人工全膝关节置换术截骨方法改良及截骨测量

目的：对人工全膝关节置换术股骨截骨方法进行了改良，通过截骨厚度的测量和临床随访对改良截骨方法的手术效果进行评估。方法：采用改良股骨截骨模板，股骨后髁截骨厚度增加3mm。对81例行人工全膝关节置换术患者术中的各项截骨厚度进行测量，分为膝内翻和膝外翻两组，对截骨厚度和假体厚度进行比较分析。术后平均随访27．1个月。结果：81例患者的屈膝间隙和伸膝间隙平均截骨厚度均小于假体厚度。膝内翻和膝外翻组间除股骨后内侧髁截骨厚度外，各项测量值间均存在显著差异。膝内翻组内侧屈伸膝间隙截骨厚度和假体厚度差异最大；膝外翻组外侧屈伸膝间隙截骨厚度和假体厚度差异最大。术后关节活动度良好，仅7．4％病例存在轻度屈膝不稳，无中、重度不稳。结论：本文对股骨截骨模板的改良是可行的，增加3mm的截骨厚度不会出现过度截骨和屈膝不稳的情况。

Modification of femoral resection and measurement of resection heights in primary total knee arthroplasty

Objective A modified femoral resection method was introduced for total knee replace-ment.Clinical effect of this modification was evaluated by measurement of the resection heights and long-term follow up.Methods The femoral resection guide was modified and the resection of posterior femoral condyle was increased 3mm.In 81 knees undergoing total knee replacement,the thickness of various cuts were measured and compared with the height of the implants.The mean values of these measurements were calculated,and comparisons were made according to the mechanical axis.The average follow-up time was 27.1 months.Results On average,the thickness of bone resection in both the flexion and the extension gap was smaller than the thickness of the prosthesis.Except the posterior femoral condyle,there were significant differences between the varus and valgus groups in all categories.In the varus group,the greatest differences between the resection and implants heights coccurred medially.In the valgus group,the greatest differences between the resection and implants heights occurred laterally.Postoperatively,the range of motion was good,only 7.4% of patients retained slight instability and none had moderate or severe instability.Conclusions The modification is feasible,and it does not result in over-resection and flexion instability.