全膝关节置换术中下肢力线对线的研究进展

全膝关节置换术(TKA)可有效治疗终末期退行性骨关节疾病。在TKA中,精确地矫正下肢力线是重要的目标,它影响着关节稳定的维持和关节功能的恢复。该文就TKA中的下肢力线对线研究进展进行综述,分析下肢力线不同对线方法的临床效果及存在的问题,包括影像学对线(冠状位对线、矢状位对线、旋转位对线)和解剖学对线(机械对线、运动力学对线、解剖对线、功能对线),旨在为外科医师在TKA中选择不同的下肢力线对线方案提供参考。     

运动学及机械对线全膝关节置换术早期临床结果对比

目的 探讨传统器械行运动学对线(KA)和机械对线(MA)全膝关节置换术(TKA)的差异和早期临床结果.方法 回顾分析2020年4月至2020年7月因膝骨关节炎在首都医科大学附属北京朝阳医院行TKA手术患者,排除既往下肢骨折病史及下肢严重畸形患者,其中男6例,女30例,平均年龄(68.4±6.0)岁.根据手术方式分为KA...     

3D截骨联合动力学对线在膝内翻全膝关节置换术中的应用

背景:终末期膝骨关节炎的治疗方式以全膝关节置换术(TKA)为主,目前国内针对机械学对线TKA(MA-TKA)和动力学对线TKA(KA-TKA)临床应用的研究报道较少.目的:探讨KA-TKA与MA-TKA治疗膝内翻骨关节炎的术后短期疗效.方法:前瞻性纳入2018年6月至2019年6月收治的符合纳入与排除标准的膝内翻骨关节...     

下肢力线的X线测量及影响因素

下肢力线的测量对疾病的诊断、治疗,预后判断、康复有极其重要的意义,特别是在下肢的矫形外科手术中如下肢延长术、膝内外翻矫正术及髋膝关节置换术,尤其重要。许多研究认为,全膝关节置换(total knee arthrop lasty,TKA)假体的使用寿命在某种程度上取决于术后下肢力线是否合适。然而,临床上往往忽视下肢力线的准确测量与评价而仅做粗略评估。本文就下肢力线X线片测量的有关问题进行综述。1有关概念及常用参考值下肢力线X线测量是指通过一定方法,利用X线片影像,测量下肢的长度、角度等各个力学参数,对比正常和畸形的差异,为临床和科研工作…     

运动力学对线在全膝关节置换术中的应用

全膝关节置换术(TKA)是治疗终末期膝骨关节炎最有效的方式。目前TKA主要参考机械力学对线,但常导致术后膝前疼痛、膝关节活动受限和不稳、假体早期磨损等并发症。近年来有学者提出运动力学对线TKA,旨在恢复膝关节正常生物力学状态。临床研究显示,运动力学对线TKA在提高术后膝关节功能评分、改善膝关节活动度及增加患者满意度等方面较机械力学对线TKA存在优势。该文就运动力学对线在TKA中的应用作一综述。     

功能学对线机器人辅助膝关节置换术研究进展

膝关节的正确对线被认为是决定全膝关节置换术(total knee arthroplasty,TKA)后长期预后的最具影响的因素之一,为了达到正确的对准目标,已经建立了许多不同的对准理念和外科技术,如机械对线(mechanical alignment,MA)、运动学对线(kinematic alignment,KA)和功能学对线(functional alignment,FA)3种对线技术各有特点,MA注重实现肢体的中性对齐,伸展和屈曲时平行且相等的骨间隙;KA以恢复患者的天然关节线为目标,使关节水平和角度正常并使生理性软组织平衡得到改善,努力重现接近正常的膝关节功能;其中随着机器人辅助手术技术而发展起来的功能学对线FA,功能学对线是一种相对较新的对齐理念,它不仅考虑到机体的下肢生理对齐,而且还旨在实现屈伸平衡,同时尊重原生软组织包膜。既做到了术中精确的恢复原位关节线的平面和斜度,又兼顾了软组织平衡,是一种更佳的对线方式。因此,正确构建患者下肢力线,有助于恢复膝关节功能、缓解疼痛症状和延长假体使用寿命具有十分重要的意义。但与传统 TKA 相比,机器人辅助 FA-TKA 手术时间延长,这意味着术后感染发生概率可能性会更大,并且目前大多数研究报道的FA技术都是短期结果,对患者远期疗效尚不清楚,因此,需要长期的研究结果来支持这项技术的应用。     

全膝关节置换术治疗膝骨性关节炎的临床效果

目的观察全膝关节置换术(TKA)对晚期膝骨性关节炎临床疗效和下肢力线的影响。方法对45例膝骨性关节炎患者(57膝)行TKA治疗,采用疼痛VAS评分、膝关节活动度(ROM)、KSS关节及功能评分对膝关节功能进行评价,采用SF-36评分对患者生活质量进行评价,摄双下肢全长片评估下肢力线。结果患者均获得随访,时间48～60(54±4)个月。1例术后5个月发生膝前痛,行股四头肌肌力锻炼后缓解。随访期间所有膝关节假体位置良好,未见骨溶解、假体松动或下沉。末次随访时,VAS评分、ROM、KSS关节及功能评分、SF-36评分、下肢力线与术前比较差异均有统计学意义(P0.01)。结论 TKA是治疗晚期膝骨性关节炎的有效方法,可以缓解疼痛,纠正畸形,恢复下肢力线,改善关节功能,提高患者的生活质量。     

踝关节中心与内外踝体表连线中点关系的X线测量

全膝关节置换(TKA)对下肢力线要求很高,要求在手术前以及手术过程中能够准确的确定下肢的力线,尤其是胫骨的力线,但是目前对于踝关节的中心体表标志的确定国内报道不多。笔者通过对56例标记后踝关节摄前后位X线片后,测量X线片上的标记点与距骨顶部中点之间的距离,并进行统计学分析,以找出确定踝关节中心体表标记方法。     

严重膝关节类风湿关节炎患者下肢力线的测量分析

目的：测量终末期膝关节受累类风湿关节炎（RA）患者下肢力线及膝关节解剖参数并分析畸形来源,为获取全膝关节置换术（TKA）术后理想的下肢力线提供参考。方法：纳入2013年1月至2020年5月因膝RA行TKA患者210例,术前均拍摄负重位双下肢全长X线片,根据下肢力线分为内翻组、中立组、外翻组。测量髋膝踝角（HKA）、机械轴股骨远端外侧角（mLDFA）、机械轴胫骨近端内侧角（mMPTA）及关节线相交角（JLCA）,比较各组间上述参数的差异,并进一步分析畸形来源。结果：严重RA外翻力线占比40.5%(85/210),其次为中立力线占比32.9%(69/210),内翻力线占比26.6%(56/210)。内翻组、中立组、外翻组HKA,mLDFA,mMPTA,JLCA组间比较,差异均有统计学意义。内翻组mMPTA、JLCA及外翻组mLDFA、mMPTA均偏离正常参考范围。结论：严重RA下肢力线分布以外翻膝为主,不同力线分布的膝关节下肢解剖不同。内翻组畸形主要来自于胫骨侧及关节间隙;外翻组畸形主要来自于股骨侧及胫骨侧,充分了解RA患者上述解剖特点有助于精确截骨并获取良好的术后力线。     

下肢力线与内侧半月板损伤修复新进展

半月板和下肢力线在膝关节负荷传递中扮演着重要作用且它们之间有着内在联系。目前对于内侧半月板损伤伴膝内翻患者手术方式的选择,不同的学者有不同的观点。近年来众多学者研究表明术式的选择及术后下肢力线异常与内侧半月板损伤修复愈合及临床效果相关。因此,在诊治每例内侧半月板损伤的患者中,应重视下肢力线评估。本文总结半月板和下肢力线的生物力学功能及之间的内在关系,并分别阐述了内侧半月板后根部损伤、退变性损伤和急性撕裂与下肢力线之间的相互影响,表明下肢力线异常及内侧半月板损伤的患者行截骨矫形术对内侧半月板损伤修复和膝骨性关节炎发生发展的重要作用,以期为临床治疗下肢力线异常的内侧半月板损伤患者提供理论指导。     

Early Outcomes of Kinematic Alignment in Primary Total Knee Arthroplasty: A Meta-Analysis of the Literature

Background

Kinematic alignment in total knee arthroplasty (TKA) seeks to more anatomically align the knee prosthesis to promote more physiological kinematics. However, there are questions about the durability, function, and complication rate of a non–mechanically aligned TKA. Therefore, the purpose of this study is to perform a systematic review and meta-analysis to evaluate early outcomes after kinematic alignment.

Computer-assisted navigation of total knee arthroplasty for osteoarthritis in a patient with severe posttraumatic femoral deformity

In the setting of extraarticular deformities of the knee, total knee arthroplasty (TKA) is difficult, as anatomical abnormalities obstruct identification of alignment landmarks and may preclude the use of traditional instrumentation. The long-term clinical value of computer assistance for TKA is a point of ongoing controversy. Few reports describe the use of computer-assisted orthopedic surgery as a method to decrease alignment outliers in TKA with associated posttraumatic deformities. In this report, a 70-year-old woman who had a severe distal femoral deformity from a previous open fracture underwent computer-assisted TKA for osteoarthritis. The use of a computer-assisted navigation system achieved a high degree of accuracy relative to the desired target alignment and led to improved function in a patient in which standard instrumentation was not feasible.     

Magnitude of Deformity Correction May Influence Recovery of Quadriceps Strength After Total Knee Arthroplasty

Background

Malalignment of the lower extremity is commonly seen in patients with severe osteoarthritis undergoing total knee arthroplasty (TKA) and is believed to play a role in quadriceps strength loss. Deformity correction is typically achieved through surgical techniques to provide appropriate ligamentous balancing. Therefore, this study examined the influence of change in lower extremity alignment on quadriceps strength outcomes after TKA.

A Comparison of Classical and Anatomical Total Knee Alignment Methods in Robotic Total Knee Arthroplasty : Classical and Anatomical Knee Alignment Methods in TKA

The purpose of this study was to compare the clinical and radiological outcomes achieved using classical and anatomical alignment methods in primary total knee arthroplasty (TKA). One hundred and seventeen patients were randomly assigned to undergo robotic-assisted TKA using either the classical (56 patients) or the anatomical alignment method (61 patients). Clinical outcomes including varus and valgus laxities, ROM, HSS and WOMAC scores and radiological outcomes were evaluated after a minimum follow-up of 2 years. Varus and valgus laxity assessments showed no significant inter-group differences (P > 0.05). Moreover, no significant differences were observed in ROM, HSS and WOMAC scores (P > 0.05). We could not find any significant difference in mechanical alignment of the lower limb. The results of this study show that two alignment methods provide comparable clinical and radiological outcomes after primary TKA.     

Asymmetry of the Leg Alignment Affects Trunk Bending in the Coronal Plane After Unilateral Total Knee Arthroplasty

Unilateral total knee arthroplasty (TKA) would produce asymmetric changes of lower extremity in patients with bilateral varus deformity. Our purpose was to investigate whether asymmetry of the leg alignment would affect trunk bending in the coronal plane after unilateral TKA. Twenty patients (mean 76 years old) with bilateral end-stage knee osteoarthritis (OA) participated. Spine images during relaxed standing were obtained on pre- and postoperative day 21. As a result, the shoulder tilted more to the TKA side and the pelvis inclined more to the contralateral OA side. These results suggested that the trunk would bend away from the contralateral OA side after unilateral TKA in patients with bilateral end-stage knee OA and varus deformity. Asymmetry of the leg alignment led to asymmetric trunk bending.     

股骨后髁偏距与股骨后滚距离对后交叉韧带切除旋转平台型假体人工全膝关节置换术后膝关节屈曲度的影响

目的观察采用后交叉韧带(posterior cruciate ligament,PCL)切除旋转平台型假体行人工全膝关节置换术(total knee arthroplasty,TKA)后股骨相对于胫骨的前后运动模式和股骨后髁偏距(posterior condylar offset,PCO)的变化,探讨二者对膝关节屈曲度(range offlexion,ROF)的影响。方法回顾分析2007年1月-2009年6月40例40膝采用PCL切除旋转平台型假体行TKA患者的临床资料。男18例,女22例;年龄56～87岁,平均70.6岁。病程5～14年,平均9.1年。左膝11例,右膝29例。术前膝关节外科学会评分(KSS)为(48.0±5.5)分,ROF为(77.9±9.0)°。手术前后摄X线片测量PCO及股骨后滚距离,以术后最大屈膝时股骨后滚距离和PCO的变化值为自变量,以膝关节最大ROF的改善值为因变量,进行多元逐步回归分析。结果术后切口均Ⅰ期愈合。患者均获随访,随访时间12～19个月,平均14.7个月。末次随访时KSS评分为(91.9±3.7)分,与术前比较差异有统计学意义(t=—77.600,P=0.000);临床效果优良。末次随访时ROF为(102.0±9.3)°,与术前比较差异有统计学意义(t=—23.105,P=0.000)。术前PCO为(31.6±5.5)mm,末次随访时为(30.6±5.9)mm,差异有统计学意义(t=3.565,P=0.001)。术后末次随访时股骨后滚距离为(—1.2±2.1)mm,95%可信区间为—1.9～—0.6 mm;27例(67.5%)发生矛盾性前移,1例(2.5%)位移为0 mm,12例(30.0%)出现后移。经多元逐步回归分析,回归方程成立(R=0.785,R2=0.617,F=61.128,P=0.000),股骨后滚距离可纳入方程(t=7.818,P=0.000),但PCO被剔除(t=1.471,P=0.150),最终得到的回归方程为y=25.587+2.349x。结论 采用PCL切除旋转平台型假体行TKA术后的股胫运动学多表现为屈膝过程中股骨相对胫骨的矛盾性前移,它是限制术后膝关节ROF的因素之一;术后PCO改变与术后ROF无相关性。     

The Impact of Mechanical and Restricted Kinematic Alignment on Knee Anatomy in Total Knee Arthroplasty

Background

Total knee arthroplasty (TKA), aiming at neutral mechanical alignment (MA), inevitably modifies the patient's native knee anatomy. Another option is kinematic alignment (KA), which aims to restore the original anatomy of the knee. The aim of this study was to evaluate the variations in lower limb anatomy of a patient population scheduled for TKA, and to assess the use of a restricted KA TKA protocol and compare the resulting anatomic modifications with the standard MA technique.

Custom-fit total knee arthroplasty: our initial experience in 32 knees

We share our initial experience of total knee arthroplasty (TKA) using customized cutting block technology in 32 TKAs from May 2010 to March 2011. Ten of these patients had prior TKA done on the other side using conventional or navigation-assisted TKA. Customized cutting blocks were generated for each of the knee using preoperative magnetic resonance imaging of knee and long-leg weight-bearing radiographs. At 6 weeks, long-leg radiographs were obtained to evaluate the coronal alignment. There were no adverse intraoperative events. Twenty-nine of the 32 knees had a mechanical axis restored to within 3°° of neutral. Of 10 patients with prior TKA without custom-fit technology, the mean blood loss and the mean skin-to-skin time was found to be lower in knees that had undergone custom-fit TKA. We conclude that this technology can be safely used in most of the cases of osteoarthritis.