目的:探讨全膝关节置换术（TKA）中应用新型股骨测量定位器与传统间隙平衡技术对术后膝关节功能、下肢力线变化及术中截骨参数的影响。方法:收集2019年10月~2021年5月在兴安盟人民医院行单侧全膝关节置换术治疗的81例膝关节骨性关节炎患者资料，其中30例使用新型股骨测量定位器进行股骨截骨（研究组），51例使用传统间隙平衡技术进行股量截骨（对照组），比较2组患者在手术时间、股骨截骨时间、术中相关参数（胫骨外侧平台截骨量、股骨远端截骨量、股骨后内髁截骨量、股骨后外髁截骨量、垫片厚度），以及术后视觉模拟评分（VAS）、膝关节活动度、美国膝关节学会评分（KSS）及西安大略和麦克马斯特大学骨关节炎指数评分（WOMAC）和相关影像学参数上的差异。结果:与对照组相比较，研究组术中股骨后内髁截骨量更少（9.0±0.98 vs 9.7±01.0，t=-3.212，P=0.002）、垫片厚度更薄（8.2±0.6 vs 9.4±1.1，t=-4.939，P=0.001）；术后随访1个月时研究组膝关节功能KSS评分（74.8±13.7 vs 66.9±14.5）及WOMAC评分（32.9±7.8 vs 38.9±8.1）表明膝关节功能恢复更快，差异有统计学意义（P<0.05）；2组患者在术后6个月、1年、末次随访[平均时间（20.6±4.2）月]膝关节功能KSS评分及WOMAC评分差异无统计学意义（P>0.05）；与术前相比，2组患者术后下肢股胫角及胫骨平台角均得到显著纠正（P<0.05），但是术后2组患者相比较股胫角及胫骨平台角无显著性差异（P>0.05）。结论:TKA中使用新型股骨测量定位器进行间隙平衡技术截骨，能够实现理想的屈曲间隙平衡并且减少股骨后内髁截骨量，患者术后短期内膝关节功能恢复效果更好。
Clinical application of a novel femoral measuring locator in total knee arthroplasty
Objective:To study the effect of using gap balance technique versus measuring osteotomy technique in total knee arthroplasty on postoperative knee joint function, lower extremity alignment changes, and intraoperative osteotomy parameters in patients with knee osteoarthritis.Methods:From October 2019 to May 2021, 81 patients with knee osteoarthritis who underwent unilateral total knee arthroplasty at Xing'anmeng People's Hospital were included, of which 30 underwent femoral osteotomy using the gap balance technique (using a novel femoral measurement locator; experimental group), and 51 underwent femoral osteotomy using the combined technique of measuring osteotomy and gap balance (control group). The operation time, intraoperative parameters (the amount of osteotomy of the lateral tibial plateau, the amount of osteotomy of the distal femur, the amount of osteotomy of the posterior medial condyle of the femur, the amount of osteotomy of the posterior lateral condyle of the femur, and the thickness of the spacer) were compared between the two groups. Posterior knee pain visual analogue scale (VAS) score, knee range of motion, knee society score (KSS), Western Ontario MacMaste (WOMAC) score, and related imaging parameters were also compared.Results:The osteotomy of the posterior medial condyle of the femur (9.0±0.98 vs 9.7±01.0, t=-3.212, P=0.002) was less and the thickness of the spacer (8.2±0.6 vs 9.4±1.1, t=-4.939, P=0.001) was thinner in the experimental group than in the control group. The KSS (74.8±13.7 vs 66.9±14.5) and WOMAC score (32.9±7.8 vs 38.9±8.1) at the 1-month follow-up were significantly better in the experimental group (P<0.05), suggesting a faster recovery of knee joint function. There was no significant difference in KSS or WOMAC score at 6 months, 1 year, and last follow up after operation between the two groups (P>0.05). The plateau angle was significantly corrected in both groups after operation (P<0.05), but there was no significant difference in the femoral-tibial angle or tibial plateau angle between the two groups after surgery (P>0.05).Conclusion:The use of the new femoral measuring locator for gap balance osteotomy in total knee arthroplasty can achieve ideal flexion gap balance and reduce the amount of osteotomy on the posterior medial condyle of the femur, and the short-term postoperative knee joint function recovery is better.
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