Intramedullary versus extramedullary tibial alignment systems in total knee arthroplasty.
Intramedullary versus extramedullary tibial alignment systems in total knee arthroplasty.
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DOI：
10.1016/s0883-5403(06)80106-3
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发表时间：
1993-02-01
期刊：
影响因子：
--
通讯作者：
Stringer, E A
中科院分区：
文献类型：
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作者：
Dennis, D A;Channer, M;Stringer, E A
进行了120例连续全膝关节置换术，以比较髓内与髓外胫骨截骨导向器的准确性。60例使用髓内导向器（组1），另60例使用髓外导向器（组2）。在第2组中，髓外导向器的远端部分向踝关节中点内侧移动3 mm，以将其定位在距骨中心上方。两组的术后胫骨部件对线角度相似（第1组，内翻0.43度;第2组，外翻0.36度）。然而，第2组中88%的胫骨部件在90度目标的2度范围内对线，而第1组中仅72%的胫骨部件对线。使用髓内或髓外截骨导向器均可获得令人满意的对线，尽管使用髓内导向器时会遇到更大范围的误差。将髓外导向器远端定位在距骨中心而不是踝关节中点上对于避免胫骨内翻切除非常重要。髓外导向器避免了髓内导向器使用的潜在并发症，包括脂肪栓塞和缺氧、术中骨折、聚甲基丙烯酸甲酯加压丧失以及由于畸形、硬件残留或病理性骨病而无法通过髓内棒。
One hundred twenty consecutive total knee arthroplasties were performed to compare the accuracy of intramedullary versus extramedullary tibial resection guides. An intramedullary guide (group 1) was used in 60 cases and an extramedullary guide (group 2) was used in another 60 cases. In group 2, the distal portion of the extramedullary guide was shifted 3 mm medial to the midpoint of the ankle in order to position it over the center of the talus. Postoperative tibial component alignment angles were similar in both groups (group 1, 0.43 degrees varus; group 2, 0.36 degrees valgus). However, 88% of tibial components in group 2 were aligned within 2 degrees of the 90 degrees goal versus only 72% of tibial components in group 1. Satisfactory alignment can be obtained with either intramedullary or extramedullary resection guides, although a wider range of error was encountered with intramedullary guide use. Distal positioning of the extramedullary guide over the center of the talus rather than the midpoint of the ankle is important to avoid varus tibial resection. Extramedullary guides avoid the potential complications of intramedullary guide use, including fat embolization and hypoxia, intraoperative fracture, loss of polymethyl methacrylate pressurization, and inability of intramedullary rod passage due to deformity, retained hardware, or pathologic bone disease.