人工膝关节翻修术后关节线位置的变化及原因分析

背景：人工膝关节翻修术后的关节线位置是影响术后效果的重要因素之一。目的：探讨人工膝关节翻修手术技术对关节线位置改变的影响及其原因。方法：回顾性分析2012年1月至2012年12月行人工膝关节翻修手术的31例患者的X线片资料及临床资料,测量术前、术后关节线的位置,分析关节线位置改变情况与股骨前后径变化和是否使用股骨远端金属加强垫块的关系。结果：本组患者人工膝关节翻修术后关节线位置较术前平均改变（1.2±3.4）mm（-4.0~8.7 mm）;关节线位置改变情况与股骨前后径变化呈线性相关;使用与未使用股骨远端金属加强垫块患者的关节线位置较术前平均改变（-0.54±2.39）mm和（2.59±3.55）mm,均有统计学差异（P〈0.01）,使用股骨远端金属加强垫块能更精确重建关节线。结论：目前,人工膝关节翻修手术技术可以重建膝关节关节线,但需要注意股骨大小的重建和骨缺损的处理。

Reasons of joint line variance after total knee revision

Background： The position of the joint line is one of the important parameters to evaluate the outcome of knee revision. Objective： To analyze the effect of surgical technique of knee revision on the joint line variance. Methods： A retrospective analysis was conducted in 31 patients undergoing total knee revision between January 2012 and December 2012. Preoperative and postoperative joint lines were measured. The correlation between the change of joint line and the distal femur anterior posterior dimension and the use of distal femur metal augment were analyzed. Results： The overall change of the knee joint line was （1.2±3.4）mm （-4.0-8.7 mm） compared to the preoperative ones. There was linear correlation between the position of knee joint and distal femur anterior posterior dimension. The change of the knee joint line was （-0.54±2.39）mm and （2.59±3.55）mm with and without use of distal femur metal augment after sur- gery （P〈0.01）. Conclusions： The knee joint line can be reconstructed by total knee revision, but more attention should be paid to the distal femur anterior posterior dimension and the bone defect.