人工全膝关节置换术中的两种截骨技术的系统综述

目的：人工全膝关节置换术（Total Knee Arthroplasty，TKA）中用于屈伸间隙和内外侧间隙平衡的截骨技术主要有间隙平衡法（Gap Balancing; GB）和测量截骨法（Measured Resection; MR）两种，而两种技术的优劣一直存在争议,本研究对两种技术进行了比较。方法:本研究通过系统回顾两种截骨技术的随机对照研究和队列研究，比较其各自的优劣。结果：纳入5篇RCT和10篇队列研究，结果表明GB组相对于MR组能够获得更好的内外侧间隙的平衡，但是，其关节线较MR组明显升高。而在关节活动度、下肢力线、截骨量、功能评分和并发症等方面，两者无明显差异。结论：GB组相对于MR组能够获得更好的内外侧间隙的平衡，但是关节线明显提高。两者在临床结果方面无明显差异，在临床实践中，应根据患者实际情况和医生熟悉的手术技术进行选择。

Comparison Between Gap Balancing and Measured Resection for Total Knee Arthroplasty: a Systematic Review

Objective: Two surgical techniques, Gap Balancing (GB) and Measured Resection (MR), can be used for bone resection to get symmetric balanced flexion and extension gaps. Controversy existing between the two techniques, hereby we conducted the systematic review to compare them. Methods: RCTs and cohort studies related with the techniques were used to compare the advantages and disadvantages in this study. Results: 5 RCTs and 10 cohort studies were included. The results showed that, compared with measured resection, gap balancing provided better symmetric balanced flexion and extension gaps and worse result about joint-line maintenance. There was no significant difference in Range of Motion (ROM), alignment, bone resection, complications, function and quality-of-life outcomes. Conclusion: The technique of gap balancing sacrificed joint-line maintenance to improve gap symmetry. As there was no significant difference in function and quality-of-life outcomes, doctors should choose the technique according to the different knees and personal practice.