垫片设计对TKA术后髌骨倾斜和胫骨旋转运动的影响

目的探讨膝关节假体垫片设计对于全膝关节置换术（TKA）后膝关节运动学的影响。方法选取使用GENESISⅡ型假体行TKA的28位膝关节骨关节炎的患者，共42膝，平均随访27．7个月。按照使用垫片的种类分为高屈曲垫片组（23膝）和标准垫片组（19膝），采用循环透视的方法对两组病例屈伸活动进行观察并储存DICOM数据。通过Image J医学影像处理软件对数据进行分析，使用CorelDRAW作图软件进行测量。通过对比两组病例在膝关节屈伸活动时胫骨内旋和髌骨倾斜等参数来分析垫片设计关节置换术后膝关节运动的影响。结果标准垫片组和高屈曲垫片组在术后活动度无差异（P=0．789）。两组在0°～120°范围活动时髌骨倾斜角无差异，活动范围达到130°时，两组有统计学差异（P=0．034）。两组在胫骨旋转活动上无差异。结论本研究结果表明垫片设计对TKA术后髌骨倾斜角有一定影响，对股胫旋转运动没有影响。

Influence of the insert design on tibial internal rotation and patellar tilt of the knee after TKA

Objective To investigate the influence of the insert design of knee prosthesis on the kinematics of knee after total knee arthroplasty （TKA）. Methods Forty-two knees in 28 patients with knee osteoarthritis undergoing TKA using the GENESIS Ⅱ were included in this study, mean follow-up of 27.7 months. The cases were divided into two groups according to the type of insert, one was high flexion insert group （23 knees） and the other was standard insert group （ 19 knees）. The motion of flexion and extension of the two groups was observed by cyclic fluoroscopy and stored as DICOM data. The DICOM data was analyzed by Image J medical image processing software and measured by CorelDRAW mapping software. To investigate the influence of the insert design of knee prosthesis on kinematics of the knee after TKA by comparing the parameters of the two groups during the movement of knee joint, including tibial internal rotation and patellar tilt. Results The ROM of standard insert group and high flexion insert group had no difference. Both groups had no differences in tibial internal rotation and patellar tilt during the 0°-120° range of motion. The two groups appeared statistically signifi- cant in patellar tilt when flexion extended to 130° （P = 0.034）. There was no diffence bewteen the two groups on tibial internal rotation. Conclusion The insert design has a certain influence on patellar tilt, but no influence on tibial rotation af- ter TKA.