Kinematic Alignment Tibial Plateau Osteotomy Technique for Oxford Unicompartmental Knee Arthroplasty of Larger Varus Deformities
柳剑 1涂意辉 2刘国彬 3李佳 3黄野1
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作者信息
1. 首都医科大学附属北京积水潭医院保膝外科,北京 102208
2. 同济大学附属杨浦医院骨科,上海 200000
3. 河北医科大学第一医院骨科,河北石家庄 050000
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摘要
目的 本研究力图证实运动学对线截骨应用于具有明显关节外畸形的单髁置换比传统机械对线截骨更具优势.方法 回顾性分析2018年7月至12月首都医科大学附属北京积水潭医院采用牛津单髁置换术治疗的29例具有明显关节外畸形(5 °～10 °胫骨畸形)的患者,其中男3例,女26例;年龄55～81岁,平均(65.8±6.5)岁.13例患者采用运动学对线截骨,16例患者采用机械对线截骨.评价指标包括人口学特点、股骨假体内外翻角(femoral varus-valgus angle,FVA)、胫骨假体内外翻角(tibial varus-valgus angle,TVA)、胫骨组件外侧平台交角(tibial component and lateral plateau angle,CLPA)、股骨胫骨组件交角(components joint angle,CJA)以及牛津膝关节评分(Oxford knee score,OKS)、西安大略和麦克马斯特大学(the Western Ontario and McMaster Universities,WOMAC)评分.结果 患者均经过5年随访.运动学对线组和机械对线组患者的FVA分别为(2.2±2.0)°、(4.7±4.3)°,TVA分别为(2.8±2.7)°、(7.5±2.5)°,CLPA 分别为(1.1±1.5)°、(5.0±2.4)°,CJA 分别为(-0.3±3.6)°、(-4.5±4.7)°,组间各项指标比较差异有统计学意义(P＜0.05),机械对线组参数明显大于运动学对线组.但两组末次随访的OKS和WOMAC评分差异无统计学意义(P＞0.05).结论 采用运动学对线截骨法,单髁假体位置更好,更符合膝关节原有解剖状态.
Abstract
Objective To provide a reference for treating larger extra-articular deformities,given that the Knee Alignment(KA)technique is considered more effective and yields better clinical outcomes than the traditional mechanical alignment(MA)technique in prosthesis orientation.Methods A retrospective analysis was conducted on 29 patients admitted to the Jishuitan Hospital between July and Decber 2018.From a cohort of 74 cemented medial OUKA patients,29 with a large varus deformity of 5 °～10 ° were enrolled,including 3 males and 26 females,aged 55～81 years,mean age(65.8±6.5)years.Among them,13 patients underwent the KA technique,while 16 received the traditional MA technique.Evaluation included socio-demographic characteristics,femoral varus-valgus angle(FVA),tibial varus-valgus angle(TVA),tibial component and lateral plateau angle(CLPA),components joint angle(CJA),Oxford knee score(OKS),and the Western Ontario and McMaster Universities(WOMAC).Results 29 patients were followed 5 years.The results for patients treated with KA and MA techniques showed significant differences:FVA was(2.2±2.0)° vs(4.7±4.3)°(P＜0.05),TVA was(2.8±2.7)° vs(7.5±2.5)°(P＜0.05),CLPA was(1.1±1.5)° vs(5.0±2.4)°(P＜0.05),and CJA was(-0.3±3.6)° vs(-4.5±4.7)°(P＜0.05).All KA group measurements were smaller,indicating significant differences between groups.However,postoperative OKS and WOMAC scores did not differ significantly between groups(P＜0.05).Conclusion A restored knee alignment and kinematics to the pre-prosthetic status.This study found significant improved accuracy for tibial components using the kinematic alignment technique
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