胫骨平台截骨参考点在全膝关节置换术胫骨假体定位中的应用效果分析

Application Effect of Reference Points of Tibial Plateau Osteotomy in the Tibial Prosthesis Positioning of Total Knee Arthroplasty

目的探讨胫骨平台截骨参考点在全膝关节置换术胫骨假体定位中的应用效果。方法选取2019年4月至2021年12月济源市人民医院收治的50例拟行全膝关节置换术治疗的膝关节疾病患者作为研究对象,按照随机数表法将其随机分为观察组(25例)和对照组(25例),观察组患者全膝关节置换术中通过胫骨平台截骨参考点确定胫骨假体放置角度,对照组患者全膝关节置换术中通过胫骨结节中内侧线确定胫骨假体放置角度,对比观察两组患者疼痛程度、膝关节功能以及局部解剖结构。结果术后2周、1个月及3个月,观察组患者视觉模拟评分法(VAS)评分与对照组无明显差异(t=1.584、1.186、1.182,P=0.120、0.241、0.243),而美国特种外科医院(HSS)评分均明显高于对照组(t=3.112、2.127、2.603,P=0.003、0.039、0.012);术后3个月,观察组患者胫骨结节至滑车中线距离明显短于对照组(t=2.595,P=0.013),髌骨倾斜角以及屈膝30°、60°、90°时髌股指数均明显小于对照组(t=3.382、2.774、2.357、2.795,P=0.001、0.008、0.023、0.007)。结论通过胫骨平台截骨参考点进行胫骨假体定位更有利于改善全膝关节置换术后膝关节功能,提高髌骨稳定性,避免髌骨倾斜,值得临床推广应用。

Objective To study the application effect of reference points of tibial plateau osteotomy in the tibial prosthesis positioning of total knee arthroplasty.Methods 50 patients with knee diseases,admitted into Jiyuan People’s Hospital for total knee arthroplasty from April 2019 to December 2021,were enrolled as research subjects,and divided,using the random number table,into study group(n=25)and control group(n=25).Patients in the study group used reference points of tibial plateau osteotomy to determine the tibial prosthesis placement angle during total knee arthroplasty,while patients in the control group used tibial tuberosity medial line to determine the tibial prosthesis placement angle during total knee arthroplasty.The pain degree,knee joint function and local anatomical structure were compared between the two groups.Results There were no statistically significant differences between the two groups in terms of the scores of visual analogue scale(VAS)of patients respectively at postoperative 2 weeks,1 month and 3 months(t=1.584,1.186 and 1.182,P=0.120,0.241 and 0.243),while the Hospital for Special Surgery(HSS)score were all obviously higher in the study group(t=3.112,2.127 and 2.603,P=0.003,0.039 and 0.012).On month 3 after the operation,the tibial tubercle⁃trochlear groove midline distance was significantly shorter in the study group compared with the control group(t=2.595,P=0.013).The patellar tilt angle and patellofemoral index at 30°,60°,and 90°of knee flexion were all signifi⁃cantly lower in the study group than that in the control group(t=3.382,2.774,2.357 and 2.795,P=0.001,0.008,0.023 and 0.007).Conclusion Tibial prosthesis positioning by reference points of tibial plateau osteotomy is more favora⁃ble for improving knee joint function after total knee arthroplasty,enhancing patellar stability,and avoiding patellar tilt,deserving to be promoted in clinical practice.