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中华关节外科杂志(电子版) ›› 2023, Vol. 17 ›› Issue (04) : 554 -559. doi: 10.3877/cma.j.issn.1674-134X.2023.04.014

综述

运动学与机械学对线在全膝关节置换中的比较研究进展
周晓强, 金宇杰, 李志强, 徐人杰, 张向鑫, 陈广祥, 虞宵()   
  1. 215000 南京医科大学附属苏州医院,苏州市立医院骨科
  • 收稿日期:2022-03-21 出版日期:2023-08-01
  • 通信作者: 虞宵

Comparative research progress of kinematic and mechanical alignment techniques in total knee arthroplasty

Xiaoqiang Zhou, Yujie Jin, Zhiqiang Li, Renjie Xu, Xiangxin Zhang, Guangxiang Chen, Xiao Yu()   

  1. Department of Orthopedics Surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou 215000, China
  • Received:2022-03-21 Published:2023-08-01
  • Corresponding author: Xiao Yu
引用本文:

周晓强, 金宇杰, 李志强, 徐人杰, 张向鑫, 陈广祥, 虞宵. 运动学与机械学对线在全膝关节置换中的比较研究进展[J]. 中华关节外科杂志(电子版), 2023, 17(04): 554-559.

Xiaoqiang Zhou, Yujie Jin, Zhiqiang Li, Renjie Xu, Xiangxin Zhang, Guangxiang Chen, Xiao Yu. Comparative research progress of kinematic and mechanical alignment techniques in total knee arthroplasty[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2023, 17(04): 554-559.

运动学对线(KA)是全膝关节置换术(TKA)中校准下肢力线的一种方法,与机械学对线(MA)不同,该方法旨在恢复患者病变前膝关节的原有运动轨迹。现有文献报道表明,KA-TKA在临床疗效及患者满意度方面优于MA-TKA,且在并发症及假体生存率方面并不逊于MA-TKA。然而,国内关节外科医师对于KA技术由概念到应用这一过程中仍存在一些困惑。本文就KA-TKA及MA-TKA的最新比较研究进展做一综述,以期为关节外科医师提供一定参考。

Kinematic Alignment (KA) is a method of aligning the lower extremity alignment in total knee arthroplasty (TKA), which is different from Mechanical Alignment (MA), which aims to Restore the original motion trajectory of the patient's natural knee joint. Existing literature reports show that KA-TKA is superior to MA-TKA in terms of clinical efficacy and patient satisfaction, and is not inferior to MA-TKA in terms of complications and prosthesis survival. However, some domestic joint surgeons still have some confusion about the process of KA technology from concept to application. This paper reviewed the latest comparative research progress of KA-TKA and MA-TKA, in order to provide some reference for joint surgeons.

表1 KA-TKA的三种手术技术比较
Table 1 Comparison of three surgical techniques for KA-TKA
手术技术 软骨补偿 胫骨截骨 股骨截骨 软组织平衡
传统器械联合卡尺校验 术中软骨全层磨损补偿2 mm,非全层磨损补偿1 mm。 标记外侧胫骨关节面椭圆形长轴,以后叉止点向前做平行线,旋转定位。髓外定位近端参照旋转定位标记线,远端参照术前规划体表标志点安装截骨模板进行截骨。 在传统技术的基础上,不设定外翻角度行股骨远端截骨,四合一截骨导板外旋0°行股骨后髁截骨。截骨块的厚度用卡尺校验。 二次截骨调整,尽可能减少软组织松解。
PSI 术中关节软骨补偿厚度2 mm。 参照与PSI配套的胫骨近端3D模型,刮除胫骨平台的残余软骨,保证相应部位和PSI紧密贴合安放,固定导向器后进行等量截骨。 参照与PSI配套的股骨远端3D模型,刮除股骨远端的残余软骨,保证相应部位和PSI能够紧密贴合安放,固定导向器后进行等量截骨。 较少使用软组织平衡技术。不推荐做广泛的软组织松解。
CAS 术中软骨补偿根据术前截骨计划及术中导航测量制定补偿厚度。 安装红外线示踪器于股骨、胫骨侧。探针收集注册骨性标志,确定髋、膝、踝关节活动中心,测量膝关节内/外翻角度制定出胫骨近端截骨计划,固定胫骨截骨模块进行胫骨截骨。 导航系统收集胫骨平台截骨后的数据分析以后,对安装股骨假体后进行模拟,股骨截骨模板连接探针,计算机导航定位截骨模板的位置后进行股骨截骨。 根据术中计算机测量膝关节间隙数据,决定是否行软组织松解。
图1 KA(运动学对线)及MA(机械学对线)技术TKA(全膝关节置换术)的示意图,右膝接受KA-TKA,左膝接受MA-TKA注:红线-胫骨机械轴线;蓝线-股骨机械轴线;绿线-下肢机械轴线;MA-TKA垂直于胫骨机械轴线进行截骨,保持下肢力线中立,不能完全恢复膝关节自然运动状态,而KA-TKA参考膝关节本身运动轴截骨,保留正常关节线倾斜角度,尽可能恢复膝关节正常生物力学状态
Figure 1 Diagram of KA and MA techniques for TKA, the right knee is KA-TKA, while the left knee is MA-TKA
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