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中华关节外科杂志(电子版) ›› 2020, Vol. 14 ›› Issue (01) : 85 -91. doi: 10.3877/cma.j.issn.1674-134X.2020.01.015

所属专题: 文献

综述

个体化导板辅助全膝关节置换运动学对线技术
温亮1, 王志为1,()   
  1. 1. 100020 北京首都医科大学附属北京朝阳医院骨科
  • 收稿日期:2019-11-23 出版日期:2020-02-01
  • 通信作者: 王志为
  • 基金资助:
    国家自然科学基金(81572180)

Kinematic alignment in total knee arthroplasty with patient-specific instrumentation

Liang Wen1, Zhiwei Wang1,()   

  1. 1. Department of orthopedics, Beijing Chaoyang Hospital, Capita Medical University, Beijing 100020, China
  • Received:2019-11-23 Published:2020-02-01
  • Corresponding author: Zhiwei Wang
  • About author:
    Corresponding author: Wang Zhiwei, Email:
引用本文:

温亮, 王志为. 个体化导板辅助全膝关节置换运动学对线技术[J/OL]. 中华关节外科杂志(电子版), 2020, 14(01): 85-91.

Liang Wen, Zhiwei Wang. Kinematic alignment in total knee arthroplasty with patient-specific instrumentation[J/OL]. Chinese Journal of Joint Surgery(Electronic Edition), 2020, 14(01): 85-91.

大部分自然人群膝关节存在不同程度的生理内翻或外翻,而目前广泛应用的全膝关节置换机械学对线技术并没有充分尊重这种生理变异,而把下肢中立位对线作为对线目标。有学者认为这可能与膝关节置换较低的术后满意率相关。在此背景下出现了一种更为尊重自然膝关节解剖形态的对线方式——运动学对线,由于该方法可能有助于减少术中软组织松解,改善膝关节术后功能并提高病人的满意率,所以近年来受到广泛关注。作者医院是国内最早使用个体化截骨导板进行运动学对线膝关节置换的单位之一。本文总结了该技术的术前规划、手术技巧和陷阱、相关理论以及临床和实验室证据等方面内容,以帮助读者全面理解运动学对线技术。

Most of the population has different degrees of natural varus or valgus knee. Mechanical alignment, the most widely used in total knee arthroplasty, however, does not fully follow this physiological variation. Neutral alignment in coronal plane is considered as goal in mechanical alignment. Some authors speculated that this may have something to do with the lower satisfaction rate after total knee replacement. Kinematic alignment, which focuses more on the articular topography of the natural knee joint, emerged in this context. As this method may reduce soft tissue release, improve knee function and patient satisfaction. Therefore, it has received widespread attention in recent years. The author’s hospital is one of the earliestinstitutions in China to perform kinematic alignment in total knee replacement using patient-specific instrumentation. This review summarized the technology’s preoperative planning, pearls and pitfalls in surgical techniques, relevant basic theories, and clinical evidences, so as to help readers fully understand kinematic alignment.

图1 KA(运动学对线)全膝关节置换的病人选择策略。HKA(髋膝踝角);MPTA(胫骨近端内侧角);PSI(个体化截骨导板);MA(机械对线);aMA(调整性机械力学对线)
图2 术中提高股骨侧PSI(个体化截骨导板)精准度的方法。从侧方观察对比股骨模型-PSI(左)和股骨-PSI(右)之间的间隙(白色箭头)可以保证股骨侧PSI安装精准
图3 提高胫骨侧截骨精度的方法。图A示术中复测胫骨力线;图B示术前小腿X线正位片上测量的胫骨平台关节线的垂线的指向(白色五角星处);对比二者可保证冠状面力线符合手术规划
图4 术前与术后3个月的下肢负重位全长X线片的下肢力线参数对比。术前片(左)和术后3个月片(右)对比影像学测量参数,可见关节线和力线均得到良好重建;mLDFA-机械股骨远端外侧角;JLCA-关节线相交角;MPTA-胫骨近端内侧角
图5 KA(运动学对线)的三轴理论与经典膝关节运动学研究中FFC(屈曲面旋转中心)和EFC(伸直面旋转中心)的对比。图A是KA三轴理论示意图[16],图中的绿点和紫点分别对应KA理论中的胫骨屈曲轴和髌骨屈曲轴;图B中的FFC和EFC分别对应股骨髁屈曲关节面和伸直关节面的圆形拟合的中心
表1 MA和KA的特征总结
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