Sagittal gap balancing with the concept of a single radius femoral component in posterior cruciate sacrificing total knee arthroplasty with patient-specific instrumentation
Sagittal gap balancing with the concept of a single radius femoral component in posterior cruciate sacrificing total knee arthroplasty with patient-specific instrumentation
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DOI：
10.1007/s00264-014-2536-2
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发表时间：
2015-04-01
影响因子：
2.7
通讯作者：
Hananouchi, Takehito
中科院分区：
文献类型：
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作者：
Hananouchi, Takehito
目的在全膝关节置换术（TKA）中，股骨假体试模放置和髌骨复位时的股骨间隙平衡（屈曲和伸展间隙之间的关系）很重要，但并不容易。本研究的目的是调查（1）当先前建议的单半径股骨部件三维计划时，屈曲和伸展间隙是否相等（其矢状中心与膝关节运动的屈伸轴相匹配）是否使用患者专用器械（PSI）执行，以及（2）PSI是否具有良好的准确性，方法对12例膝关节行后交叉韧带牺牲（Posterior cruciate ligament，PS）TKA。使用患者的术前计算机断层扫描（CT）图像，制造PSI以适合膝关节的骨表面，并同时将术前计划转移到手术室。PSI截骨后，计算膝关节屈曲和伸展时的间隙测量值。结果所有病例的屈曲间隙（平均19.1mm）大于伸展间隙（平均12.3mm）。术前和术后对线之间的角度差异在所有cases.Conclusions虽然PSI执行术前计划具有良好的准确性，屈曲间隙总是大于伸展间隙。这一发现表明，外科医生在PS-TKA中的目标可能不是屈曲和伸展间隙相等。
Purpose Sagittal gap balancing (relation between flexion and extension gaps) with placement of trial femoral components and reduction of the patella in total knee arthroplasty (TKA) is important, but it is not easy. The purpose of this study was to investigate whether (1) the flexion and extension gaps were equal when a previously suggested three-dimensional planning for a single-radius femoral component (its sagittal centre is matched with flexion-extension axis of knee movement) is executed with patient-specific instrumentation (PSI) and whether (2) PSI was done with good accuracy, which did not affect the first purpose.Methods Posterior cruciate ligament sacrificed (PS) TKA was performed on 12 joints. Using the patients' pre-operative computed tomography (CT) images, PSI was manufactured to fit on the bony surface of the knee joint and to simultaneously transfer pre-operative planning to the operating room. After osteotomy with PSI, gap measurements were calculated with the knee in flexion and extension. Angle deviations of both components were investigated with postoperative CT images.Results The flexion gap (mean, 19.1 mm) was larger than the extension gap (mean, 12.3 mm) in all cases. Angle differences between pre- and postoperative alignments were within 3 degrees in all cases.Conclusions Although PSI executed the pre-operative planning with good accuracy, the flexion gap is always larger than the extension gap. This finding suggests that surgeons may not aim for equal gaps of flexion and extension in PS-TKA.