Gap Balancing versus Measured Resection Technique for Total Knee Arthroplasty
Gap Balancing versus Measured Resection Technique for Total Knee Arthroplasty
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DOI：
10.1007/s11999-009-1112-3
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发表时间：
2010-01-01
影响因子：
4.2
通讯作者：
Sharma, Adrija
中科院分区：
文献类型：
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作者：
Dennis, Douglas A.;Komistek, Richard D.;Sharma, Adrija
目前采用多种不同的手术技术进行全膝关节置换术（TKA）。我们比较了使用测量切除或间隙平衡技术进行的膝关节置换术，以确定两种手术技术是否提供上级冠状面稳定性（通过评估股骨髁抬离的发生率和幅度进行测量）。我们使用测量的切除技术进行了40例TKA（20例PCL保留和20例PCL替代），并使用间隙平衡植入了20例PCL替代TKA。所有受试者在进行深膝弯曲时均进行了X线透视分析。冠状面不稳定（股骨髁提离）的发生率，然后使用三维模型拟合技术确定。对于使用测量切除进行的PCL保留和替代TKA组，抬离大于0.75 mm的发生率分别为80%（最大值，2.9 mm）和70%（最大值，2.5 mm），而间隙平衡组为35%（最大值，0.88 mm）。使用测量截骨的PCL保留和替代TKA中，60%和45%的患者发生了大于1 mm的抬离，而间隙平衡组中没有发生抬离。使用间隙平衡技术旋转股骨部件可获得更好的冠状面稳定性，我们认为这将改善功能性能并减少聚乙烯磨损。
Multiple differing surgical techniques are currently utilized to perform total knee arthroplasty (TKA). We compared knee arthroplasties performed using either a measured resection or gap balancing technique to determine if either operative technique provides superior coronal plane stability as measured by assessment of the incidence and magnitude of femoral condylar lift-off. We performed 40 TKA using a measured resection technique (20 PCL-retaining and 20 PCL-substituting) and 20 PCL-substituting TKA were implanted using gap balancing. All subjects were analyzed fluoroscopically while performing a deep knee bend. The incidence of coronal instability (femoral condylar lift-off) was then determined using a 3-D model fitting technique. The incidence of lift-off greater than 0.75 mm was 80% (maximum, 2.9 mm) and 70% (maximum, 2.5 mm) for the PCL-retaining and substituting TKA groups performed using measured resection versus 35% (maximum, 0.88 mm) for the gap-balanced group. Lift-off greater than 1 mm occurred in 60% and 45% of the PCL-retaining and-substituting TKA using measured resection versus none in the gap-balanced group. Rotation of the femoral component using a gap balancing technique resulted in better coronal stability which we suggest will improve functional performance and reduce polyethylene wear.