inclination include mechanical alignment,anatomic alignment,kinematic alignment,and restricted kinematic alignment technique.The common anatomical landmarks that guide knee line reconstruction include the adductor tubercle,fibular head,tibial tubercle,and the medial and lateral condyles.The computer-aided navigation system was used to establish a three-dimensional skeletal model of the knee joint,determine the size of the prosthesis,and develop a surgical plan.The application of tracer technology can guide the precise osteotomy of the femur and tibia,which can improve the reconstruction of the joint line.The robot-assisted total knee arthroplasty system uses computer software to precisely execute the individualized surgical plan by using the intraoperative robotic device,thus improving the accuracy of knee line positioning.The 3D printing technology allows for the precise and individualized surgery by printing individualized knee models,creating osteotomy slot guides,and positioning nail guides,and spacer block tools with markers to guide intraoperative joint line positioning.Conclusion In total knee arthroplasty,according to the morphological characteristics of the patient's knee anatomical node,the selection of appropriate anatomical markers and alignment technology combined with computer-aided navigation technology,orthopedic robot surgery system,3D printing technology,and other digital technologies,can improve the accuracy of the reconstruction of joint lines.