Correlation Between Intraoperative Anterior Stability and Flexion Gap in Total Knee Arthroplasty
Correlation Between Intraoperative Anterior Stability and Flexion Gap in Total Knee Arthroplasty
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全膝关节置换术术中前稳定性与屈曲间隙的相关性
DOI：
10.1016/j.arth.2018.03.030
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发表时间：
2018
期刊：
影响因子：
--
通讯作者：
Matsuda Shuichi
中科院分区：
文献类型：
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作者：
Nakamura Shinichiro;Kuriyama Shinichi;Nishitani Kohei;Ito Hiromu;Murata Koichi;Matsuda Shuichi
背景不稳定性是全膝关节置换术后常见的失败模式。只有几种方法可以通过手术期间施加的固定力来量化前部平移。本研究的目的是用新的装置测量前移量，并分析前移量与关节间隙之间的关系。方法对 50 个患有内侧骨关节炎的膝关节进行了使用后稳定植入物的手术。手术期间，使用试验植入物在膝关节屈曲 90° 时测量前向平移，施加 70 N 的牵引力。使用张量装置测量关节间隙，在屈曲时施加 178 N 的牵引力。计算前移量与关节间隙和松弛度之间的皮尔逊相关系数。结果手术期间平均前移量为 8.5 毫米（标准差 [SD] = 3.6 毫米）。内侧间隙（相关系数[r] = 0.30）、内侧松弛度（r = 0.33）和中心松弛度（r = 0.29）与前平移呈正相关，前平移随着关节间隙越大或松弛度越大而增加。结论通过向胫骨施加前向力，用新装置测量前平移，并分析前平移与关节间隙和松弛度之间的相关性。较大的内侧间隙和较大的内侧松弛与较大的前移相关，这可能导致不稳定的症状。外科医生在手术过程中应注意屈曲时内侧结构的张力，避免内侧过度释放。
BackgroundInstability is a common failure mode after total knee arthroplasty. There have been only a few methods to quantify anterior translation with fixed forces applied during surgery. The purpose of the study was to measure the anterior translation with a new device and to analyze the relationships between the amount of anterior translation and the joint gaps.MethodsFifty knees with medial osteoarthritis underwent surgery using a posterior-stabilized implant. During surgery, measurement of anterior translation was performed at 90° of knee flexion with a trial implant, applying a traction force of 70 N. The joint gap was measured using a tensor device, applying a distraction force of 178 N in flexion. The Pearson correlation coefficient was calculated between anterior translation and joint gaps and laxity.ResultsOn average, anterior translation during surgery was 8.5 mm (standard deviation [SD] = 3.6 mm). Medial gap (correlation coefficient [r] = 0.30), medial laxity (r = 0.33), and center laxity (r = 0.29) had a positive correlation with anterior translation, and anterior translation increased with larger joint gap or greater laxity.ConclusionAnterior translation was measured with a new device by applying the anterior force to the tibia, and the correlations between anterior translation and joint gap and laxity were analyzed. A larger medial gap and greater medial laxity were correlated with greater anterior translation, which could cause symptomatic feelings of instability. Surgeons should pay attention to the tension of medial structures in flexion and avoid excessive medial release during surgery.