运动学对线与机械对线全膝关节置换早期临床结果比较

doi:10.3877/cma.j.issn.1674-134X.2022.04.006

目的

探讨并对比分析应用专用工具的运动学对线全膝关节置换和机械对线全膝关节置换的早期临床结果。

方法

回顾性分析2019年3月至2021年3月间，在首都医科大学附属北京朝阳医院因膝骨关节炎行单侧全膝关节置换术，术后随访时间大于3个月且随访资料完整的患者，排除类风湿性关节炎等炎性关节病、髌股关节严重对位不良以及既往有膝关节侧副韧带或后交叉韧带损伤的患者；按对线方法分为专用工具运动学对线全膝关节置换(KA-TKA)组和机械对线全膝关节置换(MA-TKA)组，记录手术前后髋－膝－踝(HKA)角度，术前及术后3个月的膝关节临床评分(KS-C)和膝关节功能评分(KS-F)，术后3个月的遗忘关节评分(FJS)，采用独立样本t检验行统计学分析。

结果

共有162例患者纳入研究，其中KA-TKA组82例，MA-TKA组80例。两组患者术后HKA差异无统计学意义(P>0.05)；术后3个月KA-TKA组患者的KS-C评分(t＝2.259)、KS-F评分(t＝1.994)和FJS评分(t＝2.945)均高于MA-TKA组，两组间差异有统计学意义(均为P<0.05)。

结论

KA-TKA与MA-TKA相比，术后下肢力线相似，具有更好的临床评分表现和更高的膝关节功能表现，以及更高的FJS评分。

关键词: 骨关节炎，膝, 关节成形术，置换

Objective

To explore and compare the early clinical results between kinematic alignment using special tools and mechanical alignment in total knee arthroplasty.

Methods

A retrospective analysis was performed on patients who underwent unilateral total knee arthroplasty due to knee osteoarthritis with a follow-up time of more than three months and complete follow-up data.in Beijing Chaoyang Hospital, Capital Medical University from March 2019 to March 2021. The patients with inflammatory arthropathy such as rheumatoid arthritis, severe misalignment of patellofemoral joint, and previous knee collateral ligament or posterior cruciate ligament injury were excluded. According to alignment method, patients were divided into special tools kinematically aligned total knee arthroplasty (KA-TKA) group and mechanically aligned total knee arthroplasty (MA-TKA) group. The hip-knee-ankle (HKA) angle before and after the surgery, the knee joint clinical score (KS-C), the knee joint functional score (KS-F) before and three months after the surgery were recorded, as well as the postoperative forgotten joint score (FJS). Independent sample t test was used to compare the data.

Results

A total of 162 patients were enrolled, including 82 in the KA-TKA group and 80 in the MA-TKA group. There was no statistically significant difference in the postoperative HKA angle between the two groups (P>0.05). Three months after the surgery, the KS-C score (t=2.259), KS-F score (t=1.994) and FJS score (t=2.945) in the KA-TKA group were higher than those in the MA-TKA group, the differences between the two groups were statistically significant (all P<0.05).

Conclusion

KA-TKA has similar postoperative lower limb alignment, better clinical performance and higher knee function, and a higher FJS compared with MA-TKA.

Key words: Osteoarthritis, knee, Arthroplasty, replacement

图1 股骨远端髓内定位导板及插片的放置和固定。图A示定位板在内外翻平面上可进行±12°调整；图B~C示预置的2 mm厚度插片，紧贴股骨远端骨面进行定位并补偿软骨磨损

图3 胫骨侧髓外定位装置及应用。图A为垂直胫骨机械轴线放置髓外定位杆；图B为在原有的髓外定位杆上加装的与切骨导板相连接的角度卡盘，调整胫骨的切骨内外翻方向与原有的关节线方向相一致；图C为角度卡盘标尺，示可以在±8°的范围内进行内外翻调整

表1 KA-TKA与MA-TKA组患者术前资料比较(±s)

分组	例数	年龄(岁)	BMI(kg/m²)	术前HKA(°)	术前KS-C	术前KS-F
KA-TKA组	82	70±7	27±3	8±4	52±18	34±20
MA-TKA组	80	71±7	27±4	7±4	50±16	30±16
t值		0.924	0.243	0.301	0.570	1.331
P值		>0.05	>0.05	>0.05	>0.05	>0.05

表1 KA-TKA与MA-TKA组患者术前资料比较(±s)

分组	例数	年龄(岁)	BMI(kg/m²)	术前HKA(°)	术前KS-C	术前KS-F
KA-TKA组	82	70±7	27±3	8±4	52±18	34±20
MA-TKA组	80	71±7	27±4	7±4	50±16	30±16
t值		0.924	0.243	0.301	0.570	1.331
P值		>0.05	>0.05	>0.05	>0.05	>0.05

表2 KA-TKA与MA-TKA组患者术后3月随访资料比较(±s)

分组	例数	术后HKA(°)	术后3个月KS-C	术后3个月KS-F	术后3个月FJS
KA-TKA组	82	2.7±1.9	78.9±7.7	75.9±10.3	74.2±9.9
MA-TKA组	80	2.3±1.4	76.2±7.3	72.7±9.9	69.7±9.0
t值		1.528	2.259	1.994	2.945
P值		>0.05	0.025	0.048	0.004

表2 KA-TKA与MA-TKA组患者术后3月随访资料比较(±s)

分组	例数	术后HKA(°)	术后3个月KS-C	术后3个月KS-F	术后3个月FJS
KA-TKA组	82	2.7±1.9	78.9±7.7	75.9±10.3	74.2±9.9
MA-TKA组	80	2.3±1.4	76.2±7.3	72.7±9.9	69.7±9.0
t值		1.528	2.259	1.994	2.945
P值		>0.05	0.025	0.048	0.004

[1]	Singh JA, Yu S, Chen L, et al. Rates of total joint replacement in the United States: future projections to 2020-2040 using the National Inpatient Sample[J]. J Rheumatol, 2019, 46(9): 1134-1140.
[2]	Young SW, Walker ML, Bayan A, et al. The Chitranjan S. Ranawat Award: no difference in 2-year functional outcomes using kinematic versus mechanical alignment in TKA: a randomized controlled clinical trial[J]. Clin Orthop Relat Res, 2017, 475(1): 9-20.
[3]	Jeffery RS, Morris RW, Denham RA. Coronal alignment after total knee replacement[J]. J Bone Joint Surg Br, 1991, 73(5): 709-714.
[4]	Ritter MA, Faris PM, Keating EM, et al. Postoperative alignment of total knee replacement. Its effect on survival[J]. Clin Orthop Relat Res, 1994, (299): 153-156.
[5]	Bourne RB, Chesworth BM, Davis AM, et al. Patient satisfaction after total knee arthroplasty: who is satisfied and who is not？[J]. Clin Orthop Relat Res, 2010, 468(1): 57-63.
[6]	Niki Y, Nagai K, Sassa T, et al. Comparison between cylindrical axis-reference and articular surface-reference femoral bone cut for total knee arthroplasty[J]. Knee Surg Sports Traumatol Arthrosc, 2017, 25(12): 3741-3746.
[7]	Taunton MJ. What's new in adult reconstructive knee surgery[J]. J Bone Joint Surg Am, 2019, 101(2): 103-111.
[8]	Dossett HG, Estrada NA, Swartz GJ, et al. A randomised controlled trial of kinematically and mechanically aligned total knee replacements: two-year clinical results[J]. Bone Joint J, 2014, 96－B(7): 907-913.
[9]	Howell SM, Papadopoulos S, Kuznik KT, et al. Accurate alignment and high function after kinematically aligned TKA performed with generic instruments[J]. Knee Surg Sports Traumatol Arthrosc, 2013, 21(10): 2271-2280.
[10]	Howell SM, Papadopoulos S, Kuznik K, et al. Does varus alignment adversely affect implant survival and function six years after kinematically aligned total knee arthroplasty？[J]. Int Orthop, 2015, 39(11): 2117-2124.
[11]	Howell SM. Calipered kinematically aligned total knee arthroplasty: an accurate technique that improves patient outcomes and implant survival[J]. Orthopedics, 2019, 42(3): 126-135.
[12]	Faisal A, Ng SC, Goh SL, et al. Knee cartilage segmentation and thickness computation from ultrasound images[J]. Med Biol Eng Comput, 2018, 56(4): 657-669.
[13]	Howell M RD, Hull M. Kinematic alignment in total knee arthroplasty. Definition, history, principle, surgical technique, and results of an alignment option for TKA[J]. Arthropaedia, 2014, 1: 44-53.
[14]	Howell SM, Kuznik K, Hull ML, et al. Results of an initial experience with custom-fit positioning total knee arthroplasty in a series of 48 patients[J]. Orthopedics, 2008, 31(9): 857-863.
[15]	Weber P, Gollwitzer H. Kinematic alignment in total knee arthroplasty[J]. Oper Orthop Traumatol, 2021, 33(6): 525-537.
[16]	Rivière C, Villet L, Jeremic D, et al. What you need to know about kinematic alignment for total knee arthroplasty[J/OL]. Orthop Traumatol Surg Res, 2021, 107(1S): 102773. DOI: 10.1016/j.otsr.2020.102773.
[17]	An V, Twiggs J, Leie M, et al. Kinematic alignment is bone and soft tissue preserving compared to mechanical alignment in total knee arthroplasty[J]. Knee, 2019, 26(2): 466-476.
[18]	马德思，王志为，温亮，等．运动学及机械对线全膝关节置换术早期临床结果对比[J/CD]．中华关节外科杂志(电子版)，2021，15(2)：163-170.
[19]	Matsumoto T, Takayama K, Ishida K, et al. Intraoperative Soft tissue balance/kinematics and clinical evaluation of modified kinematically versus mechanically aligned total knee arthroplasty[J]. J Knee Surg, 2020, 33(8): 777-784.
[20]	MacDessi SJ, Griffiths-Jones W, Chen DB, et al. Restoring the constitutional alignment with a restrictive kinematic protocol improves quantitative soft-tissue balance in total knee arthroplasty: a randomized controlled trial[J]. Bone Joint J, 2020, 102－B(1): 117-124.
[21]	McEwen PJ, Dlaska CE, Jovanovic IA, et al. Computer-assisted kinematic and mechanical axis total knee arthroplasty: a prospective randomized controlled trial of bilateral simultaneous surgery[J]. J Arthroplasty, 2020, 35(2): 443-450.
[22]	Yeo JH, Seon JK, Lee DH, et al. No difference in outcomes and gait analysis between mechanical and kinematic knee alignment methods using robotic total knee arthroplasty[J]. Knee Surg Sports Traumatol Arthrosc, 2019, 27(4): 1142-1147.
[23]	Liu B, Feng C, Tu C. Kinematic alignment versus mechanical alignment in primary total knee arthroplasty: an updated meta-analysis of randomized controlled trials[J/OL]. J Orthop Surg Res, 2022, 17(1): 201. DOI: 10.1186/s13018-022-03097-2.
[24]	Gao ZX, Long NJ, Zhang SY, et al. Comparison of kinematic alignment and mechanical alignment in total knee arthroplasty: a meta-analysis of randomized controlled clinical trials[J]. Orthop Surg, 2020, 12(6): 1567-1578.
[25]	Yoon JR, Han SB, Jee MK, et al. Comparison of kinematic and mechanical alignment techniques in primary total knee arthroplasty: a meta-analysis[J/OL]. Medicine (Baltimore), 2017, 96(39): e8157. DOI: 10.1097/MD.0000000000008157.
[26]	Li Y, Wang S, Wang Y, et al. Does kinematic alignment improve short-term functional outcomes after total knee arthroplasty compared with mechanical alignment? A systematic review and meta-analysis[J]. J Knee Surg, 2018, 31(1): 78-86.
[27]	Luo Z, Zhou K, Peng L, et al. Similar results with kinematic and mechanical alignment applied in total knee arthroplasty[J]. Knee Surg Sports Traumatol Arthrosc, 2020, 28(6): 1720-1735.
[28]	Calliess T, Bauer K, Stukenborg-Colsman C, et al. PSI kinematic versus non-PSI mechanical alignment in total knee arthroplasty: a prospective, randomized study[J]. Knee Surg Sports Traumatol Arthrosc, 2017, 25(6): 1743-1748.
[29]	Kaneda K, Niki Y, Kuroyanagi Y, et al. Kinematically aligned total knee arthroplasty using medial pivot knee prosthesis enhances medial pivot motion: a comparative kinematic study with mechanically aligned total knee arthroplasty[J]. Arthroplast Today, 2022, 13: 24-28.
[30]	Nedopil AJ, Singh AK, Howell SM, et al. Does calipered kinematically aligned TKA restore native left to right symmetry of the lower limb and improve function？[J]. J Arthroplasty, 2018, 33(2): 398-406.
[31]	Abdel MP, Ollivier M, Parratte SA, et al. Effect of postoperative mechanical axis alignment on survival and functional outcomes of modern total knee arthroplasties with cement a concise follow-up at 20 years[J]. J Bone Joint Surg Am, 2018, 100(6): 472-478.
[32]	Nedopil AJ, Howell SM, Hull ML. What mechanisms are associated with tibial component failure after kinematically-aligned total knee arthroplasty？[J]. Int Orthop, 2017, 41(8): 1561-1569.
[33]	Howell SM, Shelton TJ, Hull ML. Implant survival and function ten years after kinematically aligned total knee arthroplasty[J]. J Arthroplasty, 2018, 33(12): 3678-3684.

[1]	庄若语, 杭明辉, 李文华, 张霆, 侯炜. 膝骨关节炎半定量磁共振评分研究进展[J/OL]. 中华关节外科杂志(电子版), 2024, 18(04): 545-552.
[2]	丁莹莹, 宋恺, 金姬延, 田华. 机器人辅助膝髋关节置换术后精细化临床护理[J/OL]. 中华关节外科杂志(电子版), 2024, 18(04): 553-557.
[3]	孔德铭, 刘铮, 李睿, 钱文伟, 王飞, 蔡道章, 柴伟. 人工智能辅助全髋关节置换三维术前规划准确性评价[J/OL]. 中华关节外科杂志(电子版), 2024, 18(04): 431-438.
[4]	赵飞鸿, 陈颖杰, 林静芳, 郑晓春, 廖燕凌. 超声引导下周围神经阻滞对髋膝关节置换术后恢复的影响[J/OL]. 中华关节外科杂志(电子版), 2024, 18(04): 457-468.
[5]	任俊筱, 浦路桥, 王志豪, 施洪鑫, 刘爱峰, 齐保闯, 徐永清, 李川. 机器人辅助全膝关节置换术的临床疗效对照研究[J/OL]. 中华关节外科杂志(电子版), 2024, 18(04): 469-476.
[6]	李志文, 李远志, 李华, 方志远. 糖皮质激素治疗膝骨关节炎疗效的网状Meta分析[J/OL]. 中华关节外科杂志(电子版), 2024, 18(04): 484-496.
[7]	许亚龙, 巩栋, 陈晓涛. 超前镇痛在全膝关节置换术中的研究进展[J/OL]. 中华关节外科杂志(电子版), 2024, 18(04): 517-523.
[8]	刘晓凡. 老年股骨头坏死髋关节置换术后康复应用多维度干预[J/OL]. 中华关节外科杂志(电子版), 2024, 18(03): 314-319.
[9]	王冰, 孙海宁, 于秀淳, 周珂, 翟凯, 苗族康. 膝骨关节炎的活动衬垫型单髁置换疗效与假体生存率[J/OL]. 中华关节外科杂志(电子版), 2024, 18(03): 337-345.
[10]	张江礼, 刘金辉, 潘西庆, 刘光源, 范虓. 全膝关节置换应用智能辅助手术导航系统治疗膝骨关节炎[J/OL]. 中华关节外科杂志(电子版), 2024, 18(03): 346-351.
[11]	杨士慷, 曹光磊. 膝骨关节炎三种术式患者满意度的术前影响因素[J/OL]. 中华关节外科杂志(电子版), 2024, 18(03): 390-397.
[12]	刘正宇, 刘春风, 王振. 改良后外侧入路半髋置换治疗股骨颈骨折的早期疗效[J/OL]. 中华关节外科杂志(电子版), 2024, 18(03): 409-413.
[13]	王啸, 李一凡, 沈素红, 曹国瑞, 史小涛, 袁彦浩, 谭红略. 全膝关节置换术后早期下肢深静脉血栓形成的时空规律[J/OL]. 中华关节外科杂志(电子版), 2024, 18(03): 414-420.
[14]	卢国良, 潘耀成. 比较不同类型假体用于骨质疏松症的老年股骨颈骨折[J/OL]. 中华关节外科杂志(电子版), 2024, 18(02): 277-279.
[15]	卢芳连, 汤莉, 何河北, 李建云, 欧栓机, 陈燕, 陈娇妹. 责任护士主导的疼痛管理在膝关节置换术后的应用[J/OL]. 中华关节外科杂志(电子版), 2024, 18(02): 285-289.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

Early clinical outcomes comparison of kinematic and mechanical alignments in total knee arthroplasty

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

Early clinical outcomes comparison of kinematic and mechanical alignments in total knee arthroplasty