测量截骨联合间隙平衡技术在全膝关节置换股骨外旋截骨中的应用

文题释义：股骨外旋截骨：因为胫骨平台正常解剖有大约3°的内倾角，在全膝关节置换术中平台截骨面是垂直于下肢力线的，故相应的股骨髁假体需要放置在外旋3°的位置，这样才可以保证屈曲间隙的内外侧平衡和良好的髌骨轨迹。股骨假体旋转不良将会导致膝前痛、膝关节屈曲失衡、活动受限、髌骨轨迹异常等问题。测量截骨：胫骨和股骨截骨相对独立，完成截骨后再进行软组织平衡以达到对称且平衡的屈伸间隙。测量截骨法参考股骨解剖标记来确定股骨假体旋转，这些解剖参考物主要是股骨通髁线，后髁连线和Whiteside线。这种截骨方法容易操作，手术时间较短，但依赖于正常的解剖标识。背景：全膝关节置换是治疗膝关节终末期疾病的有效方法，经典截骨方法包括间隙平衡技术和测量截骨技术。这2种技术各有其优缺点，术中将两者混合使用以期能取长补短，使关节置换效果达到最佳化。目的：探讨测量截骨和间隙平衡技术联合使用在全膝关节置换股骨外旋截骨中的应用操作以及早期疗效。方法：纳入2016年9月至2018年12月采用伸直间隙优先法，术中联合使用测量截骨和间隙平衡技术进行全膝关节置换的患者30例，男4例，女26例，年龄46-81岁；骨关节炎伴膝内翻24例，膝外翻2例；类风湿性关节炎伴膝外翻4例。所有患者对治疗方案均知情同意，且得到医院伦理委员会批准。术前和术后末次随访采用疼痛目测类比评分、美国特种外科医院膝关节评分、解剖股胫角和膝关节活动度评价疗效。结果与结论：①术后切口均Ⅰ期愈合，无感染、无血管神经损伤、无下肢深静脉血栓形成及假体周围骨折等早期并发症发生；②30例患者均获得随访，随访时间 6-30个月；③患者术后末次随访疼痛目测类比评分、美国特种外科医院膝关节评分、膝关节活动度及股胫角均较术前显著改善(P < 0.05)；④提示医生需对全膝关节置换中测量截骨和间隙平衡技术熟悉掌握，基于患者的具体情况在术中联合使用，以期获得更佳的软组织平衡和假体位置。联合技术易于掌握，可以使用传统截骨工具操作，从而取得良好的近期疗效。ORCID: 0000-0002-6122-082X(陆斌)中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Combination of measured resection and gap balancing technique used in femoral component rotation in total knee arthroplasty

BACKGROUND:Total knee arthroplasty is effective in managing end-stage knee disease.Measured resection and gap balancing are two different techniques.Both of two have advantages and disadvantages.A technique has been developed that combines the benefits of measured resection and gap balancing to optimize the clinical effect of total knee arthroplasty.OBJECTIVE:To evaluate the operation and early clinical effect in total knee arthroplasty about the combination of measured resection and gap balancing technique used in femoral component rotation.METHODS:Totally 30 patients were treated with the combination of measured resection and gap balancing technique in total knee arthroplasty from September 2016 to December 2018,including 4 males and 26 females,at the age of 46-81 years.There were 24 cases of osteoarthritis with varus and 2 cases of osteoarthritis with valgus.There were 4 cases of rheumatoid arthritis with valgus.All patients signed the informed consent.This study was approved by the Hospital Ethics Committee.Effects were evaluated by Visual Analogue Scale,Hospital for Special Surgery score,femorotibial angle and range of motion before surgery and during final follow-up.RESULTS AND CONCLUSION:(1)The incision healed in the first stage after operation.No early complications occurred,such as infection,vascular nerve injury,deep venous thrombosis of the lower extremities and periprosthetic fracture.(2)Totally 30 patients were followed up for 6-30 months.(3)Visual Analogue Scale,Hospital for Special Surgery score,range of motion and femorotibial angle were improved during final follow-up compared with those before surgery(P<0.05).(4)Surgeons should be familiar with measured resection and gap balancing technique in total knee arthroplasty,and then use the combination of two techniques based on the specific situation of patients to obtain better soft tissue balance and prosthesis position.The combination technique is easy to master and can be operated with traditional osteotomy tools.Thus,good short-term effect can be achieved.