The influence of tibial slope on maximal flexion after total knee arthroplasty
The influence of tibial slope on maximal flexion after total knee arthroplasty
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DOI：
10.1007/s00167-004-0557-x
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发表时间：
2005-04-01
影响因子：
3.8
通讯作者：
Vandenneucker, H
中科院分区：
文献类型：
--
作者：
Bellemans, J;Robijns, F;Vandenneucker, H
许多外科医生认为，在全膝关节置换术（TKA）中增加胫骨坡度有利于术后最大屈曲。然而，对临床文献的回顾并没有证实这一假设，也没有回答每额外胫骨坡度可以预期获得多少屈曲增益的问题。因此，本研究的目的是评估和量化胫骨坡度对当代后十字韧带 (PCL) 保留 TKA 术后最大屈曲的影响。研究人员对标准 PCL 保留 TKA 的 21 具尸体模拟进行了研究，同时再现了相同设计的功能良好 TKA 患者的三维计算机辅助视频透视记录的相同深屈股胫骨运动学。在每个膝关节中，胫骨假体以0度后斜度、4度后斜度和7度后斜度连续植入。记录每种配置的最大屈曲度。 0 度胫骨坡度时的平均最大屈曲度为 104 度，当相同的膝关节植入 4 度胫骨坡度时，平均最大屈曲度显着增加至 112 度。再次将坡度进一步增加至 7 度，平均最大屈曲度显着提高至 120 度。当术后射线照相胫骨倾斜度与最大屈曲度进行比较时，发现每额外胫骨倾斜度，屈曲度平均增加 1.7 度。在 PCL 保留 TKA 中增加胫骨坡度确实可以在胫骨插入件撞击股骨之前改善最大屈曲度。外科医生预计胫骨倾斜度每增加 1 度，屈曲度平均增加 1.7 度。
Many surgeons believe that increasing the tibial slope in total knee arthroplasty (TKA) is beneficial with regard to maximal postoperative flexion. Review of the clinical literature, however, does not confirm this hypothesis, neither does it give an answer to the question of how much flexion gain can be expected per degree extra tibial slope. The purpose of this study was, therefore, to evaluate and quantify the influence of tibial slope on maximal postoperative flexion in contemporary posterior cruciate ligament (PCL)-retaining TKA. Twenty-one cadaver simulations of a standard PCL-retaining TKA were studied while reproducing identical deep flexion femorotibial kinematics as documented by three-dimensional computer-aided videofluoroscopy from patients with well-functioning TKAs of the same design. In each knee the tibial component was consecutively implanted with 0 degrees posterior slope, 4 degrees posterior slope, and 7 degrees posterior slope. Maximal flexion was recorded for each configuration. Average maximal flexion at 0 degrees tibial slope was 104 degrees, and increased significantly to 112 degrees when the same knees were implanted with 4 degrees tibial slope. Increasing the slope further to 7 degrees again significantly improved average maximal flexion to 120 degrees. When postoperative radiographic tibial slope was compared to maximal flexion, an average gain of 1.7 degrees flexion for every degree extra tibial slope was noted. Increasing the tibial slope in PCL-retaining TKA does indeed improve maximal flexion before tibial insert impingement occurs against the femoral bone. The surgeon can expect an average gain of 1.7 degrees flexion for every degree extra tibial slope.