全膝关节置换术下肢力线的影响因素

doi:10.3877/cma.j.issn.1674-134X.2023.03.015

人工全膝关节置换术是目前治疗膝关节疾病的主要术式，在减轻病变关节疼痛、改善关节功能方面具有良好的效果。TKA的目标就是恢复正常膝关节的功能和稳定。但在接受TKA的患者中，有高达20%的患者对术后效果不满意，而下肢力线与关节稳定性、假体松动率、患者满意度密切相关。存在力线不佳的患者通常有一系列症状如：膝关节不稳和膝关节疼痛，严重者会出现早期假体松动。影响下肢力线的因素众多，如股骨外翻截骨角度、股骨外旋截骨角度、确定胫骨冠状位力线的方法、胫骨旋转对线等都对膝关节置换术后下肢力线产生重要影响。下肢力线不佳是膝关节翻修的一个常见指征。本文通过文献回顾围绕对下肢力线的影响因素进行分析，旨在提高关节外科医生的关注。

关键词: 关节成形术，置换，膝, 下肢

Total knee arthroplasty (TKA) is the main operation method in the treatment of knee diseases, which has good effect in reducing the pain of diseased joints and improving joint function. The goal of the TKA is to restore normal knee function and stability. However, 20% of patients receiving TKA are not satisfied with the postoperative results, and the lower limb alignment is closely related to joint stability, prosthesis loosening rate, and patient satisfaction. Patients with poor alignment usually have symptoms such as knee instability, knee pain, and early prosthesis loosening in severe cases. Many factors might affect the force line of lower limb, for example, the osteotomy angle of femoral valgus, the osteotomy angle of femoral external rotation, the method of determining the coronal position of the tibia line of force, and the alignment of the tibia rotation all have important effects on the lower limb line of force after knee replacement. Poor alignment of the lower limb is a common indication of knee revision. Through literature review, the influencing factors of lower limb force line were analyzed to improve the attention of joint surgeons.

Key words: Arthroplasty, replacement, knee, Lower extremity

表1 全膝关节置换术下肢力线的影响因素

Table 1 Influencing factors of lower extremity alignment in total knee arthroplasty

分类	具体因素
股骨侧因素	股骨外翻截骨角度股骨外旋截骨角度
胫骨侧因素	确定胫骨冠状位力线的方法胫骨旋转对线

表1 全膝关节置换术下肢力线的影响因素

Table 1 Influencing factors of lower extremity alignment in total knee arthroplasty

分类	具体因素
股骨侧因素	股骨外翻截骨角度股骨外旋截骨角度
胫骨侧因素	确定胫骨冠状位力线的方法胫骨旋转对线

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Influencing factors of lower extremity alignment in total knee arthroplasty

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Influencing factors of lower extremity alignment in total knee arthroplasty